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Health Care Experience

Tasha Bomar

HCS35

December 6, 2012
Cassandra M. Wineglass

The Health Care Industry continues to grow daily and provide benefits for those who are

in need of employment or just want to be educated on the topic there of. With the world and the

fast paste we live in it is extremely important to find your area of need and focus. My area of

focus just so happens to be Health Care Information. For this week’s assignment, I targeted the

area of Medicare Part B. This area of operation was created to enroll institutional providers that

wish to bill for services offered by Medicare. Here we find the review and processesing of the

the CMS 855 B. There are several providers that are allowed to complete this application.

Ambulance Service Supplier, Ambulatory Surgical Center, Clinic/Group Practice, Independent

Clinical Laboratory, Independent Diagnostic Testing Facility(IDTF), Intensive Cardiac

Rehabilitation Supplier, Mammography Center, Mass Immunization (Roster Billing Only), Part

B Drug Vendor, Portable X-Ray Supplier, and Radiation Therapy Center are just to name a few.

Extensive training is given to ensure that you learn the different types of applications needed to

enroll Institutional Providers. Physicians and Non-Physician Practitioners are processed with the

application called the CMS 855 I & R. These applications are set in place for a provider to

complete and ensure Medicare approval. The applications are either given what is called a

Provider / Medicare Identification Number, or make recommendations for approval. In addition

To reviewing the application, CMS has set in place provider standards that must be adhered

to. There are 30 set in place, but I will only name a few. These standards can be viewed by

anyone at http://www.hqaa.org/docs/30supplierstandardsabv.pdf. “A supplier must be in

compliance with all applicable Federal and State licensure and regulatory requirements

and cannot contract with an individual or entity to provide licensed services.”

(http://www.hqaa.org/docs/30supplierstandardsabv.pdf) All applications must

be signed by what is called an Authorized Official. He or she must be someone who can legally

bind a company.” A supplier has to maintain a physical facility on an appropriate site. CMS or

it agents must be allowed to conduct on site inspections to ascertain compliance.”

An onsite inspection takes place to ensure that the provider is located at the address submitted in

section 4A of the application. Several pictures over the area are taken for address verification.

standards. Pictures taken are sent to analyst for review. There are lists of questions asked during

the survey. It is the responsibility of the analyst to ensure complete documentation of the

answers given before a final determination is reached. Once a provider number is issued CMS

has set in place what is called a Revalidation Process. This process takes place every three to four

years to ensure that the provider is still in good standing. If the provider is non-compliant they

are either inactivated or revoked from the Medicare Program. A reactivation of the provider

number or PTAN (Provider Transaction Number) is the simply way to regain access to the

number again. They will have to go back through the entire application process. If the number is

revoked it is a strong possibility the provider will have to sit out of the Medicare program for a

minimum of a year or more. The number of years given are all based on a case-by-case basis.

For this week’s assignment I had the opportunity to review a young lady by the name of

Angela Spradley who has been with Palmetto GBA(Blue Cross Blue Shield) for the last 5 years.

We were able to discuss her role as a Provider Enrollment Analyst. The following is a questions...
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