Help - Frequently Asked Questions (FAQs) (2024)

Frequently Asked Questions (FAQs)

Please click on a question for its corresponding answer.

What is an example of an Ownership Change vs. a CHOW?
The most common example of the difference between an ownership change and a CHOW involves stock transfers. For instance, assume that a business entity’s stock is owned by A, B, and C. A sells his stock to D. While this is an ownership change, it is generally not a formal CHOW under 42 CFR 489.18. Thus, the ownership change from A to D should be reported as a change of information, not a CHOW. If you have any questions on whether an ownership change should be reported as a CHOW or a change of information, contact your Medicare fee-for-service contractor or CMS Regional Office.

How do I obtain an NPI?
You can obtain a National Provider Identifier (NPI) through the National Plan and Provider Enumeration System (NPPES). To access more information on applying, see the Links to More Information section.

How do I obtain a Medicare ID number(the OSCAR or PIN, collectively referred to as Provider Transactions Access Number (PTAN))?
For Part A services, the Online Survey Certification and Reporting (OSCAR) number, also referred to as the Certification Number, is administered via the OSCAR system. For Part B services, the Provider Identification Number (PIN) is administered by the Medicare contractor. Most providers will not have a Medicare Identifier (ID) to enter for an initial enrollment application. For more information, please see the Glossary section.

What is a Reassignment of Benefits?
Please see the Glossary section for more information.

How do I calculate 5% indirect ownership?
The following contains an explanation of the term "indirect ownership".

Example 1:

Level 2:Company B (60%)

Level 1:Company A (100%)

  • Company A owns 100% of the Enrolling Supplier.
  • Company B owns 60% of Company A.

In this example, Company A is the direct owner of the Enrolling Supplier. Company B, as an owner of Company A, is an indirect owner of the supplier. To calculate Company B’s indirect ownership in the supplier, multiply 100% (Company A’s ownership in the supplier) by 60% (Company B’s ownership in Company A). This comes to .6; as such, Company B has a 60% indirect ownership interest in the supplier.

How do I calculate indirect 5% ownership (Financial Control)?
The following contains an explanation of the term "indirect ownership (financial control)".

The percentage of financial control can be calculated by using the following formula: Dollar amount of the mortgage, deed of trust, or other obligation secured by the Enrolling Supplier or any of the property or assets of the Enrolling Supplier DIVIDED BY Dollar amount of the total property and assets of the Enrolling Supplier.

Example: Two years ago, a supplier obtained a $20 million loan from Entity X to add a third floor to its facility. Various assets of the supplier secure the mortgage. The total value of the supplier’s property and assets is $100 million.

Using the formula described above, divide $20 million (the dollar amount of the secured mortgage) by $100 million (the total property and assets of the Enrolling Supplier). This results in .20, or 20%. Because Entity X’s interest represents at least 5% of the total property and assets of the Enrolling Supplier, financial control exists and Entity X must be reported.

Why is Internet-based PECOS restricting me from enrolling in more than one State?
The system reflects existing Medicare policy on this topic. Contact your Medicare contractor for more information.

Under Medicare regulations, am I a provider or a supplier?
Please see the Links to More Information section of Help for a link to the CMS website anda link to the Code of Federal Regulations website.For additional information, contact your Medicare contractor.

How do I know when I need to create a new enrollment vs. when I need to update an existing enrollment?
The following are scenarios that require a new enrollment record to be created:

  1. The services you render - For example, you may want to change specialties.The series of questions provided by the Medicare enrollment Application Questionnairethat appears after the My Enrollments page will help guide you through this process.
  2. Your location - New state surveys, certification statements, and otherdocumentation may be required.
  3. Provider based vs. Free standing requirements - Contact your Medicare contractorfor more information.

How do I know that I am filling out the correct online form?
Internet-based PECOS is designed to select the correct CMS-855 formand reason for submittal through a series of questions asked in the beginningof the application process.

How do I print the following: Attachments or Submission History?
There are two ways to access and print Attachment Information and the Submission History Report.Print options are available to users once all Topics are completed successfully and the userclicks the Submission button on the Topics Summary page.

