Hello, my name is Matthew Glantz, Health Policy and Market Access Manager for the AADSM. In this presentation, we will cover the application process your practice must follow in order to build Medicare for oral appliance therapy. We'll help you understand the steps to take before enrolling. We'll outline what information you'll need to gather before starting the enrollment form. Follow this with the goal of helping you to complete the enrollment form accurately. We will not cover all the steps of the application process in detail, but we will provide links to several of the other steps at the end of the presentation. Before we start the application, there are several definitions that are helpful for you to know. The first is CMS, which stands for Centers for Medicare and Medicaid Services. The second is DMEPOS, which stands for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies. The third is supplier. Oral appliance therapy is considered a durable medical device under Medicare's current rules. That's why we're filling out the Form 855-S. Approval of Medicare requires several steps. In this presentation, I am going to focus primarily on completing the enrollment application. But first, let me review all the steps you will need to be aware of. Before you begin the process of building to build Medicare, there are several steps you should take to ensure a smooth enrolling process. Number one, you'll need to have a National Provider Identification Number, also known as an NPI. This is a unique number assigned by government to healthcare providers. If you don't have an NPI number, we are not going to cover this today. But for more information on how to obtain one, there will be a link posted at the end of this presentation. Number two, you'll need to have a surety bond. A surety bond is a special insurance policy that Medicare requires you to have before you can submit claims. A good starting point is to reach out to your current insurance provider to see if they can set you up with a $50,000 surety bond for Medicare. If you need more information about how to obtain a surety bond, there will be a link posted at the end of this presentation. Number three, accreditation. You will see accreditation listed as a requirement throughout Medicare's website and information pages. But dentists are exempt from the accreditation requirement, which is an important point to remember while filling out the 855-S. Again, as a dentist, applying for Medicare billing privileges, you do not need to first become accredited. Number four, comprehensive liability insurance. In addition to your professional liability insurance, Medicare also requires you to have general liability insurance in an amount of $300,000. Professional liability insurance covers issues related to potential malpractice, whereas general liability coverage addresses other types of damages that may occur at your practice. Be sure to list the National Supplier Clearinghouse as a certificate holder on your general liability coverage. You should contact your existing insurance provider for more information. Number five, supplier standards. Medicare has several rules that you must follow as an approved provider. I recommend that you review these rules before enrolling as a Medicare supplier. You can find a copy of the supplier standards in the 855-S form. Number six, PCOS and fee. Before submitting your enrollment application to Medicare, you'll need to enroll in Medicare's online claims and reimbursement system, which they call PCOS. You'll also need to submit an application fee, currently $595, before Medicare will review your application. We'll not cover PCOS's sign-up and fee submission in detail here, but if you'd like more information about that, please see the links at the end of the presentation. Number seven, once you have these requirements taken care of, you are ready to complete the enrollment application form. I will be revealing that in more detail for you next. Being prepared before you start your application is the key to a smooth application process. Here's some information to collect before you start your application. Number one, you'll need your national provider identification number. Number two, you'll need your tax ID number. Number three, you'll need your business address and your legal business name. Number four, you'll need contact information for the officials within your office you have chosen to manage Medicare. Number five, you'll need the opening date of your practice. Number six, you'll need your posted hours of operation. Number seven, you'll need your business structure, which can include LLC, sole proprietorship, or partnership. Number eight, you'll need your insurance information. Number nine, you'll need any adverse legal documentation. Examples are no vacations, resolutions, and reinstatement letters. Number 10, you'll need a bank letter waiving the right of offset for Medicare receivables. This is only necessary if the bank you receive your electronic payment transfers from also holds a loan. Number 11, ownership information about your practice. Number 12, the CMS 460 participation agreement, which I'll discuss more now. As part of the enrollment process, dental professionals have the option of enrolling as either a participating or non-participating supplier in the Medicare program. Non-participating providers accept Medicare and always take assignment. Taking assignment means the provider accepts Medicare's approved amount for healthcare services as full payment. They're also not allowed to balance bill patients. Non-participating providers and suppliers sign no agreements and may choose on a claim by claim basis whether they want to accept assignment. Non-participating providers who do not accept assignment on a claim will be limited as the amount they charge the beneficiary. Only non-participating providers may choose to submit non-assigned claims. They are also allowed to balance bill patients. You choose this SAS in your form CMS 460, which can be submitted with enrollment for up to 90 days later. This SAS can also be changed annually. You are now ready to begin to complete the 855-S form. This application can be done both online or by mail. Fortunately, we've already collected most of the information you will need to complete the application. We will now begin a