Question 1

What is revenue cycle management in healthcare?

Accepted Answer

Revenue cycle management is the end-to-end financial process of a healthcare encounter, from confirming a patient's insurance coverage before the visit through coding the encounter, submitting the claim, posting payment, and resolving any balance that remains. Each stage depends on the one before it: a claim cannot be paid correctly if eligibility was never verified or the service was never authorized.

Question 2

What RCM services does Niyutsa Technologies provide?

Accepted Answer

We provide eligibility verification and prior authorization, medical billing and coding, accounts receivable follow-up and denial management, and certified CPT coding. These can be engaged individually or as a complete revenue cycle service alongside our existing provider credentialing and payer enrollment work.

Question 3

How does credentialing affect medical billing?

Accepted Answer

A provider who is not credentialed and enrolled with a payer generally cannot be reimbursed by that payer, and claims submitted before enrollment is effective are commonly denied. Because Niyutsa Technologies handles both credentialing and billing, enrollment gaps are visible as a cause of denials rather than being rediscovered months later in aged receivable.

Question 4

Can we use billing services without credentialing services?

Accepted Answer

Yes. The billing and RCM services are available independently. Practices already credentialed with their payers frequently engage only the billing, coding, or accounts receivable services.

Question 5

Do you work inside our existing practice management system?

Accepted Answer

Yes. We work within the practice management and EHR systems clients already use, so charges, payments, and authorization records live in your system of record rather than in a separate platform you would have to reconcile.

Question 6

How is patient health information protected?

Accepted Answer

Protected health information is handled under HIPAA requirements, including a Business Associate Agreement with each client practice, access limited to staff assigned to that client's work, and secure channels for transferring documentation.

Question 7

What does Pecos Enrollment include?

Accepted Answer

Pecos Enrollment covers the complete preparation, submission, and follow-through required for this specific credentialing function — from initial document collection through final payer approval and effective-date confirmation. Our team manages every step so nothing is left for the provider or practice to track manually.

Question 8

How long does Pecos Enrollment take to complete?

Accepted Answer

Timelines vary by payer and provider type, but most engagements involving pecos enrollment reach completion in 60 to 120 days. We provide a specific timeline estimate during intake based on your exact payer mix and current credentialing status.

Question 9

Is Pecos Enrollment included in Niyutsa Technologies' standard credentialing engagement?

Accepted Answer

Pecos Enrollment is available as part of our standard credentialing service and can also be engaged on its own for practices that need this specific function addressed. Contact us for a scope-specific quote based on your current situation.

Question 10

Who handles Pecos Enrollment at Niyutsa Technologies?

Accepted Answer

Pecos Enrollment is managed by our dedicated credentialing specialists who handle this function daily across hundreds of provider engagements, ensuring consistent, accurate submissions and fast turnaround on any payer follow-up requests.

Question 11

What is the difference between PECOS and NPPES?

Accepted Answer

PECOS (Provider Enrollment, Chain, and Ownership System) is used to enroll in Medicare. NPPES (National Plan and Provider Enumeration System) is used to obtain and manage an NPI number. Every Medicare provider needs both — an NPI first, then a PECOS enrollment. NPPES is administered by CMS separately from PECOS and has its own login credentials.

Question 12

Can I file a PECOS application on paper instead of online?

Accepted Answer

Paper CMS-855 forms can still be filed by mail, but processing times for paper applications are significantly longer than for PECOS online submissions — typically 90 to 120 days versus 60 to 90 days for PECOS. Paper filings also have higher error rates because they lack the built-in validation of the online system. We recommend PECOS online for all applications where possible.

Question 13

How do I know when my PECOS application was approved?

Accepted Answer

CMS notifies providers of PECOS approval through the PECOS system itself and by mailed letter to the correspondence address on file. We monitor application status daily and notify you immediately when your PTAN is issued, so you do not have to wait for the mailed confirmation to begin billing preparation.

Question 14

What happens if I do not respond to a PECOS development letter?

Accepted Answer

MAC development letters carry a 30-day response window. If you do not respond within 30 days, the MAC will deny the application and you must restart the enrollment from the beginning. This is why our same-business-day response practice is critical — we ensure development letters never lapse.

Question 15

How do I add a new practice location to my PECOS enrollment?

Accepted Answer

Adding a new practice location requires a PECOS update through a change of information filing. Failure to update PECOS when practice locations change causes Medicare claims for services at the unregistered location to be denied. We handle location changes and other PECOS updates as part of our ongoing maintenance program.

Question 16

How do I get credentialed with Medicare?

Accepted Answer

Getting credentialed with Medicare requires a complete CAQH ProView profile (for payers that use CAQH), a formal application submitted through Medicare's provider enrollment process, and verification of your license, board certification, malpractice history, and work history. Niyutsa Technologies manages this entire process, including any Medicare-specific application requirements.

Question 17

How long does Medicare credentialing take?