  1. From the My Enrollments Page: under the Administrative menu on the My Enrollments Page,there are options to print partial and complete enrollment applications.
  2. From the Submission page(s), a user can print certification statements for theapplication being submitted, delegated official certification statements, attestationstatements for supervising physicians, authorization statements for reassignments, and anyother supporting documentation.

How can I determine what documents I need to submit with my enrollment application?
You can view a list of required supporting documentation corresponding to your enrollment application by following one of the methods below:

  • My Enrollments:
    1. For enrollment applications in New, Edit, Submit, In Progress, or Approval Pending Regional Office Review status, select the View button on the My Enrollments page next to the enrollment application.
    2. Select the "View Printable Supporting Documentation" option.
    3. Select the "View and Print" hyperlink next to "Supporting Documentation."
  • "Required and/or Supporting Documentation" topic:
    1. For enrollment applications in New or Edit status, select the More Options button from the My Enrollments page and select the "Continue Working on Application" option.
    2. Access the "Required and/or Supporting Documentation" topic from the Topic View.
    3. Select the "View Required and/or Supporting Documentation" hyperlink.
  • Submission:
    1. For enrollment applications in New or Edit status, proceed with submitting the application.
    2. The Submission Page will display the "Required and Supporting Documents" section.
Note: You may submit documents electronically by accessing the "Required and/or Supporting Documentation" topic on the Topic View if your enrollment application is in New or Edit status.

What is the difference between an enrollment application and an enrollment record?
An application is the form submitted for approval to enroll in the Medicare program.An enrollment record is the approved application data once it is in Internet-based PECOS.

When I submit an application, am I automatically approved?
The Medicare contractor will review your application to determine whether you meet all of therequirements for enrollment.

I made a mistake on my enrollment application. How do I make a correction after I clicked the submit button?
Users may still request a correction via phone and/or e-mail if the enrollmentapplication is currently being processed by a Medicare contractor.The new information, however, cannot be given and accepted via phone or e-mail.It must still be submitted through Internet-based PECOS.The Medicare contractor will provide information when you can perform this action.See Links to More Information for access to Medicare contractor contact information.

Where can I find mailing instructions?
Mailing instructions can be found on the Submission page(s). The Submission page opens once the userclicks on the Submission button after all Topics are successfully completed on the Topics summary page.

How do I return to the My Enrollments page?
Users can return to the My Enrollments page by clicking on the 'My Enrollments' link at the top righthand side of the page.

How can I create an initial enrollment application for Medicare?
A user can create an initial enrollment application for Medicare by simply selecting the Create Initial Enrollment Application button, which displays on the My Associates page and the My Enrollments page.

How can I update existing Medicare Information?
From the My Enrollments page, users can select existing applications and update their Medicare information.

What is a Status?
There are two types of statuses used in Internet-based PECOS, application status and enrollment status.

  • Application status indicates the phase that the application process is currently in.
  • Enrollment status indicates the phase that a previously approved application is currently in.

What is a Scenario?
A scenario is the reason why a user is submitting an application. There are approximately 20 types of enrollmentscenarios that Internet-based PECOS can accommodate. One example is a provider enrolling in Medicare for the first time.

What is a Topic?
A Topic is a section of the CMS-855 form within Internet-based PECOS.

What is the submission process?
The submission process is a set of actions that enable a provider/supplierto use the Internet to submit an enrollment application, or an update toexisting enrollment information, to the appropriate Medicare contractor,along with the required paper documentation and paper documents that areto be downloaded from Internet-based PECOS and signedand mailed to the same contractor.

Why wasn’t the information I previously entered saved on one of the Topic pages?
If you navigate away from a page through one of the following meanswithout entering a complete set of information for a Topic, thepreviously entered information will not be saved:

  • Topic dropdown
  • Page header
  • Page footer

I selected "No" for one or more of the following Topics:Individual Information; Resident Status; Final Adverse Actions; Organizations with Ownership Interest and/or Managing Control; Individual Control; Chain Home Office; Billing Agency; IDTF Interpreting Physician; IDTF Technicians; Reassignment; Nursing Registries; Skilled Nursing Facility Address.Once I completed the remaining Topics, I noticed that the Topics where I answered "No" were marked as incomplete on the Topics Summary page. What do I do?
From the Topics Summary page, select the first Topic that had been marked as incomplete.Make sure that the answer "No" is selected. From this point,navigate via the "Next Topic" link provided per page until theTopics Summary page is reached.The Topics answered with a "No" should now be marked as completeand the "Submit Application" button should be available.

