Provider Enrollment - FAQ's
Below are some of the most common questions. We hope this is helpful. If you can not find the answer that you are looking for contact Provider Enrollment.
Frequently Asked Questions
Q. How does an agency obtain a Provider Number?
A. The first step is to obtain certification from Medicare, JCAHO, or CHAP. Once you have obtained certification you should contact the Provider Enrollment Department in your Region to assist you in the application process.
Q. How do I contact Medicare, JCAHO, or CHAP to find out how to become Certified?
A. You can go to the particular website to find out the requirements and steps that you should follow.
Medicare: www.cms.hhs.gov/home/medicare.asp
JCAHO: www.jointcommission.org
CHAP: www.chapinc.org/chap-consumer.htm
Q. How do I find a consumer?
A. Some Non-Agency Providers find a consumer through word of mouth, through a friend, neighbor, etc. You can visit the CareStar web site for providers. Click on “Request for Services.” Here, Case Managers post consumers who need a provider. You can read about the services needed. If you are interested in this posting you should contact the Case Manager for more information.
Q. What do I need to do to get my Non-Agency Personal Care Aide number?
A. You will need to submit the following things to the Provider Enrollment Department in your region. A copy of your Social Security Card, a copy of a current government issued ID with your name, photo, current address, and expiration date on it, a copy of your STNA or HHA certification or other equivalent training completed in the last 24 months, a copy of your current First Aide Certification, and a letter of referral from an Ohio Home Health Care, Transitions MRDD, or Transitions Carve-Out Waiver Consumer who wants you to be their provider.
Q. Does an RN or LPN need to have a consumer referral letter before they apply for a Provider Number?
A. No. An RN or LPN does not need to have a consumer referral letter.
Q. What is the difference between an RN’s and an LPN’s function?
A. An RN has more training and has specialized knowledge, judgment, and skill in the biological, physical, behavioral, social, and nursing sciences. The LPN has basic knowledge in these areas. According to Ohio Law and the Ohio Board of Nursing an LPN may provide nursing care only at the direction of a physician or a registered nurse.
Q. How do I get an RN Supervisor?
A. The RN supervisor can be any RN that you know and who is willing to act as your Supervisor.
Q. What are the duties of an RN Supervisor?
A. The RN Supervisor is responsible for observing and evaluating the LPN’s performance and the assessment of the consumer including the consumer’s response to nursing interventions.
Q. Must an RN Supervisor also be an RN Provider?
A. No, an RN Supervisor does not need to have a Medicaid Provider Number, but must have an active nursing license.
Q. Does the RN Supervisor get paid for this duty?
A. The RN may or may not be paid by the LPN that he/she is supervising. This is worked out between the RN and the LPN.
Q. Where do I get the forms so I can bill for services?
A. You can obtain forms on the internet by going to the CareStar website.
1. In the upper Right hand corner under “Find It Fast” click on Ohio HomeCare Information.
2. Click on Provider Information.
3. Next click on Provider Compliance Monitoring.
4. Click on Ohio Administrative Code.
5. On the left hand side, scroll down to Billing Instructions.
6. Go to Bin 1002 and highlight HCFA 1500 Claim Form. You can download this form and save it to your documents. Or if you use a billing agency, you can obtain forms from that Agency.
Q. Who do I call to get my 1099?
A. This is provided by the State. You should call Toll Free- 614-466-6742
(Providers are not employees ot the State. They are self-employed.
Providers receive 1099's not W'2)
Q. How do I submit a bill?
A. Submit all claims to: Ohio Department of Human Services, P.O. Box 2644, Columbus, Ohio 43266. DO NOT FOLD THE CLAIM FORM.
Q. I was a Non-Agency RN Aide and I am now an RN. What do I need to do to work as an RN?
A. You will need to contact the Provider Enrollment Department in your Region to request another provider application to become an RN Provider.
Q. What is a “485”?
A “485” is a form used by Medicare Certified Agencies to document the Plan of Care for their patients. This is the Plan of Care which is submitted to and signed by the physician. Medicaid or CareStar does not have a Plan of Care Form as such but a Plan of Care must be written by the RN on the case to be followed by the caregivers for that consumer.
Q. Where do I get a “485”?
A. Neither Medicaid nor CareStar has a Plan of Care form as such. You are allowed to write your own plan of care. This must be signed by the Consumer’s physician and followed by the caregivers.
Q. Is there a special documentation form?
A. You can use a spiral note pad or a form which you have created on your computer. An Example of a documentation sheet is included with our application packet.
Q. What is needed, a state background check or a federal background check?
A. If you have lived in Ohio for the last five (5) years you only need a State Background check. If you have NOT lived in Ohio for the last five (5) years, you will need to get BOTH a State background check and also a Federal background check.
|
