3 Things to Set Up Once You Receive Your Provider Number
Congratulations home health and/or hospice agency! You’ve received your provider number! But now what?!
Most agencies await this moment because it means that after many long, expensive months (and sometimes years if you’re in California, Florida or Texas) they can start billing and start making money. What most people fail to realize is that there are still several stepping stones on their way to Medicare billing.
At Smart Business Solutions, we believe that business should be easy, which is why we’ve compiled a list of important steps to ensure that you are registered properly for claims submissions and all the miscellaneous processes required by Medicare. We love to see home health and hospice agencies grow and are committed to providing as much help as possible! Good luck!
Here are the first 3 things you need to set up when you finally receive your Medicare provider number:
To do any kind of billing agencies first need to get their Medicare submitter number from EDI. Each intermediary has their own EDI department, and their own forms for sign up. Depending on your location, you will be applying to one of four Medicare intermediaries.
Set up your EDI Connection and ERA Receipts
To successfully enroll into EDI, each agency will need to complete the following forms for their specific fiscal intermediary.
EDI Enrollment
The EDI Enrollment form is your contract and application to Medicare billing. As part of the form, you are promising that all of your claims will contain accurate data, that the claim data is based on your patient records and evaluations, and that you are completely responsible for all claims submitted. This form establishes your agency's set up into EDI.
EDI Submitter Action Request
The EDI Submitter Action Request form designates the person, company or software vendor that will be sending your claim files and receiving your ERA files. This form only needs to be completed the first time you are applying to EDI for your billing set up. By submitting this form, you are attesting that you have business associate agreements with all your vendors.
Part A Logon Request
The Part A Logon Request form requests access and a username and password to the DDE system. In this form, you can enter all of the people you authorize to access the DDE system with information for your agency.
ERA Enrollment
The ERA Enrollment form instructs NGS where to send your ERA's. This form only needs to be completed once. Any changes to this information can be handled via your connectivity software.
NGS
Complete the following forms, print, sign and fax them to the appropriate fax numbers:
Palmetto GBA
Palmetto GBA provides a new agency enrollment packet with all of the above forms in one place. Click here to access this information.
CGS Medicare
CGS Medicare has an electronic EDI application process. To access this, click here.
Set up OASIS Submissions
OASIS submissions are required as a Condition of Participation for the Medicare program. The rule is that each OASIS must be submitted within 30 days of the date of the document. OASIS submissions are important because they contribute to an agency's Home Health Compare scores and to an agency's OBQI/OBQM reports.
Prior to 2015, each state was responsible for the acceptance and management of OASIS submission data. As of January 1, 2015, CMS has implemented a national OASIS submissions database. New home health agencies need to complete the Access Request Form online in order to acquire their username and password for OASIS submission.
Once your agency receives the username and password for OASIS submission, you can use the link below to submit your OASIS files:
Sign up to an HH CAHPS Vendor
HH-CAHPS are surveys created to measure the patient's perception of the home health agency's care. These scores contribute to a home health agency's Home Health Compare scores. The agency submits their census to a HH-CAHPS vendor from which a random sample is taken for the survey. HH-CAHPS can be performed either via telephone or via a mailed survey.
To properly sign up for HH-CAHPS submission, agencies first need to register for their username and password. Once this is received, go to the list of approved HH-CAHPS vendors below and chose the HH-CAHPS vendor you would like to contract with.