I know I have an existing enrollment record, but for some reason Idon’t see it on the My Enrollments page. What do I do?
For existing enrollment record information, please contact your Medicare contractor.See the Links to More Information section to find contact information foryour Medicare fee-for-service contractor.

If I have an existing enrollment record, what actions can I undertake?
You can undertake the following actions with respect to an existing enrollment record:

  • Add information
  • Edit information
  • Delete information

Why can’t I access an enrollment record that I created?
If you belong to an employer organization who works on behalf ofa provider organization, your access to the provider’s Medicareinformation may have been removed even if you initially createdthe enrollment record. If the provider organization revokes youraccess, you will no longer have access to the provider’senrollment information.

If I have an National Provider Identifier (NPI), does that meanI’m eligible to enroll as a provider in Medicare?
Having an NPI does not constitute Medicare enrollment eligibility.Users will have to go through the application process in Internet-basedPECOS or submit a paper CMS 855 Medicare provider/supplier enrollmentform to a Medicare contractor to become eligible for Medicare.


Your new name must be changed in the PECOS Administrative Interface to bereflected in Internet-based PECOS. Please contact your Medicare-fee forservice contractor to change your name.

Am I required to obtain a surety bond?
Please visit https://palmettogba.com/palmetto/npewest.nsf or call the PALMETTO DME (for West) customer service line at 1-(866) 238-9652 to obtain information on the supplier types that are exempt from getting a surety bond.
Please visit www.novitas-solutions.com or call the NOVITAS DME (for East) customer service line at 1-(866) 520-5193 to obtain information on the supplier types that are exempt from getting a surety bond.

Am I required to fill out the entire section if I am just changing one field?
If you are reporting a change to existing information, check "Change", provide the effective date of the change, complete the appropriate fields in the section that requires a change and sign and date the certification statement.

Do I need to provide an expiration date if I am reporting a new bond or surety bond company?
Yes, you must furnish the expiration date of the current bond if reporting either a new bond or surety bond company.

Am I required to have liability Insurance?
Yes, all DMEPOS suppliers must have liability insurance and must submit a complete copy of their liability insurance policy or evidence of self-insurance with this application.

Why do I have to provide the name and telephone number for both my insurance agent and my underwriter?
This contact information is necessary for the contractor to verify your policy. CMS will not verify this information with your insurance agent.

Can a physical location have multiple sets of claims information?
Yes, a physical location can have multiple sets of claims information associated to it.

Should the business location for a DMEPOS supplier be accredited?
Please contact your designated National Provider Enrollment (NPE) DMEPOS Contractor- Novitas Solutions for East or Palmetto GBA for West for more information.

Can a DMEPOS supplier have multiple accreditations?
Yes, a DMEPOS supplier is allowed to have multiple accreditations.

How do I know if I am exempted from accreditation?
Please contact your designated National Provider Enrollment (NPE) DMEPOS Contractor - Novitas Solutions for East or Palmetto GBA for West for more information.

Can I supply both non-accredited products and other products and services?
Yes, a DMEPOS supplier who provides non-accredited products may also provide other products and services.

Can I change my organization structure?
A user cannot change their organization structure in PECOS PI. However, a user can change their organization structure by performing a change of information via paper application.

Can I change my role as displayed in the Individual Control content unit?
No, a user cannot change their role once they have completed the scenario selection process. A user would have to deactivate their enrollment and submit another one.

What is an ITIN?
An Individual Taxpayer Identification Number (ITIN) is a tax processing number issued by the Internal Revenue Service. It is a nine-digit number that always begins with the number 9 and has a 7 or 8 in the fourth digit. IRS issues ITINs to individuals who are required to have a U.S taxpayer identification number but who do not have and are not eligible to obtain a Social Security Number (SSN) from the Social Security Administration (SSA).

