Medicare Provider Enrollment Rejection

Nothing is more frustrating than when you Medicare provider enrollment rejection notice arrives in your email inbox.

What happens if your physical therapy Medicare provider enrollment application is denied?

If you are a physical therapist applying to become a contracted Medicare provider for outpatient physical therapy services this article will walk your through some of the most common mistakes that may lead to an application denial.

Medicare Provider Enrollment Rejection #1

One of the most common rejections you may see is when a physical therapy provider is enrolling as an individual and simultaneously enrolling a business as a sole owner.

Sole Owner of a PC, LLC, PLLC or other business entity

I have completed over 100 phyiscal therapy private practice and provider enrollments with Medicare over the past year and in approximately 10% of cases I will recieve an email notifying me that the application is not needed for the transactino in question.

PECOS will have providers submit a single enrollment when the therapist and business need a Medicare ID, also known as a Medicare provider number (PTAN).

Occasionally the system will automatically generate an 855r which is not required for sole owners who are also therapists.

When this happens an email is generated, but in most cases this is a positive sign and usually means the Medicare ID is going to be arriving in the next 24 to 48 hours.

Here is an example of what you will see in your email:

Form Type: 855R
Date: 03/24/2022
Status: REJECTED
Status Reason: APPLICATION IS NOT NEEDED FOR THE TRANSACTION IN QUESTION

Resolution: None

There is nothing to do in this case. You will receive your Medicare PTAN in a day or two for both you personally and your business.

Medicare Provider Enrollment Rejection #2

Non-Response to Development

A second common reason for a physical therapist’s Medicare provider enrollment to be rejected is due to non-response.

In these cases the Medicare Administrative Contractor (MAC) has requested additional information via email, but the therapist did not respond to that email within 30-days.

The 3 most common Medicare requests for information include:

1. Verification of a diploma
2. Verification of the provider’s name
3. Verification that the provider is the sole owner of the business

Additional information requests include:

1. When the business name is different on the NPI Registry or Bank Account from what is present on the IRS CP-575 letter.
2. When the therapist’s personal name is different on the NPI Registry compared to the state licensing board’s registry.

Resolution:

Keep a close eye on your email. Be sure you have the correct email in your PECOS account. Reply to any request for information as soon as possible. In some cases your MAC representative will include a phone number for you to call directly.

If you missed the communication and recieve this rejection code, you may submit the same Medicare provider enrollment application via PECOS and follow up by calling your MAC’s enrollment department.