Practice Management

We are working with the understanding that we cannot submit our Medicare enrollment for a new office location until we have the final certificates for our equipment.  Is that correct or can we submit the application with the information from the home site for the modality?  We are accredited with IAC.  Do the requirements vary by MAC?  We are in Florida and First Coast is our MAC.  We are opening a new location in January, 2020.  We are a physician group practice not an IDTF.

I appreciate input from the group. 

Thank you,

Nancy Brooks, FACMPE, CHC

Revenue Cycle Manager

Radiology Regional Center, PA

nbrooks@radiologyregional.com

3660 Broadway

Fort Myers, FL 33901-8005

(239) 425-4773 Direct

(239) 834-6106 Fax

http://radiologyregional.com

Hi Nancy,

The 855B application asks for your FDA mammo certification number, state certifications, and accreditations for advanced imaging. The FDA mammo cert # is the only cert # that must be on claims. Your FDA mammo cert # can be added after your enrollment has been approved, but that may delay your ability to use your mammo machine. You could also edit your application once it has been submitted and before it's approved, but sometimes First Coast messes up the app when that happens. None of our physician-owned imaging center clients have ever included their MRI, CT, NM, etc, accreditations on their 855B enrollments. The only time we've ever had payment issues for higher imaging is when there has been an issue with the FDA mammo cert number.

Also, an FYI about First Coast...

With all Medicare carriers, you are only allowed to submit the Medicare enrollment 60 days prior to the effective date. If you're opening on 1/1/2020, then you are able to submit your PECOS or paper application as early as 11/1/2019. First Coast nearly 100% of the time does site visits for new locations that get opened in localities 03 and 04. When I've questioned this in the past, they said it was because of the high rate of Medicare fraud in south Florida. Even if you submit in early November, they likely won't approve your new location until they physically visit the center in January after it has opened. With that being said, if you say your center is going to open on 1/1/2020, but it gets delayed until 1/20/2020, and then First Coast sends a site visitor to your office on 1/10/2020, they will terminate your application. You can get your app re-opened, but it's a pain. Because of this, I highly suggest using your actual start date on your application, not an estimated date.

If you have any other questions, I'd be happy to help.

Best regards,