Medicare/Medicaid certification?

[sasini01]

Good day to all,

I spoke to a headhunter about an NP position in a nursing home, and he asked me if I am "medicare/medicaid certified". I have never heard of this as a certification (usually people talk about "being familiar with medicare/medicaid regulations") - but I never worked in long-term care before... I am in NY. I googled this and all I found was that facilities need to be medicare/medicaid certified, but nothing about individuals. Any thoughts? Thanks!

[Corey Narry, MSN, RN, NP]

The National Provider Number (NPI) is the one universal number used for billing services to Medicare. However, there is also a Provider Transaction Access Number (PTAN) issued by Medicare Administrative Contractors (MAC) to a provider enrolled in Medicare or bill services rendered to Medicare beneficiaries. MAC's are private entities tasked with processing Medicare claims. The federal government awards contracts to a number of MAC's per region or jurisdiction in the US. For example, in NY, which is jurisdiction K, the National Government Services (NGS) is the MAC awarded the contract for processing Medicare A and B claims. Providers bill for services under Medicare B. You should be enrolled as a provider with NGS.

Further reading:

What are MAC's - from CMS

NPI and PTAN - from CMS

NGS website - has a link for enrolling as a provider

[sasini01]

Thanks Juan! I will look into that

[NRSKarenRN, BSN, RN]

Start here: How to apply for an NPI

Then apply for Medicare Provider enrollment = PECOS

Next apply for Medicaid provider enrollment in state you expect to practice.

Often first employer helps one to navigate this provider enrollment maze as will also need to added to each insurance plan panel too.