Maine Medicare Provider Bond: A Comprehensive Guide

January 11, 2022

Maine Medicare Provider Bond

This guide provides information for insurance agents to help their customers obtain a Maine Medicare Provider bond

At a Glance:

  • Average Cost: Between 0.75% to 5% of the bond amount per year based on the applicant’s credit
  • Bond Amount: Determined on a case by case basis (more on this later)
  • Who Needs it: All Maine home health agencies (HHAs) and durable medical equipment (DME) providers that are enrolled with Medicare
  • Purpose: To ensure that MaineCare will receive compensation for financial harm if they overpay Medicare payments
  • Who Regulates Medicare Providers in Maine: The Office of MaineCare Services

Background

Maine requires all Medicare providers operating in the state to enroll with the Office of MaineCare Services. Maine enacted the enrollment requirement to both ensure that eligible providers receive compensation for services provided that are covered by Medicare and that they do not engage in unethical business practices. To ensure that the Office of MaineCare Services does not suffer financial harm for overpayments, HHAs and DME providers must purchase and maintain a surety bond to be eligible for enrollment.

What is the Purpose of the Maine Medicare Provider Bond?

Maine requires HHAs and DME providers to purchase a surety bond as part of the application process to enroll as a Medicare provider. The bond ensures that the public will receive compensation for financial harm if the HHA or DME provider violates the terms of the bond. Specifically, the bond protects the Office of MaineCare Services if the provider fails to refund any Medicare overpayments. In short, the bond is a type of insurance that protects the Office of MaineCare Services if the provider does not return overpayments received for services covered by Medicare.

Maine Medicare Provider Bond Form

Maine Medicare Provider Bond Form

How Can an Insurance Agent Obtain a Maine Medicare Provider Surety Bond?

BondExchange makes obtaining a Maine Medicare Provider surety bond easy. Simply log in to your account and use our keyword search to find the “Medicare provider” bond in our database. Don’t have a login? Enroll now and let us help you satisfy your customers’ needs. Our friendly underwriting staff is available by phone at (800) 438-1162, email, or chat from 7:30 AM to 7:00 PM EST to assist you.

At BondExchange, our 40 years of experience, leading technology, and access to markets ensures that we have the knowledge and resources to provide your clients with fast and friendly service whether obtaining quotes or issuing bonds.

How is the Bond Amount Determined?

The Maine Office of Medicare Services has different bonding requirements for HHAs and DME providers, as outlined below:

  • HHA providers: $50,000 or 15% of the total Medicare payments received in the previous fiscal year, whichever is greater
  • DME providers: $50,000 per National Provider Identifier (NPI). An additional $50,000 bond is required for each adverse legal action occurring within the past ten years.

Is a Credit Check Required for the Maine Medicare Provider Bond?

Surety companies will run a credit check on the owners of the HHA or DME provider to determine eligibility and pricing for the Maine Medicare Provider bond. Owners with excellent credit and work experience can expect to receive the best rates. Owners with poor credit may be declined by some surety companies or pay higher rates. The credit check is a “soft hit”, meaning that the credit check will not affect the owner’s credit.

How Much Does the Maine Medicare Provider Bond Cost?

The Maine Medicare Provider bond can cost anywhere between 0.75% to 5% of the bond amount per year. Insurance companies determine the rate based on a number of factors including your customer’s credit score and experience. The chart below offers a quick reference for the bond cost on a $50,000 bond requirement.

$50,000 Medicare Provider Bond Cost

Credit Score Bond Cost (1 year)
800+ $375
625 – 799 $500
600 – 624 $1,250
575 – 599 $1,500
500 – 574 $2,500

*The credit score ranges do not include other factors that may result in a change to the annual premium offered to your customers, including but not limited to, years of experience and underlying credit factors contained within the business owner’s credit report.

Who is Required to Purchase the Bond?

Maine requires all home health agencies and durable medical equipment providers to purchase a surety bond prior to enrolling as a Medicare provider.

