Provider Enrollment & Privileging Flashcards

A physician group wants a newly hired physician to bill Medicare under the group's TIN. Which CMS form reassigns the physician's Medicare benefits to the group?

Answer: CMS-855R

The CMS-855R reassigns an individual practitioner's right to receive Medicare payments to a group or organization.

Which CMS enrollment form does a clinic or group practice use to enroll as a supplier organization?

Answer: CMS-855B

Clinics, group practices and certain other suppliers enroll with the CMS-855B.

A physician has no plans to bill Medicare but must order lab tests for Medicare patients. Which form lets them enroll only to order and refer?

Answer: CMS-855O

The CMS-855O enrolls practitioners solely to order, certify or refer Medicare items and services.

Which form does a provider submit to receive Medicare payments by electronic funds transfer?

Answer: CMS-588

The CMS-588 is the Medicare EFT authorization agreement.

After a Medicare Administrative Contractor approves a physician's enrollment, which Medicare-specific identifier does it issue?

Answer: PTAN

The MAC issues a Provider Transaction Access Number (PTAN) when it approves Medicare enrollment.

Which NPI type does an incorporated group practice need?

Answer: Type 2

Type 2 NPIs go to organizations such as groups, hospitals and corporations.

Which online system do providers use to submit and manage their Medicare enrollment electronically?

Answer: PECOS

PECOS (Provider Enrollment, Chain, and Ownership System) is CMS's online Medicare enrollment system.