Your Service Organization’s Provider Account/ Contract with Medicare:
It is important for you to understand the components of your provider agreement with Medicare. Although Comstar provides all clients with assistance in the management of their account, we cannot do so without your involvement. There are three major components in managing your ongoing relationship with Medicare as a Part B Contracted Service Provider:
- Compliance with all State and Federal Regulations for Ambulance Service Providers (including license requirements, HIPAA compliance, etc.)
- Notification to Medicare if there are changes in your Organization (via an 855B Change of Information (COI) Application)
- Revalidation (855B Full Enrollment Application and the 588 EFT Application) of your Provider Account approximately every 5 years when requested by Medicare
Notification of Change of Information for your Organization*: Your contract with Medicare as a Part B Provider requires you to notify them of major changes in your organization. Depending upon the type of change, there are required time frames that differ regarding how long you have to notify Medicare. These notifications include the following:
- Final Adverse Actions/Convictions regarding the provider’s Authorized or Delegated Officials
- Bank Account (“old” account may not be closed until a payment arrives in the newly created/approved account)
- Authorized/ Delegated Officials (most common: removing a retired official and assigning a new official)
- Physical Location of the Vehicles
- Billing Agent
- Removal or addition of new vehicles
- New Paramedic Intercept Agreements
- Addition of a Geographic Area(s) new to your service.
- Overpayments of Funds
*Failure to notify Medicare of changes in your organization may affect your credentials as a provider.
Revalidations: Medicare is currently in Cycle 2 Revalidations. Highlights of Cycle 1 and Cycle 2 Revalidation include:
- During Cycle 1 of the revalidations (Prior to February 2016), Medicare focused on an initiative to have every provider enrolled in Medicare’s on-line portal PECOS. During this cycle, Comstar was able to work with the majority of our clients to get set- up with their online accounts with PECOS. If you have not set one up, please contact our Provider Relations department on our client dedicated phone line as soon as possible. The number is (800) 742-3001.
- During Cycle 2 of Revalidations, Medicare is establishing the five year cycle for each provider beginning in February 2016.
- Each Provider can determine their Revalidation due date 6 months in advance by going to https://data.cms.gov/revalidation
- If you are not due in the next 6 months, your account will be listed as TBD.
- Submitting your revalidation application online via the PECOS portal is the Medicare recommended method. As stated by Medicare the advantages of submitting via internet-based PECOS web include:
- Faster application process
- Automatic selection of proper enrollment forms
- Fewer submission errors/omissions
- Ability to e-sign the application rather than mailing in a wet signature to Medicare
- Ability to upload all required and supporting documents for both current and future use. When you revalidate 5 years later, you will have a pre-populated application that only needs changes. In your case many of the pieces of information may not have changed (e.g. basic identifying information of your organization, physical location, some or all of the vehicles, authorized officials, etc.). Having your current application on-line will make future COI’s or Revalidations less time consuming.
- You may complete your Revalidation application on your own, or if elected, Comstar will prepare all documents for your review and submission. There is an associate Medicare fee of $560 (*subject to change each fiscal year) to revalidate. Comstar does not charge a fee to prepare your revalidation as it is one of our value added services. Comstar requires the following to proceed with any revalidation on your behalf:
- Clients must have an online account with Medicare with their web portal PECOS so that the application can be submitted electronically. Comstar will walk you through that account set up via a conference call if you don’t have one as of yet.
- As revalidations are generally required every 5 years, clients should be aware of the year of their last revalidation date so that can anticipate when their revalidation will be due. We can walk you through that process.
- Given that Medicare is now posting revalidation requests 6 months in advance of the due date (https://data.cms.gov/revalidation), Comstar requires that all documents we request from our client in order to complete the application be provided to us no later than 1 month prior to your due date so we have the time needed to prepare the application. If there are missing documentation 1 month prior to the application due date, Comstar will provide the client with detailed instructions of how they can finish the application on their own.