The exact steps for a provider or medical director of a hospice to enroll or opt-out of Medicare may vary, but generally, the process involves the following steps:
- Determine eligibility: Ensure that the provider or medical director meets the eligibility criteria for Medicare enrollment or opt-out. This may include having the necessary qualifications, licenses, and certifications.
- Obtain an NPI: Obtain a National Provider Identifier (NPI) if the provider or medical director doesn’t already have one. The NPI is a unique identification number assigned to healthcare providers.
- Complete the application: Fill out the appropriate enrollment or opt-out application. For enrollment, this may involve completing the CMS-855 application form. The specific form required may depend on the provider’s individual circumstances.
- Gather required documentation: Gather any required supporting documentation, such as licenses, certifications, proof of education, and identification.
- Submit the application: Submit the completed application and supporting documentation to the appropriate Medicare administrative contractor (MAC) for processing. The MAC will vary based on the provider’s geographic location.
- Await review and approval: The MAC will review the application and supporting documentation for completeness and compliance. This process may involve verifying credentials, conducting background checks, and confirming eligibility.
- Receive approval or denial: Once the application has been reviewed, the provider or medical director will receive notification of either approval or denial of their enrollment or opt-out status.
It is important to note that the specific requirements and process may vary, and it is recommended to consult with the MAC or a healthcare attorney for personalized guidance and assistance with the enrollment or opt-out process.
Resources:
To Enroll visit here MLN9658742 – Medicare Provider Enrollment (cms.gov)
to Opt-Out visit here Manage Your Enrollment | CMS
