Medicare Revalidation for Ambulance

Ambulance Provider Enrollment and Revalidation: Medicare Part B

Ambulance companies must “enroll” with Medicare (and other payers) before their claims will be paid. Unfortunately, the enrollment process is filled with hidden challenges and delays, which will impact cash flow. Of course this issue does not go away after the initial enrollment is done. Provider enrollment must be “re-validated” at least once every five years, once again exposing the provider’s cash flow to a variety of risk factors. Contact PMC for assistance with your ambulance provider enrollment project…1-800-635-7577

Medicare Provider Enrollment for Ambulance Companies

Current Clients: Save time and protect your cash flow by reviewing the following information carefully. We will need certain documents so that we can build your enrollment application. Remember, if you have been asked to “revalidate” your company’s Medicare enrollment, time to respond is limited.

Getting Started

Whether you are enrolling for the first time or you are facing a revalidation, PMC is ready to assist. We have been helping EMS and ambulance providers with this task for over twenty years. The following items will be needed from your office before we can assemble your enrollment / revalidation application.

Ambulance 855B – Section 6

“Section 6” of the Medicare 855B requests personal information concerning a provider’s leadership personnel. We will need the provider to assemble this information since we do not have it on file. The download link above can be used to print a copy of “section 6”. This section should be filled out for each member of a Board of Directors, each owner (5% or more ownership) and all managing employees. “Managing employees” are individuals who are in a position such as CEO, CFO, Director, General Manager, Chief, Captain, etc. If your agency is operated directly by a municipality, city, town or county government, it is not necessary to include a section 6 for council members, county commissioners or county supervisors. We will only need a copy of “section 6” for individual(s) actively engaged in day to day management of the service. This usually includes the “Town or City Manager”, “Rescue Captain” or “Chief”. The Medicare enrollment & revalidation application will require at least one signature from an “Authorized Official. Most providers include a second “delegated official” for the purpose of business continuity. Include a “Section 6” for any individual who will serve as a signing Authorized or Delegated Official. 
*We are seeking clarification from our local Medicare carrier in reference to West Virginia  “Ambulance Authority Board” members, until we learn more, these board members should all complete a “Section 6”.
Feel free to contact Keith Waycaster directly for assistance at 304-575-2866.

Ambulance 855b – Section 14 & 15

The next form we need is what is called “Section 15 – Signatures”.  This part of the overall 855B form has places for two types of individuals to sign. One is the “Authorized Official” the other is the “Delegated Official”. The Authorized Official is usually the organization’s President, CEO, Chairman of the Board, City Manager, Etc. The Delegated Official is usually the Operation’s Director, Captain or Chief. Anyone who signs as an authorized or delegated official, must have a “Section 6” completed for them as well.  It is recommended that you have two Authorized Officials or at least one Delegated Official listed and signing this section. If Medicare ever contacts you directly, they will only work with one of these people. You can have up to four individuals in these roles. When the Delegated Official signs the application in this section, the Authorized Official must counter sign their signature.

Ambulance 588 – Direct Deposit Authorization

This form is used to update your bank account information for Medicare’s Direct Deposit of your payments. This form is required, paper checks are no longer available from Medicare Part B. The 588-EFT form must be signed by either the Authorized or the Delegated Official that signs section 15 above.  Attach a voided check for the account you want to use to receive Medicare deposits.

These items are also required….

  • DMV Registration cards for each ambulance
  • Proof of Insurance for each ambulance
  • Proof of Insurance on the Organization as a whole (Professional Liability Coverage)
  • Most recent EMS Agency License from your state’s Office of EMS
  • Proof of recognition by the IRS as a 501 C3 corporation, if applicable. (Govt Entities Excluded)
  • Something that shows the date of incorporation of the business, this can be the organizations articles of incorporation or the receipt from the Secretary of State’s Office issued after the Articles were filed. For Government entities such as Towns Cities and Counties, we just need to know the date when the organization was chartered.
  • Governmental Entities – Financial Resposnsibility Statement
  • IRS Letter # CP-575 or the IRS’ replacement (IRS Form 147C) (See note below)
Note:  When you applied originally for an FEIN (Tax ID number) with the IRS, the letter they sent you back, awarding the Tax ID # was a letter called a “CP-575”. That is what Medicare wants to see.  If it is not available to you and your accountant does not have it on file, a replacement letter can be obtained by calling the IRS and asking for a replacement letter, the replacement letter is called “IRS Form #147C”. You can call the IRS Business Helpline at 1-800-829-4933, between 7AM and 7PM, Monday – Friday.  If you can answer their screening questions when you call, they will usually fax this letter to your office directly which will save us the week or more it takes to have it mailed to you. We would do this for you but the IRS does not allow outside parties to request these letters.
  • One original / voided check for use with the EFT application
  • A check made out to the “US Center for Medicare & Medicaid Services” (CMS).  If paid in the year 2013, the amount will be $532.00.
 Some of these documents and forms will no doubt raise questions…this page is designed to help you get started. We are ready to assist you in any way possible.