How Do I Elect Method II Reimbursement?

To be reimbursed under Method II, a CAH must file a written election with the fiscal intermediary/MAC at least 30 days before the start of the cost reporting period to which the election applies. Newly certified CAH's must make this election within a reasonable time frame after initial certification to a CAH status.

The request letter for Method II must include:

  1. The provider name, provider number and the cost reporting period of the CAH
  2. Practitioner's name, billing number and services for which billing rights are reassigned.
  3. A statement of how the CAH intends to bill additional physicians who are added during the year. For example, the CAH should specify if it intends to bill the Part B carrier or the fiscal intermediary/MAC for the new physicians. If it intends to bill the fiscal intermediary/MAC, the CAH will need to submit copies of the CMS-855R to the Part A fiscal intermediary/MAC upon the addition of the new physicians.

Requests can be sent to:

Overnight Mail:
WPS Medicare
Attn: Tabetha Smith,
Audit Supervisor
3333 Farnam Street
Omaha, NE 68131
Regular Mail:
WPS Medicare
Attn: Tabetha Smith,
Audit Supervisor
P.O. Box 8310
Omaha, NE 68108

Once the facility's documentation is reviewed, the facility's provider specific file in the Fiscal Intermediary Shared System (FISS) will be updated and a confirmation letter of the facility's Method II election will be sent to the facility's designee. After a CAH is designated for Method II reimbursement, all physician professional fees billed will be reimbursed 115% of the Medicare fee schedule amounts. For any new physicians to be added during the cost reporting period, the provider will submit a CMS-855R for each new physician to the Part A FI/MAC. The CMS-855R will be retained for documentation purposes by the FI/MAC. It should be noted that respondent correspondence related to Method II reimbursement is sent only for initial application and at annual re-election. No additional correspondence is generated for new physicians added during the course of the year after re-election has been made.

Once the election is approved, the election must remain in effect for the entire cost reporting period of the CAH.

Page Last Updated: Thursday, 15-Dec-2011 14:39:05 CST