As a DMEPOS Supplier, when must I revalidate?
Medicare law mandates that a DME Supplier revalidates three years after the initial enrollment or the last revalidation. Please wait until you have been contacted by your designated National Provider Enrollment (NPE) DMEPOS Contractor- Novitas Solutions for East or Palmetto GBA for West- to revalidate.

When should I enroll as self-employed?
You should enroll as self-employed (sole-proprietorship) when you provide healthcare services from a facility that you own, lease or rent. (As a self-employed practitioner, you are considered legally the same as your business for tax purposes).

When should I enroll as a sole-owner of PA, PC, LLC?
You should enroll as a sole owner when you provide practitioner services through an incorporated business of which you are the only owner (As a sole owner, you are considered legally distinct from your business for tax purposes).

When should I enroll as a group member only?
You should enroll as a group member only when you provide healthcare services only as the employee of another provider. (As a group member only, you reassign all your benefits to the provider you are employed with).

When should I enroll as a group member and self employed?
You can enroll as a group member and self employed when you provide healthcare services as an employee of another provider. (As a group member and self employed practitioner, you only reassign some of your benefits to the provider you are employed with).

How should I enroll if I have multiple sole ownerships?
If you have multiple sole ownerships, and you have not enrolled in Medicare as a practitioner before, select the Create Initial Enrollment Application from the My Associates page or the My Enrollments page and then select the sole owner option from the Applicant Description Page. Proceed through the set of questions. This will create both a practitioner and organization enrollment record for the sole ownership. If you have previously enrolled in Medicare as a sole owner, you can select the existing practitioner enrollment from the My Enrollments page. Select Change of Information and then select Yes that you are changing the physical location. You will then be asked if you are adding a new business for which you are the Sole Owner. This will allow you to enroll the new PA, PC, LLC for which you are the sole owner. You should do this for each sole ownership business you have.

How should I enroll if I have multiple businesses that I own/lease (the practitioner and business are legally the same)?
If you are a practitioner who owns multiple businesses, you will need to create a new application for each business. The practitioner must use a different TIN for each business for billing purposes if they are in the same state. For each new business with a different TIN, select the Create Initial Enrollment Application button from the My Associates page or the My Enrollments page to create a new application for that sole proprietorship.

If I am a DMEPOS Supplier and I have a new Business location, can I add this location to an existing enrollment?
No, if you have a new business location, you must complete a new application. Each DMEPOS enrollment can only have one current business location.

I am already enrolled as self employed. Can I also enroll as a sole owner of a PA, PC, LLC?
Yes, you can enroll as both a sole owner and self employed using the same enrollment record. You should select the existing self employed enrollment record on the My Enrollments Page. Select Change of Information and then select Yes that you are changing the physical location. You will then be asked if you are adding a new business for which you are the Sole Owner. This will allow you to enroll the new PA, PC, LLC for which you are the sole owner.

What is the difference between revalidation and reactivation for DMEPOS Suppliers?
If your enrollment record has previously been Voluntary Withdrawn or Deactivated, then you would need to Reactivate your enrollment in order to resume claims payment. This can be accomplished by selecting the existing enrollment on the My Enrollments Page and selecting Reactivation. If your enrollment is Approved, but you have been contacted by your designated National Provider Enrollment (NPE) DMEPOS Contractor- Novitas Solutions for East or Palmetto GBA for West to revalidate, then you would need to select the existing enrollment on the My Enrollments Page and select the Revalidation option. This will allow you to update the enrollment with any new information and re-submit the application for approval.

How is enrolling as a Disregarded Entity different from enrolling as a Sole Owner or as Self Employed?
A disregarded entity is a business entity that chooses to be disregarded as separate from the business owner for federal tax purposes. Most businesses choose to be counted as separate from their owners for liability reasons, however, a disregarded entity chooses to be considered the same as the owner. An example of a disregarded entity is a single-member limited liability company (LLC) that chooses to be taxed as a sole proprietorship. Therefore, a disregarded entity is closely related to a sole proprietorship in PECOS since a sole proprietorship is a self employed individual who is considered legally the same as the business he/she owns. On the other hand, a sole owner of a PA, PC, LLC is considered legally distinct from the business.