step-by-step review of the application. The first page of CMS Form 855-S outlines the standards your practice must meet to obtain and retain your billing privileges. While many of these standards will not apply to you, it is important to remember that these are the rules you'll need to follow. I recommend having a copy of the rules posted in your practice's office. The second page begins by outlining which providers are required to complete this application to enroll in the Medicare program and receive a Medicare billing number. As you can see, dentists are listed along with physicians on this list. They also list the circumstances under which a person should apply. Page 3 contains basic instructions on how to fill out the form that you should read carefully. It also includes the general process you will follow for approval, along with certain tips to avoid any delays in your enrollment. Page 4 includes a list of the many acronyms in the form and the address you will use when sending in your completed form. For many of you watching this webinar, you will be applying to bill Medicare for the first time. It is important for you to fill in any answers that apply to you. Missing any required parts of the form will only lead to delays in approval. I will point out some of the areas where you may be able to skip unnecessary sections. This page begins with filling in your basic information, including the state where your practice is located, your legal business name, your NPI, and tax ID numbers. This page also outlines who is considered to be a new enrollee. This page also notes that all new enrollee forms must be signed by an authorized official, which is defined as a chief executive officer, general partner, or direct owner who will grant the legal authority to enroll a business in the Medicare program. Page 6 outlines the reasons why you are submitting this application and what sections of the form you must complete. For Part C, new applicants will check the first box, which requires the completion of all sections. Part D applies to those making changes to their existing enrollment. Since all information being provided by new enrollees here are new changes, you can skip this part. Section 2 on this page covers your practice location information. This section includes information like business name, location, and your opening date. One point to note here is that the change and effective date boxes you see in this section, which are repeated throughout the form, are only used by suppliers who are making changes to their enrollment. New enrollees can ignore these boxes. Next comes your hours of operation. You can fill in your practicing hours on an average week here. In Section 2, you'll provide more information about your practice. For Part C, you'll add your business type. For many of you, you will select either Limited Liability Corporation, Partnership, or Sole Proprietorship. For Part D, you will select how your practice is registered with the IRS. Most practices will select Proprietary here. For Part E, you will select the state you are licensed in. Section 3 covers the products you provide and your accreditation. For Part A, you will select Dentist-Physician as your supplier type. The next two parts, Parts B and C, do not need to be filled out on your form. Currently, as was mentioned earlier, dentists applying to bill Medicare are exempt from the accreditation process. You can skip these two sections. Part D on page 10 has generated some confusion for dentists. This section covers the products and services furnished by applying supplier. At first look, there is no clear choice for dentists providing oral appliance therapy, but there is a correct choice. You must select for OAT. In this field, dentists providing oral appliance therapy should select Orthosis Custom Fabricated, which is right at the bottom here. Section 4 of the form will ask you for several mailing address choices. Each address will cover a different purpose. For Section A, you will fill out one of these two fields. Use the first if your business is a corporation, partnership, or LLC. You'll need your tax ID number, your 1099 mailing address, and a copy of your IRS form CP-575. If you are a sole proprietor, you'll fill out the second field. You will need your social security number. This section on page 12 establishes mailing contacts for correspondence, special payments, and medical records. For Part B, you can establish a new mailing address for correspondence regarding your Medicare supplier enrollment. Alternatively, you may also choose to have all correspondence mailed to your business location address you selected in Section 2A by checking the first box. If you want a separate address for correspondence, fill it out in the first field. Part C designates an address for your enrollment revalidation request package. Like the previous part, you can choose to use your business or correspondence address. Part D on page 13 asks you to designate an address for any unique or special payments that are not sent via electronic funds transfer. Once again, you can elect to send these payments to your business or correspondence address. Part E asks for information about where your patient's medical records are stored. You can select your business location as a storage location, fill in another address, or provide the name of the electronic facility where the records are kept. Electronic storage will be filled in here. Section 5 covers your liability insurance coverage. While many of you may currently have coverage for professional liability, you also need general coverage in the amount of at least $300,000 for each incident, and the insurance must always remain in force. The primary difference between general liability and professional liability is in the types of risks they each cover. General liability covers physical risks, such as bodily injuries and property damage. Professional liability covers more abstract risks, such as errors and omissions in the services your business provide. You should speak to your insurance company to confirm what your policy covers. You will fill in this information in the field below. Section 6 covers your surety bond, which we explained earlier. You will include information about the surety bond company, the amount it covers, and the effective date. If you have any