Accepted Answer

Medicare credentialing typically takes 45 to 120 days from application submission to approval, depending on current processing volume and whether your CAQH profile is complete and attested at the time of submission. We track every Medicare application and follow up proactively rather than waiting for status inquiries.

Question 18

Is Medicare's panel currently open to new providers?

Accepted Answer

Panel status with Medicare varies by specialty and geographic market and can change without public notice. We verify current panel status for Medicare as part of every credentialing engagement, and where a panel is closed, we prepare a formal panel reopening request documenting patient access needs.

Question 19

Does Niyutsa Technologies handle Medicare re-credentialing as well as initial enrollment?

Accepted Answer

Yes. We manage ongoing Medicare re-credentialing on the standard cycle Medicare requires, along with CAQH attestation, demographic updates, and any development letters Medicare issues during the recredentialing review.

Question 20

What is the difference between Medicare fee-for-service and Medicare Advantage credentialing?

Accepted Answer

Medicare fee-for-service (Traditional Medicare) enrollment is through PECOS and administered by CMS. It covers all fee-for-service claims from enrolled providers. Medicare Advantage plans are operated by private insurers who contract with CMS to offer Medicare benefits — each plan requires its own separate credentialing application. Enrolling in fee-for-service Medicare does not make you in-network with any Medicare Advantage plan, and vice versa.

Question 21

How do I apply for a Medicare provider number?

Accepted Answer

Medicare provider enrollment is completed through the PECOS online system at pecos.cms.hhs.gov. The application type depends on your provider category — individual physicians use Form 855I, group practices use Form 855B, and reassignment of benefits is handled through Form 855R or the equivalent PECOS electronic process. We manage the entire PECOS application on your behalf, including identity proofing and electronic signature coordination.

Question 22

What is a Medicare opt-out affidavit and who should consider it?

Accepted Answer

A Medicare opt-out affidavit is a formal declaration that a physician or practitioner has chosen to be excluded from Medicare. Opted-out providers can enter private contracts with Medicare beneficiaries for services that Medicare would otherwise cover, outside the standard Medicare payment system. Opt-out is typically considered by concierge or direct primary care physicians, certain psychiatrists, and providers who prefer not to be bound by Medicare's fee schedule. Opt-out must be renewed every 2 years.

Question 23

What triggers a Medicare revalidation and how long does it take?

Accepted Answer

CMS requires all enrolled providers to complete revalidation on a cycle of 3 to 5 years depending on provider type. CMS notifies providers of upcoming revalidation deadlines approximately 6 months in advance through the PECOS system and by mail to the correspondence address on file. Revalidation processing time is similar to initial enrollment — 60 to 90 days. We monitor revalidation deadlines for all active clients and begin the process 120 days before the deadline to ensure continuous enrollment.

Question 24

Can Medicare enrollment be transferred when a provider moves to a new practice?

Accepted Answer

Medicare enrollment is provider-specific, not practice-specific, so the provider's enrollment follows them. However, when a provider changes practices, several PECOS updates are required: updating the practice location and billing entity, filing new reassignment of benefits with the new group, and removing reassignment from the prior group. These changes must be filed promptly to ensure claims from the new practice location route correctly and prior-practice claims close properly.

Question 25

What is PECOS and how do I use it?

Accepted Answer

PECOS (Provider Enrollment, Chain, and Ownership System) is the CMS online portal for Medicare enrollment applications. It replaces paper Form 855 for most provider types and provides real-time validation, status tracking, and electronic signature capabilities. We manage the entire PECOS application process on your behalf.

Question 26

How long does Medicare enrollment take?

Accepted Answer

Medicare enrollment through PECOS typically takes 60 to 90 days from application submission to PTAN issuance. Processing speed depends on the regional MAC jurisdiction, application completeness, and whether development letters are issued. Our same-day development letter response keeps timelines at the shorter end.

Question 27

What is a PTAN and when will I receive it?

Accepted Answer

A PTAN (Provider Transaction Access Number) is your unique Medicare billing identifier issued after enrollment approval. PTANs are issued by your regional MAC and confirmed via the PECOS system. You receive your PTAN at the end of the enrollment process, typically 60 to 90 days after application submission.

Question 28

Can I bill Medicare before enrollment is complete?

Accepted Answer

Generally no. CMS does not allow retroactive billing for services rendered before the Medicare enrollment effective date in most circumstances. Starting the PECOS application 90 to 120 days before a provider start date is the most effective way to avoid billing gaps.

Question 29

What happens during Medicare revalidation?

Accepted Answer

CMS requires all enrolled providers to revalidate enrollment every 3 to 5 years. Revalidation confirms your credentials and practice information remain current. Missing a revalidation deadline results in automatic deactivation of billing privileges with no retroactive billing allowed during the deactivation period.

Complete RCM and Medical Billing Services

Four services, one revenue cycle

Eligibility Verification & Prior Authorization

Medical Billing and Coding

Accounts Receivable (AR) Management

CPT Certified Medical Coding

Billing problems usually start before the claim

Medical billing and RCM questions answered

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