In 1965, the Social Security Act established the Medicare and Medicaid Programs. Medicare is a federal health insurance program that provides coverage to over 55 million Americans including:
- People age 65 or older
- Some people under age 65 with disabilities
- People with End-Stage Renal Disease (ESRD)
Medicare coverage is divided into coverage got hospitalization (Part A), outpatient services (Part B), and prescription drugs (Part D). Most services provided by advanced practice nurses, physician assistants, and physicians are reimbursed under Part B. For information on Medicare Part A and Part B, visit the CMS Website.
Applying for a Medicare Provider Number
The Center for Medicare and Medicaid Services (CMS) is the federal agency that administers the Medicare Program. CMS contracts with various Medicare Administrative Contractors (MACs), sometimes referred to as regional intermediaries or Medicare carriers, to process claims and handle provider relations.
Novitas Solutions is the carrier for Texas and several other states. Therefore, Novitas Solutions processes Medicare provider applications and answer any questions for health care providers in Texas. Refer to the CMS Map to find the MAC for other states.
Enrolling online is the most efficient way to become a Medicare provider. The first step, however, is applying for a National Provider Identifier (NPI) Program. Read “The NPI: What You Need to Know.” Once providers have an NPI, they may proceed to applying for a Medicare number through their state’s MAC. To apply in Texas, go to Novitas Enrollment.
Medicare Reimbursement Resources
For information on “Incident to Services,” see Carolyn Buppert’s article titled “Billing ‘Incident To’ When an Established Patient Has a New Problem,” and the MLN Matters article #SE0441 title “Incident to Services.”
The Henry J. Kaiser Family Foundation. (2015). Total number of Medicare beneficiaries. Retrieved from http://kff.org/medicare/state-indicator/total-medicare-beneficiaries/