Medicare Credentialing 101 - Requirements for Therapists
Therapists work with patients across a spectrum of needs and backgrounds. Having access to Medicare is important for many patients to obtain the level of care they require.
To qualify as a Medicare provider, therapists must apply and meet Medicare credentialing requirements. In this blog, we’ll outline what you need to get your practice registered with Medicare.
National Provider Identifier (NPI) Application
One of the main Medicare credentialing requirements is obtaining an NPI. This designates that therapist as a recognized medical care provider in the United States.
Therapists can apply directly through the National Plan & Provider Enumeration System website. Practitioners can also download the form from the NPPES website and mail it in. For issues regarding the NPI documents, call 1-800-465-3202.
Enroll in the Medicare Program
Using the NPI obtained through NPPES, a therapist can now enroll in the Medicare system. The application form is available through the Provider Enrollment, Chain, and Ownership System (PECOS). Medicare charges no fees for therapists to enroll in the program.
There are individual forms for unique services or billing needs. Medicate can be billed directly with form CMS-855I or reassigned to another entity through form CMS-855R.
During the application process, therapists must designate two specializations. For example, you might apply as a clinical psychologist, an independently practicing psychologist, or another medical specialist. Specialist codes are available through the Centers for Medicare and Medicaid Services.
Medicare Screening
Once applied, therapist applications are screened and evaluated. Providers must meet a variety of expectations, including:
Valid license and honestly submitted information
Applicants are not on the federal excluded parties list
Applicants have a valid practice address
Applicants are not listed as deceased with the Social Security Administration
If nothing is flagged during the Medicare screening process, your practice could be approved for Medicare.
Work with a Medicare Consultant
A Medicare consultant works closely with therapists to ensure all Medicare credentialing requirements are met. Consultants like Medicare Consulting for Therapists provide a variety of services tailored to therapists, including:
Billing
Medicare enrollment
Medicare documentation
Ability checks
Documentation
Medicare audit preparation
One of the biggest advantages of working with a Medicare consultant is their extensive understanding of the Medicare system and the Medicare Advantage. Working with a consultant ensures your practice doesn’t incur lengthy waits for coverage or leaves clients waiting for care.
Medicare Consulting for Therapists
Medicare Consulting for Therapists is run by Gabrielle Juliano-Villani. With years of experience with Medicare, and assisting therapists with Medicare credentialing requirements, Gabrielle helps therapy firms streamline billing.
Gabrielle works with firms across a range of specialties, including:
Grief and loss
Trauma
Trauma-informed care
Adults and older adults
Clients with chronic pain issues
Clients with chronic health issues
Her extensive knowledge of Medicare keeps therapists covered in any situation.
Medicare Credentialing Course
For new therapy clinics or therapists looking for additional support with Medicare, Gabrielle and Medicare Consulting for Therapists can help. Check out the Medicare Credentialing Course today.