medicare reassignment of benefits application

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PECOS for dummies Part I: Reassigning Benefits

• by Rocky Fenton

Are you a confused or burnt-out provider? Well just be burnt-out, because we are about to give you a step-by-step guide to reassigning your benefits through PECOS! Reassigning benefits means you can start seeing Medicare patients under a new organization, and in return be reimbursed something less dismal than most of your commercial payors fee schedules. And if you are still confused – feel free to reach out to our team and we will be more than happy to assist you!

Note: you can find all this information on the Noridian website and on YouTube. I provided both links below.

Enrollment: PECOS Reassignment of Benefits through Individual Provider

Source: https://med.noridianmedicare.com/

Source Video: https://www.youtube.com/watch?v=GmwKposslao

• Log in to PECOS
• Select “My Associates”
• On the “My associates” page select “View Enrollments”
• Scroll to the “Existing Enrollments” section – Select “View/Manage Reassignments” – “Manage Reassignments”
• Select “Add a new reassignment”
• Answer if entity or individual receiving benefits is enrolled in Medicare (Yes typically)
• “Additional Changes” dialogue box should show – select “no” unless changing other information
• Select “Start Application”
• Navigate to “Reassignment” topic – Click “Begin Submission”
• “Filter Reassignment of Benefits” dialogue box should show – Select “Add Information”
• Select whether benefits will be reassigned to “Individual” or “Organization” – Select “Next Page”
• Effective Date of Information – ** cannot be more than 60 days in future from when application is received, or application will be returned
• Legal business name – should match exactly as it appears on IRS documentation
• Fill out remaining TIN and NPI information – Select “Next Page”
• Enter Medicare ID number, including all preceding numbers and letters. If it is a new organization, enter “Pending” and select next page
• “Reassignment Practice Location Choice” dialogue box should appear. Select what the primary (and secondary if necessary) practice location you intend the provider to practice. Enter the location address and continue
• Verify the information and select “Next Topic”. Or if adding multiple reassignments to multiple TINs – Select “Add information” at the top and repeat the previous steps
• “Contact Person” dialogue box should appear. Review and add any contacts. Select “Review Complete”
• Check the “Error/Warning” tab and review anything that needs attention. Click “Begin Submission” when complete
•  Signature method – If provider is completing the application select “Electronic”. If someone is working on behalf of the provider – select “E-Sign” and instructions will be sent to the provider’s email that you enter on the following prompt. Select “Next Page”
• The following page will require documentation uploaded. “Authorization Statements” will be E-Signed by the provider. Once this has been completed – select Complete Submission
• Application status can be monitored from the My Enrollments Page
• If the application is returned for correction
• 30 days are allotted for the corrections to be made
•  All signatures must be submitted for processing to begin on the application
•  Upload the required documents as a PDF or TIFF

Enrollment: PECOS Reassignment of Provider through Organizations Enrollment

Source Video: https://www.youtube.com/watch?v=x-rIn0NQRWc

• Select “View Enrollments”
• Select “View/Manage” Reassignments at the bottom of the dialogue box
• Select “Manage Reassignments”
• Select “Add reassignment of benefits where someone is reassigning benefits to the group or organization”
• “Additional Changes” dialogue box should show – select “No, I only need to make Reassignment Updates” if you do not wish to make any other changes
• Select “Start Application” and navigate to the “Reassignment” topic
• “Filter Reassignment of Benefits dialogue box will show – select “Add Information”
• “Accept Reassignment” dialogue box should show – fill out the requested information for who will be accepting reassignment
• “Medicare Identification Numbers” dialogue box should show – enter Medicare Identification Number. If the organization has more than one ID – select “Add More” and fill out the remaining IDs
• “Practice Location Address…” dialogue box should show – select the Primary location where services are rendered. This section can also be left blank
• *Note – Multiple Reassignment additions can be made on one 855B enrollment, however it is recommended to limit this to 25 reassignments to be added or deleted to decrease processing time
• “Contact Person” dialogue box should show – select “add information” and complete the main contact’s information and click “Save”
• “Enrollment Submission” dialogue box should show – Review any warning / error checks if needed. Select “Begin Submission” on the “Error/Warning Check” tab
• A Signature method prompt will appear – If the provider is signing off, select “Electronic” and select “Next Page”
• If you are the provider and are E-Signing, review the terms and conditions at the bottom and check the “Yes” box. If you are not the provider, you can enter the providers email address and instructions will be sent to them for an E-signature.
• Select the “Complete Submission” button.

