CMS 855 A Medicare Application: The Medicare System
The CMS (Center for Medicare Services) brought about a historical change in home care in 2000 when they introduced OASIS ( Outcomes and Assessment Information Set). This OASIS document has given us the opportunity to do the right thing for our patients. We use it to assess the condition of this whole person. We can then treat this whole person because we know all of his systems, all of his needs, all of his comorbidities that may affect his healing. We no longer treat one symptom. Oasis helps us to be aware of how we make a difference.
Oasis shows the nation in Home Health Compare on the internet how we have helped patients have less pain, have less shortness of breath, can be more independent with medications, heal wounds, and stay out of the hospital. Oasis shows Medicare the condition of our patient so they can use the payment system to provide us with a budget to take care of our patient.
PPS (Perspective payment system) is the complex governmental system to ensure we have financial reimbursement to meet the needs of each specific patient. The Oasis questions give us clinical points, functional points and service points which fit into tables of payment. The government does want us to take care of people. It also wants to protect our taxpayers from fraud.
Is this patient eligible to receive home care services paid for by Medicare? Is he homebound? Is there a skilled need? Are the visit needs intermittent? Is home health the reasonable and necessary way to care for this patient? Does this patient have a residence? Does he have a physician? Did you learn in Kindergarten to follow the rules? Everything goes better when we know the rules and follow them. Medicare has given us a great list of rules. These COP’s (Conditions of Participation) are made to protect our patients, and their rights. They also give us guidance to run our agencies. We can follow the rules and have qualified staff, have legal protection with physician orders, have clinical records with great documentation . When the surveyor comes to visit we need to show her that we follow the rules. If we are following the rules we get a good report card with no G tags which we will be proud to put up on the refrigerator just like the good old days. Click here for a list of CMS Medicare Contractors, including Palmetto GBA
What is Medicare?
The Medicare Program is administered by the federal government of the United States of America. Medicare guarantees access to health insurance for Americans ages 65 and older as well as Americans disabled for longer than 2 years. In 1965, Congress created Medicare to provide health insurance to these individuals, regardless of income or medical history. In 1972, Congress expanded Medicare eligibility to include any American that has suffered permanent disability and receive Social Security Disability Insurance (SSDI) payments as well as those who have end-stage renal disease (ESRD). In 2001 the program was extended to cover any American with ALS (Lou Gehrig’s disease).
In 2010, Medicare provided health insurance to 48 million Americans—40 million people age 65 and older and eight million younger people with disabilities. Medicare serves a large population of old, sick, and low-income people. Without Medicare, many of these people would not have access to health insurance.
Medicare has four parts — A, B, C and D.
Part A - Hospital Insurance program, which covers inpatient hospital, skilled nursing facility, home health care and hospice care.
Part B - Supplementary Medical Insurance program, which covers physician, outpatient, home health, and preventive services. Medicare Parts A and B cover all “reasonable and necessary” medical services and hospital services, including lab tests, skilled nursing and some home health care and excluding vision, hearing, dental and long-term care.
Part C - Medicare Advantage, which allows Medicare enrollees to participate in private health plans that must cover all the Part A and B benefits as an alternative to Traditional Medicare.
Part D - Outpatient Prescription Drug Program.
Medicare today offers the choice of an open-network plan (Traditional Medicare) or a network plan (Medicare Advantage) with a standard benefit package. The overwhelming majority of people with Medicare have traditional Medicare (76 percent) and the rest have a Medicare Advantage plan (24 percent). With traditional Medicare, the federal government pays directly for health care. With Medicare Advantage, the federal government pays private health plans which can offer additional benefits to provide health coverage. Medicare enrollees generally have Parts A and B. If they elect to participate in Medicare Advantage, they also will have Part C. In addition, if they need prescription drug coverage, they might have Part D.
CMS 855 A Medicare Application Medicare Enrollment Process
1. We submit the current version of the CMS 855 A Medicare Application. If you are looking to obtain the CMS 855 A Medicare Application, an electronic copy of the current CMS 855 A Medicare Application can be found at Click here for the CMS 855 A Medicare Application
2. We submit the correct CMS 855 A Medicare Application for your provider or supplier type to the Medicare fee-for-service contractor servicing your State or location. The Medicare contractor that serves your State or Home Health Care Agency location is responsible for the processing of the CMS 855 A Medicare Application. Click here for the CMS 855 A Medicare Application Processor Detail
3. Assist you with your CMS 855 A Application? We do much more than just assist you with the completion & submission of your CMS 855 A Medicare Application. If you are enrolled in Medicare, but have not submitted the CMS 855 Medicare Application since 2003, you are required to submit a complete CMS 855 A Medicare Application. Providers and suppliers should follow the instructions for completing an initial CMS 855 A Medicare Application. When completing the CMS 855 A Medicare Application for the first time, each section of the CMS 855 A Medicare Application must be completed. When reporting a change to your CMS 855 A Medicare Application, complete each section listed in Section 1B of Medicare Application CMS 855 A.
4. In addition to completing your CMS 855 A Application, we request and obtain your National Provider Identifier (NPI) number before required as part of the CMS 855 A Medicare Application process. We literaly complete every step of the Medicare Accreditation process, from the CMS 855 A Application to completion of Medicare Accreditation.
5. We complete the Electronic Funds Transfer Authorization Agreement (CMS 588) with your CMS 855 A Medicare Application (if applicable). CMS requires that providers and suppliers who are enrolling in the Medicare program or making a change their their CMS 855 A enrollment data, receive payments via electronic funds transfer. When completing the CMS 588 with the CMS 855 A Medicare Application, please be sure to complete each section.
6. We complete a package that will include all supporting documentation along with your CMS 855 A Medicare Application. In addition to a Complete CMS 855 A Medicare Application, each provider or supplier is required to submit all applicable supporting documentation at the time of filing along with the CMS 855 A Medicare Application. Supporting documentation includes professional licenses, business licenses and if applicable, an authorization agreement for Electronic Funds Transfer Authorization Agreement(CMS-588).
7. If you would like to know more about the CMS 855 A Medicare Application process or need help completing the CMS 855 A Medicare Application, contact 21st Century Health Care Consultants for a free consultation. We will answer any questions you have about the CMS 855 A Medicare Application and offer advise as to what your next step should be after completion of the CMS 855 A Medicare Application. We will come to your site and walk you through a mock Medicare Accreditation audit and even consult you over the phone at time of audit. We will not complete the CMS 855 A Medicare Application, we will walk you through the entire Medicare Accreditation process.
have specialized in CHAP (The Community Health Accreditation
Program), ACHC (The Accreditation Commission for Health Care) and
JCAHO (Joint Commission) Accreditation Certification for Medicare Accreditation, Medicaid Accreditation, Private Duty Accreditation,
Personal Care, and Companion Care Services.