Can I utilize an existing practitioner enrollment where I am the sole owner of a PA, PC, LLC to add a practice location where I am self-employed (i.e., render healthcare services at a facility that I own/lease/rent)?
Yes, you can select the existing practitioner enrollment and do a Change of Information. You will then be able to add a practice location to the enrollment. This will enroll you in PECOS as both a sole owner and as self-employed.

What if an organization with ownership interest and/or managing control has separate addresses for each role (5% or more ownership control, partner, managing control) on my enrollment application?
If an organization has different addresses for each role, you should enter each role separately by selecting the "Add Information" button at the top of the Summary Page for Organization(s) with Ownership Interest and/or Managing Control.

As a DMEPOS Supplier, what would happen to my hours of operations and jurisdiction area covered when I delete my practice location?
Your hours of operations and jurisdiction area covered will not be modified. The user must save the hours of operation and jurisdiction area covered when adding a new practice location.

Why are there reassignments assigned to myself?
If you are enrolled as a sole owner of a PA/PC/LLC in PECOS, all benefits must be reassigned to your organization to associate yourself as the sole owner of the PA/PC/LLC and approve the enrollments in order to bill Medicare for services rendered in your practice location.

Why can I not add, edit or delete MED sanction information?
The MED sanction information is read-only and therefore you can not add, edit, or delete this information.

I had MED sanctions and have been reinstated. My enrollment is not currently in an approved status. What steps do I need to take to change my enrollment in approved status?
You cannot re-submit your current enrollment to the contractor. You need to create a new initial enrollment application. Indicate the MED sanction and reinstatement information in the Final Adverse Actions section.

When I view and print my 855S PDF form in section 2B there is a 'P' or 'S' displayed in the checkboxes. Why are these letters and not checkmarks?
The letters in the checkboxes are used to distinguish between the primary DME Supplier type (denoted with a 'P') and any secondary DME Supplier types (denoted with an 'S') you may have selected for this enrollment application. There will always be one and only one letter 'P' and any number of letter 'S' selections checked on the PDF form.

My DME Supplier type listed on the 855S PDF form section 2B is different from my DME Supplier type on my enrollment application. Is this okay?
Yes, some of the DME Supplier types in Internet-based PECOS are not worded exactly as those on the 855S PDF Form. Additionally, the 'Physician, other than Optometrist or Dentist' checkbox and the 'Other' checkbox on the 855S PDF form represent multiple DME Supplier types in Internet-based PECOS.

I chose a DME Supplier type on my enrollment application that was not 'Other', but when I view/print the 855S PDF Form the 'Other' checkbox is selected in section 2B. Do I need to correct my DME Supplier type on my enrollment application?
Some DME Supplier types on the enrollment application are not listed on the 855S PDF form. For these specialties, the 'Other' checkbox will be marked with a 'P' (Primary DME Supplier type) or an 'S' (Secondary DME Supplier type) and the specialty will be printed with a '(P)' or a '(S)' on the line to the right of the checkbox. If multiple specialties are selected that will be categorized as "Other" types, they will all be printed on the line; if any of the specialties in this category is the primary DME Supplier type, then the checkbox will be marked with a 'P', otherwise it will be marked with an 'S'.

I chose multiple Physician types as my DME Supplier type in the enrollment application, but only the 'Physician, other than Optometrist or Dentist' checkbox is marked on the 855S PDF form. Is this correct?
Yes. Internet-based PECOS lists many more Physician DME Supplier types than those that are listed on the 855S PDF form. All selected Physician specialties except Optometrist and Dentist will be represented by the 'Physician, other than Optometrist or Dentist' checkbox on the 855S PDF form. If any of the selected Physician specialties in this category is the primary DME Supplier type, then the 'Physician, other than Optometrist or Dentist' checkbox will be marked with a 'P' (Primary DME Supplier type), otherwise it will be marked with an 'S' (Secondary DME Supplier type).

As a DMEPOS supplier, what are the standards that my business must follow?
The standards for DMEPOS suppliers can be found at http://www.cms.gov/MedicareProviderSupEnrollHelp - Frequently Asked Questions (FAQs) (66).

My application is now in a final status. What does my enrollment status mean for my billing privileges?
Approved - The enrolling provider or supplier has been determined to be eligible under Medicare rules and regulations to receive a Medicare billing number and be granted Medicare billing privileges.

