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Medicare Suppliers: Open Enrollment Ends Dec. 31st

From the Desk of Ronda Buhrmester

We are in the middle of open enrollment which means if your company is currently enrolled as a participating supplier, now is the time to change your status to non-participating. Why is it important to consider changing your enrollment status? 

Enrolled as a participating supplier means that the supplier accepts the Medicare fee schedule and will bill all claims on an assigned basis.

Being enrolled as a non-participating supplier means there are options for the supplier to either submit the claim on an assigned basis or on a non-assigned basis. With the current reimbursement rates, having the option to bill as non-assigned is key in order to survive. Suppliers cannot continue to accept the cuts to reimbursement while still accepting assignment.

It’s important for hospital based DME suppliers to know that the enrollment status follows the tax ID. Many hospital based DME suppliers are under the hospital’s tax ID which means the DME supplier follows the enrollment status of the hospital which is participating. In order to change to non-participating status, the hospital-based DME supplier would have to get a separate tax ID.

Some Frequently Asked Questions:

 

  1. A participating supplier gets reimbursed at a higher rate? False. This applies to physician services, not DMEPOS suppliers.

 

  1. There are many advantages to being enrolled as a participating supplier. False. The only reward for being enrolled as a participating supplier is getting listed in the supplier directory!

 

  1. On non-assigned claims, there is a limiting charge to the beneficiary. False. There is not a limiting charge for DMEPOS suppliers. 

 

  1. With non-assigned claims, there is not any liability for the suppliers. False. Actually, the liability still exists with that claim. It does not matter if the claim is being submitted as assigned or non-assigned; the supplier can still get a denial and still get an audit on a non-assigned claim.

 

  1. If a claim is being submitted as non-assigned, obtaining an ABN will cover the supplier?  False.  The purpose of an ABN does not change with a non-assigned claim.  The purpose of an ABN is the same for assigned or non-assigned claims which is a reason for denial such as lack of medical necessity, same/similar equipment, upgrade to another code, and over-utilization.

While there is still one more year during the gap period for any willing supplier before the next round of competitive bid is implemented, a few reminders for suppliers in competitive bidding areas (CBA).  Having a competitive bid contract does not direct the enrollment status for suppliers.   A supplier with a CB contract can be enrolled as non-participating and can submit claims as non-assigned for those items not included in competitive bid.   Having a contract under the Medicare CB programs simply states a supplier must accept assignment on those products within the contract.

Suppliers located in a CBA that do not have a contract for CB items would not get reimbursed for CB items on any claim – assigned or non-assigned. If the beneficiary chooses to use a non-contracted supplier and waive their Medicare benefits, the item would be a cash transaction. In such a case, the supplier should make sure to use an ABN (option 2).

How to Change Enrollment Status?

If your company is considering changing its Medicare enrollment status to non-participating, use your company letterhead stating that the enrollment status is changing to non-participating for January 1, 2020, and include your supplier number, NPI, and tax ID along with contact information.

Another option is changing the enrollment status within PECOS.This change must be done by Dec. 31st, 2019.

Open enrollment occurs only during the period of Nov. 15–Dec. 31 of each year.

Keep in mind, that once January arrives, this does not mean changes have to be made immediately. The current business model can continue as is on January 1, implement the change to non-assigned when prepared.

Please reach out with questions or to schedule a call.

Ronda Buhrmester

[email protected]

217-493-5440

 

 

 

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