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HomeMedicare Dispatch → Medicare Q & A: Spring 2011 Update

Medicare Q & A: Spring 2011 Update Print E-mail
Written by Benjamin L. Frosch   
Saturday, 05 March 2011 16:00

Q:   We are a ten person group practice with four partners.  We are in the midst of moving and understand that we must submit a CMS 855B advising Florida Provider Enrollment of our new location.   Our question addresses the signature requirements in section 15.  It states that it needs to be signed by an authorized official, since there are four partners, can any us sign section 15 of the CMS 855B?

Administrator, Orlando

A:    For initial enrollment and revalidation, the certification statement (section 15) must be signed and dated (preferably in blue ink) by an authorized official.  An authorized official is an appointed official to whom the organization has granted legal authority to enroll it in the Medicare program, make changes or updates to the organization's status, and commit the organization to fully abide by the statues, regulations, and the program instructions of the Medicare program. 

            Assuming that all four of the partners are established authorized officials, any of the four can sign.  However, if you are not sure, you may want to check with Florida Medicare Provider Enrollment.  Although there are four partners in your entity, are all four partners enrolled and approved by Medicare as authorized officials? If you find out that there is only one individual partner recognized by Medicare as an authorized official, you may want to consider adding all the partners of the group as authorized officials.

 

Q: Up until a few weeks ago, I was an employee of a group.  I have decided to leave the group and start my own practice.  My problem is that I do not know my Medicare PTAN, and because of my adversarial departure from the group, they are taking the position that they do not have to give me my Medicare PTAN.  What would be the quickest way for me to obtain my Medicare provider number from Florida Medicare?

Cardiologist, Miami

 A:   The easiest way to obtain your Medicare provider number is if your former employer provides you with the Medicare approval letter which was issued when you joined their group.  That letter would have your Florida PTAN (provider number) and NPI.   Since it sounds like that is not going to happen, you need to send a written request to Medicare Provider Enrollment, PO Box 44021 Jacksonville, FL 32231-4021.  Put in the correspondence your request for the provider number, your legal business name, NPI number, telephone and fax number.  Additionally, since you have left the group it would behoove you to submit a CMS 855R (Reassignment of Benefits) deactivating your relationship with your former employer. 

 

Q:   The overwhelming majority of our patients are Medicare beneficiaries.  From time-to-time, we have Medicare patients that have other third party insurance and Medicare is their secondary.  My question is how is a Medicare payment determined?

Billing Manager

Gastroenterology Practice, Palm Beach

A:  The Medicare Secondary Payment (MSP) is determined by a series of calculations and comparisons. The primary insurer's claim processing details on their explanation of benefits (EOB) is needed to determine the secondary payment amount.   Three calculations are made per procedure; the lowest of the three is the secondary payment. 

1.) Determine what the Medicare primary payment would be.

  • Note the Medicare allowed amount for the procedure
  • If applicable subtract the Medicare deductible amount applied towards the procedure
  • Multiply the difference by the appropriate percentage:  62.5%, 80%, 85%, or 100% depending on the procedure code and/or provider

2.) Compare the Medicare allowed amount to the primary insurer's allowed amount, select the higher of the two

3.) Subtract the primary insurer's paid amount from the billed amount

 

Q:  I just opened up my own surgical practice and need some information from Medicare pertaining to global surgery days and the relative units (RVU) for a particular code. Can you direct me to that information?

Surgeon, Broward County           

A: The Centers for Medicare and Medicaid Services (CMS) make that information available on their website.  After you access their website, you need to find the "National Physician Fee Schedule Database Tool".  Click on that icon and you will find all the indicators which will have global surgery days including: pre-op, intra-operative, and post-op days.   You may also access that website by going to www.FCSO.com, which will direct you to that National Physician Fee Schedule database.

ABOUT THE AUTHOR:  Benjamin L. Frosch is the President of Frosch Medical Consultants, Inc. in Plantation, FL. 
If you have a question please click on the link to
ASK BEN
Last Updated on Sunday, 14 August 2011 16:58
 


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