Denied - The enrolling provider or supplier has been determined to be ineligible to receive Medicare billing privileges.

Opt Out - A physician or practitioner has chosen not to enroll in the Medicare program. This means that neither the physician/practitioner nor the Medicare beneficiary can submit claims to Medicare for services performed.

Revoked - The provider or supplier's billing privileges are terminated.

Deactivated - The provider or supplier is no longer rendering services to Medicare patients and/or has planned to cease operations. For certified providers or suppliers this will also terminate your provider agreement.

Deleted - The enrollment submission has been deleted by the Medicare contractor.

Rejected - The provider or supplier's enrollment application was not processed due to incomplete information or that additional information or corrected information was not received from the provider or supplier in a timely manner.

Withdrawal of Application While in Process - The enrollment application has been withdrawn prior to being processed to completion.

How do I change my PECOS password?
You may change your PECOS password by selecting the "Forgot Password" link on the PECOS Welcome and Login pagehereandfollowing the instructions on the screens.

Note: CMS recommends that PECOS users change their PECOS passwords at least once a year. User IDs cannot be changed.

Who do I contact if I cannot remember the password I established to use for PECOS?
You may change your PECOS password by selecting the "Forgot Password" link on the PECOS Welcome and Login pagehereand following the instructions on the screens. More information can be found by clicking the following link: Forgot Password FAQ.Help - Frequently Asked Questions (FAQs) (72)

If you need additional assistance, please contact the External User Services (EUS) Help Desk.

External User Services (EUS)
Hours of Operation: Monday - Friday, 7am-7pm EST
Website:

https://eus.custhelp.comHelp - Frequently Asked Questions (FAQs) (73)
By Chat: Live Chat Launch PageHelp - Frequently Asked Questions (FAQs) (74)
By E-mail: EUSSupport@cgi.com
By Phone:
Toll-Free : (866) 484-8049
TTY/TDD : (866) 523-4759

How long does it take to change a PECOS Password?
In most cases, a password change can be made in less than 2 minutes.

Can I change my PECOS User ID?
For security reasons, you cannot change your PECOS User ID.

What is ownership or investment interest?
Ownership or investment interest means an interest in an entity through equity, debt, or other means, and includesan interest in an entity that holds an ownership or investment interest in any entity that furnishes designated healthservices, as defined in 42 C.F.R. section 411.351. It does not include an interest that satisfies the requirementsat 42 C.F.R. 411.356(a) or (b).

What is a physician?
Physician means a doctor of medicine or osteopathy, a doctor of dental surgery or dental medicine, a doctor of podiatric medicine, a doctor of optometry, or a chiropractor, as defined in section 1861 (r) of the Social Security Act. A physician and the professional corporation of which he or she is a sole owner are considered one and the same.

What is an immediate family member?
Immediate family member means a husband or wife of a physician; birth or adoptive parent, child, or sibling; stepparent, stepchild, stepbrother, or stepsister; father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, orsister-in-law; grandparent or grandchild; and spouse of a grandparent or grandchild.

What is a physician-owned hospital?
Physician-owned hospital means any Medicare participating hospital (as defined in 42 C.F.R. section 489.24) in which a physician, or an immediate family member of a physician, has an ownership or investment interest in the hospital. The ownership or investment interest may be through equity, debt, or other means, and includes an interest in an entity that holds an ownership or investment interest in the hospital. This definition does not include a hospital with physician ownership or investment interest that satisfy the requirements at 42 C.F.R. section 411 456(a) or (b).

What is a physician owner/investor?
Physician owner/investor means a physician (or an immediate family member of such physician) with a direct or an indirectownership or investment interest in the hospital.

As a DMEPOS Supplier, how do I know which National Provider Enrollment (NPE) Contractor I should Contact?
NPE Contractors are Novitas Solutions and Palmetto GBA. Novitas Solutions handles DMEPOS Supplier enrollment for the eastern states and Palmetto GBA handles DMEPOS Supplier on the western states. Please visit http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/Enroll-as-a-DMEPOS-Supplier to find out which NPE MAC is handling the DMEPOS Supplier enrollment in your state.

Help - Frequently Asked Questions (FAQs) (2024)

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