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Reassignment Notice - Premium Increase

What is it.

You'll get this notice if you get Extra Help and your current Medicare drug plan premium is increasing above the amount covered by Extra Help. This BLUE notice lets you know that you'll be reassigned to a new Medicare drug plan for the coming year, unless you join a new plan on your own.

When should I get it?

Late October

Who sends it?

What should i do if i get this notice.

• Keep the notice.
• Compare plans to see which plan meets your needs.
• Change plans, if you choose, in early December.

Download a sample

" Reassignment Notice - Premium Increase [PDF, 573 KB] "

Get this notice in Spanish [PDF, 614 KB] .

Publication, product, or other number

Product No. 11209

Unofficial name

Blue notice

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Medicare and Social Security go-broke dates are pushed back in a ‘measure of good news’

FILE - Social Security Administration commissioner Martin O’Malley testifies on Capitol Hill, March 20, 2024, in Washington. The go-broke dates for Medicare and Social Security have been pushed back as an improving economy has contributed to changed projected depletion dates, according the annual Social Security and Medicare trustees report released Monday, May 6, 2024. O’Malley called the report “a measure of good news,” but said, “Congress still needs to act in order to avoid what is now forecast to be, in absence of their action, a 17% cut to people’s Social Security benefits.” (AP Photo/Mariam Zuhaib, File)

FILE - A Social Security card is displayed on Oct. 12, 2021, in Tigard, Ore. The go-broke dates for benefit programs Medicare and Social Security have been pushed back as an improving economy has contributed to changed projected depletion dates, according the annual Social Security and Medicare trustees report released Monday, May 6, 2024. (AP Photo/Jenny Kane, File)

FILE - President Joe Biden speaks about his administration’s plans to protect Social Security and Medicare and lower healthcare costs, Feb. 9, 2023, in Tampa, Fla. The go-broke dates for benefit programs Medicare and Social Security have been pushed back as an improving economy has contributed to changed projected depletion dates, according the annual Social Security and Medicare trustees report released Monday, May 6, 2024. (AP Photo/Patrick Semansky, File)

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WASHINGTON (AP) — The go-broke dates for Medicare and Social Security have been pushed back as an improving economy has contributed to changed projected depletion dates, according to the annual Social Security and Medicare trustees report Monday.

Still, officials warn that policy changes are needed lest the programs become unable to pay full benefits to retiring Americans.

Medicare’s go-broke date for its hospital insurance trust fund was pushed back five years to 2036 in the latest report, thanks in part to higher payroll tax income and lower-than-projected expenses from last year. Medicare is the federal government’s health insurance program that covers people age 65 and older and those with severe disabilities or illnesses. It covered more than 66 million people last year, with most being 65 and older.

Once the fund’s reserves become depleted, Medicare would be able to cover only 89% of costs for patients’ hospital visits, hospice care and nursing home stays or home health care that follow hospital visits.

Meanwhile, Social Security’s trust funds — which cover old age and disability recipients — will be unable to pay full benefits beginning in 2035, instead of last year’s estimate of 2034. Social Security would only be able to pay 83% of benefits.

Social Security Administration Commissioner Martin O’Malley called the report “a measure of good news,” but told The Associated Press that “Congress still needs to act in order to avoid what is now forecast to be, in absence of their action, a 17% cut to people’s Social Security benefits.”

About 71 million people — including retirees, disabled people and children — receive Social Security benefits.

President Joe Biden responded to the report by saying that “as long as I am president, I will keep strengthening Social Security and Medicare,” adding that he wants high-income taxpayers “to pay their fair share” to bolster funding for the benefit programs.

Lawmakers have for years kicked Social Security and Medicare’s troubling math to the next generation. Social Security benefits were last reformed roughly 40 years ago, when the federal government raised the eligibility age for the program from 65 to 67. The eligibility age has never changed for Medicare, with people eligible for the medical coverage when they turn 65.

Congressional Budget Office report ing has stated that the biggest drivers of debt rising in relation to GDP are increasing interest costs and spending for Medicare and Social Security. An aging population drives those numbers.

