Medicare Provider Enrollment

Below, you will find information for RDNs about the benefits of becoming an Medicare provider and how to enroll in Medicare. If you are looking for information about Medicare billing, please refer to the Academy's pages "Providing the Service and Billing Under Medicare" and "Medicare MNT." Visit the Centers for Medicare and Medicaid Services website for the latest Medicare related news.

Topics Covered on this Page
Reasons for RDNs to Enroll as Medicare Providers
Enroll in Medicare Online
Enroll in Medicare by Mail

Reasons for RDNs to Enroll as Medicare Providers

  • Participating in Medicare is simpler than you think: While Medicare rules and regulations may appear complicated, they actually are more “black and white” than those of private payers and are consistent no matter the state in which you practice. So it is very easy to know what CPT codes to use for billing, what diagnoses are covered, how many hours of coverage are available per year, and how much you will get paid.
  • You can help those in need. While utilization of Medicare MNT services is growing, unfortunately, less than 1% of Medicare beneficiaries who are eligible for MNT services generally receive them (based on 2013 data). By becoming a Medicare provider and marketing your services to referring physicians, you can make a significant difference in the health of this large and needy population.
  • Seize a huge business opportunity. There are over 31 million Medicare beneficiaries and this number continues to grow as the baby boomers age. Twenty-eight percent of these beneficiaries have diabetes and 17% have chronic kidney disease. So this population represents a huge potential market of clients for MNT services.
  • Why turn away business? If you don’t enroll as a Medicare provider, then you cannot provide MNT services to these individuals unless you formally “opt out” of the Medicare program. Otherwise, you need to turn away the business and send the patients to another RDN who is a Medicare provider.
  • You help pave the way for expanded coverage: Increasing the pool of RDN Medicare providers paves the way for expansion of MNT coverage by both public and private payers. We need to show CMS that there is an adequate pool of RDN providers to support expansion of the Medicare MNT benefit beyond diabetes and renal disease. We also need to increase utilization of the current benefit to support expansion efforts. When RDNs don’t seize existing opportunities for coverage of MNT services, it becomes difficult to convince payers that more coverage is needed. And private payers frequently follow the lead set by Medicare when establishing their coverage policies.
  • Translate your value into dollars. As health care payment moves further towards a pay-for-performance model, opportunities exist for you to demonstrate your value to patients, health care providers, health care administrators and payers by providing MNT services to Medicare patients. MNT services provided by RDNs to patients with diabetes has been proven to improve clinical outcomes and decrease overall costs of care. In the new world of payment, those results translate into dollars for providers and the health care practices with whom they work. Working with the Medicare population can help RDNs secure a role for themselves as a valuable member of the interdisciplinary, patient-centered health care team.

Fill Out a Medicare Provider Application Online

You can apply directly on the CMS website through the Internet-based Provider Enrollment, Chain and Ownership System.

Additional PECOS and Online Medicare Provider Application Resources from CMS:

Send Your Medicare Provider Application by Mail

If you prefer to send in your application by mail instead of online, you can download applications and mail your completed form to a Medicare Administrative Contractor in your state. You can download PDF versions of the applications below:

Note: Depending on your practice setting and employment relationship, you may have as few as one form to complete (CMS 855I), or more than three forms to complete (CMS 855B, CMS 855I, and a CMS 855R form for each employer whom you may reassign your benefits). For example, if a group of RDs form together as a practice, and the practice has not previously qualified for Medicare Part B services, the CMS 855B form may be required, in addition to the CMS 855I and CMS 855R.

  • Medicare Advantage

    Medicare Advantage Plans, sometimes called Medicare Part C, Medicare+Choice Plans or MA Plans, are health coverage plans offered by private insurance companies or managed care organizations that contract with Medicare to provide Medicare Part A and B benefits to Medicare beneficiaries.