| Page updated 12/6/11 |
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Lymphland International Lymphedema Online
Dear Medicare Part B Providers,
Eligible Physicians and Practitioners Who Need to Enroll in the Medicare Program
for the Sole Purpose of Ordering and Referring Services for Medicare
Beneficiaries
The Centers for Medicare & Medicaid Services (CMS) expanded its claim editing of
ordering and referring providers to meet the Social Security Act requirements.
Physicians and practitioners of the types listed below may order items or
services for Medicare beneficiaries or may refer Medicare beneficiaries to other
Medicare providers or suppliers:
• Doctor of Medicine or Osteopathy;
• Doctor of Dental Medicine;
• Doctor of Dental Surgery;
• Doctor of Podiatric Medicine;
• Doctor of Optometry;
• Doctor of Chiropractic Medicine;
• Physician Assistant;
• Certified Clinical Nurse Specialist;
• Nurse Practitioner;
• Clinical Psychologist;
• Certified Nurse Midwife; and
• Clinical Social Worker.
The physicians and practitioners described above must do the following:
Complete the paper form CMS-855I, “Medicare Enrollment Application for
Physicians and Non-Physician Practitioners,” by completing the following
sections listed below and mail the completed form to the designated Medicare
enrollment contractor:
Section 1 – Basic Information (they would be a new enrollee)
Section 2 – Identifying Information (section 2A, 2B, 2D and if appropriate 2H
and 2K)
Section 3 – Final Adverse Actions/Convictions
Section 13 – Contact Person
Section 15 - Certification Statement (must be signed and dated—blue ink
recommended)
The physicians and practitioners described above must include a cover letter
with their paper form CMS-855I, “Medicare Enrollment Application for Physicians
and other Practitioners,” stating the provider is only enrolling for the sole
purpose of ordering and referring items or services for a Medicare beneficiary
to other providers and suppliers and cannot be reimbursed for services
performed. This should be done for each applicant.
Refer to the Medicare Program Integrity Manual, Chapter 15, Section 16.1 and
Change Request 7097 at http://www.cms.gov/MLNMattersArticles/downloads/MM7097.pdf
for further instructions.
Thank you,
Provider Outreach & Education (POE)
Cahaba GBA- J10 A/B MAC
Cahaba GBA- Title XVIII Part B Carrier for Mississippi
INFORMATION ON DISABILITY HELP FOR THOSE WITH LYMPHEDEMA
First, download and read some of the indicated materials and dig into the Office of Personnel Management
web site: http://www.opm.gov/disability/
Read the Powerpoint presentation by Cheryl Bates-Harris of the National Disability Rights Network http:
www.cessi.net/ticketpartnerssummit/PDF/245P_Everything.ppt
Her notes to the presentation can be downloaded from http://drnpa.org/File/fedemployscha.pdf
Note especially Slide 7, bullet 9), defining disability as "distortion of limb". Depending on how serious your
case is
your letter will either document how your lymphedema prevents you from performing all of the activities a
non-disabled
person can perform, how you will require special accommodations, or how your condition will progress
knowing
the natural history of primary lymphedema.
You will need an MD with a knowledge of the pathology, natural history, treatment and burden of
lymphedema
to write the letter. Contact your lymphedema therapist to identify an appropriate physician in your area.
The following abstracts summarize the therapy caps for 2012 [Ref. MLN Matters® Number: MM7529]:
Therapy caps for 2012 will be $1880.00
The Deficit Reduction Act of 2005 directed the Secretary to implement a process for exceptions to therapy
caps for medically necessary services. The Affordable Care Act extended the exceptions to therapy caps
through December 31, 2010; and, the Medicare and Medicaid Extenders Act (MMEA) of 2010 extended
the therapy caps exceptions through CY 2011. The exceptions process will continue unchanged for the
time frame directed by Congress.
Robert Weiss, M.S.
Lymphedema Patient Advocate
National Lymphedema Network
Eligible Physicians and Practitioners Who Need to Enroll in the Medicare Program
for the Sole Purpose of Ordering and Referring Services for Medicare
Beneficiaries
The Centers for Medicare & Medicaid Services (CMS) expanded its claim editing of
ordering and referring providers to meet the Social Security Act requirements.
Physicians and practitioners of the types listed below may order items or
services for Medicare beneficiaries or may refer Medicare beneficiaries to other
Medicare providers or suppliers:
• Doctor of Medicine or Osteopathy;
• Doctor of Dental Medicine;
• Doctor of Dental Surgery;
• Doctor of Podiatric Medicine;
• Doctor of Optometry;
• Doctor of Chiropractic Medicine;
• Physician Assistant;
• Certified Clinical Nurse Specialist;
• Nurse Practitioner;
• Clinical Psychologist;
• Certified Nurse Midwife; and
• Clinical Social Worker.
The physicians and practitioners described above must do the following:
Complete the paper form CMS-855I, “Medicare Enrollment Application for
Physicians and Non-Physician Practitioners,” by completing the following
sections listed below and mail the completed form to the designated Medicare
enrollment contractor:
Section 1 – Basic Information (they would be a new enrollee)
Section 2 – Identifying Information (section 2A, 2B, 2D and if appropriate 2H
and 2K)
Section 3 – Final Adverse Actions/Convictions
Section 13 – Contact Person
Section 15 - Certification Statement (must be signed and dated—blue ink
recommended)
The physicians and practitioners described above must include a cover letter
with their paper form CMS-855I, “Medicare Enrollment Application for Physicians
and other Practitioners,” stating the provider is only enrolling for the sole
purpose of ordering and referring items or services for a Medicare beneficiary
to other providers and suppliers and cannot be reimbursed for services
performed. This should be done for each applicant.
Refer to the Medicare Program Integrity Manual, Chapter 15, Section 16.1 and
Change Request 7097 at http://www.cms.gov/MLNMattersArticles/downloads/MM7097.pdf
for further instructions.
Thank you,
Provider Outreach & Education (POE)
Cahaba GBA- J10 A/B MAC
Cahaba GBA- Title XVIII Part B Carrier for Mississippi
INFORMATION ON DISABILITY HELP FOR THOSE WITH LYMPHEDEMA
First, download and read some of the indicated materials and dig into the Office of Personnel Management
web site: http://www.opm.gov/disability/
Read the Powerpoint presentation by Cheryl Bates-Harris of the National Disability Rights Network http:
www.cessi.net/ticketpartnerssummit/PDF/245P_Everything.ppt
Her notes to the presentation can be downloaded from http://drnpa.org/File/fedemployscha.pdf
Note especially Slide 7, bullet 9), defining disability as "distortion of limb". Depending on how serious your
case is
your letter will either document how your lymphedema prevents you from performing all of the activities a
non-disabled
person can perform, how you will require special accommodations, or how your condition will progress
knowing
the natural history of primary lymphedema.
You will need an MD with a knowledge of the pathology, natural history, treatment and burden of
lymphedema
to write the letter. Contact your lymphedema therapist to identify an appropriate physician in your area.
The following abstracts summarize the therapy caps for 2012 [Ref. MLN Matters® Number: MM7529]:
Therapy caps for 2012 will be $1880.00
The Deficit Reduction Act of 2005 directed the Secretary to implement a process for exceptions to therapy
caps for medically necessary services. The Affordable Care Act extended the exceptions to therapy caps
through December 31, 2010; and, the Medicare and Medicaid Extenders Act (MMEA) of 2010 extended
the therapy caps exceptions through CY 2011. The exceptions process will continue unchanged for the
time frame directed by Congress.
Robert Weiss, M.S.
Lymphedema Patient Advocate
National Lymphedema Network