Need Answers to Medicare Enrollment Questions?

CMS Creates Online Resources to Assist Physicians

July 20, 2010 05:25 pm Sheri Porter

CMS is aiming to quell confusion in the physician community surrounding new Medicare enrollment requirements that are embedded in the recently passed health care reform legislation by offering physicians targeted guidance to help them through the process.

Specifically, CMS addresses concerns about provisions found in section 6405 of the Patient Protection and Affordable Health Care Act that deal with Medicare enrollment processes for physicians who do not send claims for services provided directly to a Medicare contractor for payment.

The new four-page resource, titled "Medicare Enrollment Guidance for Physicians that Infrequently Receive Reimbursement from the Medicare Program(," refers to a "specific set of physicians" who will need to enroll in the Medicare program for the sole purpose of certifying or ordering services for Medicare beneficiaries.

Accordingly, CMS says it has created an "abbreviated" enrollment process for those physicians and health care professionals who are employed by

  • the Department of Veterans Affairs;
  • the U.S. Public Health Service;
  • the Department of Defense's TRICARE program; and
  • federally qualified health centers, rural health clinics or critical-access hospitals.

Physicians engaged in fellowship programs also fall under the special set of rules, as do dentists.

The CMS document also answers questions about how to verify current enrollment in CMS' Provider Enrollment, Chain and Ownership System, or PECOS. Physicians who are not already enrolled in PECOS and who are included in the above list are advised to forgo electronic enrollment because CMS' system cannot accommodate the abbreviated enrollment form; instead, those physicians should use the paper enrollment application(

CMS reminds all other physicians who provide services to Medicare beneficiaries -- or who want to order products or services for patients or refer beneficiaries -- that they also must enroll in PECOS(, either online or by using the paper application.

However, the agency strongly suggests that physicians review a "getting started" guide( before proceeding with online enrollment.

Cynthia Hughes, C.P.C., an AAFP coding specialist, told AAFP News Now that she continues to field members' PECOS-related questions. She said it is important for family physicians who bill Medicare for services and reassign their Medicare payments to a group practice (corporation) to complete a CMS Reassignment of Medicare Benefits form(

"Physicians who are not currently accepting electronic fund transfers will be required to do so as part of the enrollment process by completing a CMS Electronic Funds Transfer Authorization Agreement(," Hughes added.

She also suggested that physicians access a state-by-state listing of Medicare contractors( to ensure that they have accurate phone numbers on hand should Medicare enrollment questions arise.