questions, call your bond company. Section 7 covers any final adverse legal actions, such as convictions, exclusions, revocations, and suspensions against your practice. All applicable legal actions must be reported regardless of whether or not the records were expunged or any appeals are currently pending. You must fill out the basic information about the actions at the bottom of the page and Include with the completed form any copies you have of the relevant legal documents. This section applies to the business you detonated in Sections 1B and 2A. If you have no final adverse legal actions, you can check the box in Part C and move on to the next section. The next two sections cover the owners of your practice and who has managing control of the business. Section 8 applies to businesses operating as a corporation, partnership, or LLC. Any organization that exercises operational or managerial control over the business is considered a managing organization and must be reported. On this page, we will add the information for the owners within your corporation, partnership, or LLC. This section needs to be filled out for each owner. The page can be copied and added to the document. At the bottom of the page, you must add any final adverse legal actions for any organization defined on the page. You must complete this page for anyone with an ownership role or partnership interest in your practice. Section 9 applies to individuals instead of organizations. You must fill out the section if you are a owner of the practice, a director or board member, a managing employee of the practice, an individual with partnership interest, or you have been selected as a delegated or authorized official in Section 14 and 15, which I will explain later. On this page, you will add the information for all required individuals. Like the previous section, this page may be copied for each individual. You will also need to add any additional final adverse legal action for each individual at the bottom of the page and include any legal documents with the application. In Section 10, you will add information of your billing agency. It's important to remember that you remain responsible for the accuracy of the claims submitted on your behalf. If you're not working with the billing agency, you may check the box below and move on to Section 11. In Section 11, you will establish a contact person in case the National Supplier Clearinghouse has any questions. You can elect to designate the delegated official or authorized official you select in Sections 14 and 15 to serve this role. The contact person reported in this section will only be authorized to discuss issues concerning this enrollment application. Section 12 provides a checklist of the documents you will need to submit with 855-S form. It is a good idea to collect as many of these documents as you can before you start the application process. We have already covered many of these items earlier. Not all these requirements will apply to every applicant. Section 13 explains the penalties for deliberately furnishing false information in this application to gain or maintain enrollment in the Medicare program. It is important to check and double check the information you submit in this application. These rules authorize both civil and criminal liabilities for fraud. You should read this section carefully and keep a copy in your office. The next two sections allow you to select certain officials within your practice to handle certain matters regarding the application or your practice's enrollment. Section 14 establishes a delegated official, an individual who is delegated by authority to report changes and updates to supplier's enrollment record by an authorized official. The delegated official must be an individual with ownership interests in the practice or a W-2 managing employee of the supplier. An independent contractor is not considered employed by a supplier and therefore cannot be a delegated official. Delegated officials may not delegate their authority to any other individual. You can add or remove officials using this form. The official can also be used as your contact points on pages 19 and 20. All signatures must be original. Applications with signatures deemed not original or not dated will not be processed. Section 15 establishes an authorized official for your practice. This official is usually a owner, CEO, or general partner within a business. The official is the person to whom your practice will grant the legal authority to enroll in the Medicare program and commit the practice to fully abide by the rules of the Medicare program. You can add multiple officials using this form, and each of these officials must also be included in Section 9 of this form. The information for each authorized official is filled out here. You can add additional pages if necessary. All signatures must be original. Applications with signatures deemed not original or not dated will not be processed. The last page covers the Medicare Supplier Privacy Statement. You should read this document carefully and keep a hard copy in your office. The information collected in this form will be entered into the PCOS system. Now that you have completed your application, here are some important last second tips. First it's important to check your work. Second, you can check the status of your submission at the National Supplier Clearinghouse by phone or online. Third, it is important to be prepared for questions from the National Supplier Clearinghouse about any missing material or mistakes. But do not be afraid to ask questions. On this page are the links we mentioned throughout the presentation. First is a link to NPPS where you will receive your NPI number. Second are two links that help you find more information on surety bonds. Third is a link to PCOS. Fourth is a link to where you can pay your fee for the application. Fourth are two links where you can download the Form 855-S. Fifth is a link to download the form CMS-460 Participation Agreement. Last is some more information on OAT reimbursement from the AADSM. Thank you for watching this webinar. If you have any questions, my name is Matthew Glanz. My email address is mglans.aadsm.org. Thanks for watching.

Medicare

dentists

oral appliance therapy

enrollment process

liability insurance

CMS Form 855-S