Last Modified: 12/25/2018 Location: FL, PR, USVI Business: Part A, Part B
Medicare enrollment for ‘mass immunizers’
The following information has been excerpted from the Centers for Medicare & Medicaid Services (CMS) Internet-only manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 15, Section 188.8.131.52 -- Mass Immunizers Who Roster Bill.
An entity or individual who wishes to furnish mass immunization services -- but may not otherwise qualify as a Medicare provider -- may be eligible to enroll as a “mass immunizer” via the Form CMS-855I (individuals) or the Form CMS-855B (entities).
Providers may expedite their enrollment process by completing and submitting their application online through the Internet-based Provider Enrollment Chain and Ownership System (PECOS) . Click here to find out more.
Such suppliers must meet the following requirements:
• They may not bill Medicare for any services other than pneumococcal pneumonia vaccines (PPVs), influenza virus vaccines, and their administration.
• They must submit claims through the roster billing process.
• The supplier, as well as all personnel who administer the shots must meet all applicable State and local licensure or certification requirements.
The roster billing process was developed to enable Medicare beneficiaries to participate in mass PPV and influenza virus vaccination programs offered by public health clinics and other organizations.
Note: The following information regarding the enrollment of mass immunizers:
• The effective date provision in 42 CFR § 424.520(d) does not apply to the enrollment of mass immunizers. This is because the individual/entity is not enrolling as a physician, non-physician practitioner, physician group or non-physician practitioner group.
• In section 4 of the Form CMS-855, the supplier need not list each off-site location (e.g., county fair, shopping mall) at which it furnishes services. It need only list its base of operations (e.g., county health department headquarters, drug store location).
For more information on mass immunization roster billing, refer to:
• Publication 100-02, Benefit Policy Manual, Chapter 15, section 184.108.40.206
• Publication 100-04, Claims Processing Manual, Chapter 18, sections 10 through 10.3.2.3
Note: Section 10.3.1 outlines the requirements for submitting roster bills.
New providers must first obtain a National Provider Identifier (NPI) prior to enrollment. Visit https://nppes.cms.hhs.gov/NPPES/Welcome.do for NPI enrollment information.
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