The new report projects that Medicare’s income will be higher than last year’s because the number of covered workers and average wages will be higher. The report also notes that expenses should drop. That’s due mostly to a policy change regarding how Medicare Advantage rates are accounted for and lower-than-expected spending for inpatient hospital and home health agency services.

Medicare Advantage plans are a version of the federal program run by health insurers.

A March 2023 poll by The Associated Press-NORC Center for Public Affairs Research shows that most U.S. adults are opposed to proposals that would cut into Medicare or Social Security benefits , and a majority support raising taxes on the nation’s highest earners to keep Medicare running as is.

The future of Social Security and Medicare has become a top political talking point as President Joe Biden and Republican former President Donald Trump both campaign for reelection this year.

Biden, a Democrat, has vowed to rebuff any Republican-led efforts to cut Medicare or Social Security benefits to brace for the shortfall. He’s pitched raising taxes on people making $400,000 or more a year, to shore up Medicare . He has not offered up a plan for Social Security, however.

Trump, in an interview with CNBC in March, indicated he would be open to cuts to Social Security and Medicare. The former president said “there is a lot you can do in terms of entitlements, in terms of cutting.”

Nancy Altman, president of Social Security Works, an advocacy group for the social insurance program, said Monday’s report shows that “Congress should take action sooner rather than later to ensure that Social Security can pay full benefits for generations to come.”

AARP CEO Jo Ann Jenkins said “ the stakes are simply too high to do nothing.”

Michael A. Peterson, CEO of the Peter G. Peterson Foundation, said “the longer Congress delays reform, the more challenging the options become, and these programs are too important to continue to let them drift toward insolvency. There are many solutions available to strengthen Social Security and Medicare, and it’s critical that Congress provide greater certainty and stability for the future.”

Murphy reported from Indianapolis.

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CMS Newsroom

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Reassignment

Each year CMS reassigns low income beneficiaries from PDPs that are going above the regional LIS benchmark (and did not, or could, not waive a de minimis amount of premium above the benchmark), and from PDPs and MA plans that are terminating (which includes MA plans that are reducing their service areas).  These beneficiaries are reassigned into a PDP that is below the regional LIS benchmark.  CMS does not reassign beneficiaries that are LIS eligible with 100% premium subsidy and have voluntarily elected a plan, otherwise referred to as “choosers”, unless the plan in which the beneficiary is  enrolled is terminating or reducing its service area and the beneficiary would be left with no Part D coverage.  The link below sets out the counts of beneficiaries reassigned by reason (i.e.  premium increase, plan termination), by region and by effected PDP sponsor.    

Each year before CMS processes reassignments, it sends to plans via the Health Plan Management Systems memorandums reiterating the parameters of reassignment, providing updates that will affect reassignment for a given year, and providing key dates to plans so that they will know what to expect.  One memorandum relates to the annual PDP reassignment, which affects PDPs going above the regional LIS benchmark and terminating PDPs.  The other memorandum is the annual MA reassignment, which relates to terminating MA plans, and MA plans reducing their service areas.  Below is a list of these memorandums beginning with the 2016 reassignments for effective dates of January 1, 2017.  Each year thereafter we will add the current year's memorandums.   

For a complete list of previous years Reassignment data please visit the bottom of the Limited Income Resources page.

2023 MA Reassignment for Jan 2024 (PDF)

2023 PDP Reassignment for Jan 2024 (PDF)

2022 PDP Reassignment for January 2023 (XLSX)

2022 MA Reassignment for January 2023 (XLSX)

2021 PDP Reassignment for Jan 2022 (PDF)

2021 MA Reassignment for Jan 2022 (PDF)

2020 PDP Reassignment for Jan 2021 (XLSX)

2020 MA Reassignment for Jan 2021 (XLSX)

2019 PDP Reassignment for Jan 2020 (XLSX)

2019 MA Reassignment for Jan 2020 (XLSX)

2018 PDP Reassignment for Jan 2019 (XLSX)

2018 MA Reassignment for Jan 2019 (XLSX)

2017 PDP Reassignment for Jan 2018 (XLSX)

2017 MA Reassignment Memo (PDF)

2017 MA Reassignment for Jan 2018 (XLSX)

2017 PDP Reassignment Memo (PDF)

2016 MA Reassignment for Jan 2017 (XLSX)

2016 PDP Reassignment for Jan 2017 (XLSX)

2016 MA Reassignment Memo (PDF)

2016 PDP Reassignment Memo (PDF)