Revised Medicare forms ask doctors if they accept new patients

The responses on the enrollment applications will be used to update the Physician Compare website, CMS says.

By Charles Fiegl — Posted July 25, 2011

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The Medicare program is taking a more direct approach to determining whether physicians are willing to take on new Medicare patients.

The Centers for Medicare & Medicaid Services in July added the question "Do you accept new Medicare patients?" to its enrollment forms for health care professionals. Physicians and nonphysician practitioners must complete applications -- and answer yes or no to the new question -- when enrolling in the Medicare program or updating their enrollment information.

The Medicare agency had attempted to gauge the number of physicians who accept new patients using a different method earlier this year. The Dept. of Health and Human Services proposed a plan to use "secret shoppers" to investigate the availability of primary care physicians to new patients with public insurance compared with those with private insurance plans. HHS put the plan on hold indefinitely after sharp criticism from federal lawmakers and physicians.

CMS said the addition of the question on the enrollment forms was not related to the termination of the secret shopper idea. Officials working on the Medicare agency's Physician Compare website had requested that the question be added for future versions of the online comparison tool, said CMS spokeswoman Ellen Griffith.

"We actually have received suggestions from both physicians and beneficiaries to add this element, since it is frustrating to beneficiaries to call physicians who are not accepting new patients and for those physicians to field those calls when they are not taking new patients," Griffith said.

Doctors or office staff that handle program paperwork will encounter the question on page 5 of the Medicare enrollment application for physicians and nonphysician practitioners, known as the 855I form. The applications are filed by those who are signing up for the Medicare program for the first time, making a change such as registering a new address, or revalidating enrollment information, said Leslie Witkin, president of Physicians First, a physician consulting and management service in Orlando, Fla.

Witkin said the question about accepting new patients also appears on CMS's online enrollment platform, known as the Provider Enrollment, Chain, and Ownership System, or PECOS.

Upgrades to Physician Compare

CMS uses physician enrollment information to populate the entries on Physician Compare, which the administration promotes as a resource for Medicare beneficiaries who are looking for doctors. However, physicians have criticized the site, which debuted in December 2010, for mistakes and missing information.

The American Medical Association had asked CMS to allow physicians to review their information before it was published online, but the agency did not honor the request. The Association has urged CMS to ensure the accuracy of the information so patients can make educated decisions regarding their health care needs.

CMS says it has taken steps to improve the website since it went online. Currently, the site displays the names and contact information of physicians enrolled in the Medicare program. The agency also posts information on whether a physician has participated satisfactorily in the Medicare physician quality reporting system.

Future versions of the website will include more data on physicians. The health system reform law requires CMS to expand the site by adding performance information by 2013. CMS has proposed using information from the PQRS program as a way to measure performance, according to the proposed 2012 Medicare physician fee schedule. CMS would publish the percentage at which a doctor reported performing particular clinical quality actions, the agency said.

Other upgrades are scheduled to be completed by the end of 2012. They include monthly data refreshes to incorporate updates, such as successful participants in the Medicare electronic prescribing and electronic medical record incentive programs, and links to specialty board websites that provide information on board certification status.

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How to get Medicare enrollment forms

The Centers for Medicare & Medicaid Services requires health professionals and suppliers billing Medicare to complete enrollment applications when joining the program and when changing or confirming enrollment information. Most doctors rely on office staff or credentialing departments to complete and mail the forms.

  • Medicare online enrollment (link).
  • Physicians and nonphysician practitioners (855I) (link).
  • Physicians and nonphysician practitioners reassigning Medicare benefits (855R) (link).
  • Clinics, group practices and other suppliers (855B) (link).
  • Institutional health professionals (855A) (link).
  • Durable medical equipment, prosthetics, orthotics suppliers (855S) (link).

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