To paraphrase Maine statute 2320, a home health agency is an agency that meets all of the following criteria:

  • Is licensed or certified to provide skilled nursing or other therapeutic services
  • Has standards and rules established by a professional group, associated with the agency, that includes at least one physician and one registered nurse
  • Is available to provide home health care services 7 days a week and has a phone answering service available 24 hours a day
  • Provides the services of a coordinator that is responsible for case discovery, planning, and assuring that patients receive the services ordered by a physician
  • Contracts the services of a physician or physician-advisor licensed by the state
  • Holds periodic case conferences for the purpose of individualized patient care planning and utilization review
  • Maintains complete medical records on each patient

The MaineCare benefits manual defines a durable medical equipment provider as any individual or business that provides medical equipment that:

  • Can sustain repeated use
  • Is primarily used to serve a medical purpose
  • Is not generally useful in the absence of illness or injury
  • Is able to be used in an individual’s home or residence

How Do Maine HHA and DME Providers Enroll With Medicare?

Medicare providers in Maine must navigate several steps to secure their enrollment. Below are the general guidelines, but providers should refer to the enrollment guide for details on the process.

Enrollment Period – HHA and DME providers must revalidate their enrollment every three years or at the request of the Office of MaineCare Service

Step 1 – Determine the Enrollment Type

Maine requires Medicare providers to obtain specific enrollments based on the nature of their business and the applicant’s role within the organization. Below are the different Maine Medicare provider enrollment types:

    • Individual provider: Owns and operates their own practice and provides health care services under their own Social Security Number (SSN) and a Type 1 Individual NPI
    • Incorporated Individual Provider: Is considered to be a provider group and must obtain both a Type 1 Individual and Type 2 Organizational NPI
    • Provider group: Collective group of individual practitioners providing health care services. There are two different provider subgroups:
      • Groups that operate under a Federal Employer Identification Number (FEIN) and a Type 2 Organizational NPI
      • A sole proprietor that operates as a group under the SSN of the sole proprietor. The individual practitioners operate under a Type 1 Individual NPI
    • FOA provider: Entity that provides healthcare services. Can operate under a Type 1 Individual or Type 2 Organizational NPI
    • Out of State Provider: Located in any state other than Maine
    • Non-billing, Ordering, or Prescribing provider: Must enroll to prior to providing services to MaineCare members
    • Managing Employee: Individual who exercises operational or managerial control over the supplier or provider

Step 2 – Register as a Trading Partner

Providers must register as a trading partner through the MaineCare Health PAS Online Portal. The enrollment application is located in the provider’s trading partner account, and registering through the online portal allows providers to complete the application. Providers can register here and are encouraged to utilize the trading partner guide for assistance in setting up their account.

Step 3 – Complete the Application

After registering as a trading partner, providers are able to sign in to their account and complete the enrollment application. Providers must complete the application in its entirety and should refer to the enrollment guide for help navigating the process.

Step 4 – Purchase a Surety Bond

HHA and DME providers must purchase and maintain a surety bond (see above for limits)

How do Maine Medicare Providers Revalidate Their Enrollment?

Medicare providers can revalidate their enrollment online through their trading partner account. HHA and DME providers must revalidate their enrollment every three years or at the request of the Office of MaineCare Service.

What are the Insurance Requirements for Medicare Providers in Maine?

Maine does not require Medicare providers to purchase any form of liability insurance as a prerequisite to enrollment. HHA and DME providers must purchase and maintain a surety bond (see above for limits).

How Do Maine Medicare Providers File Their Bond?

Medicare providers should mail their completed bond form, including the power of attorney, to the following address:

MaineCare Provider Enrollment
PO Box 1024
Augusta, ME 04332-1024

The surety bond requires signatures from both the surety company that issues the bond and from a representative of the provider. The surety company should include the following information on the bond form:

  • Legal name and address of entity/individual(s) buying the bond
  • Surety company’s name and state of incorporation
  • Obligee’s name
  • Bond amount
  • Date the bond goes into effect
  • Date the bond is signed

What Can Maine Medicare Providers Do to Avoid Claims Against Their Bond?

To avoid claims on their bond, HHA and DME providers must ensure that they refund all overpayments to the Office of MaineCare Services.

What Other Insurance Products Can Agents Offer Medicare Providers in Maine?

Maine does not require HHA and DME providers to purchase any form of liability insurance as a prerequisite to enrolling as a Medicare provider. However, most reputable businesses will seek to obtain this insurance anyway. Bonds are our only business at BondExchange, so we do not issue any other types of insurance, but our agents often utilize brokers for this specific line of business. A list of brokers in this space can be found here.

How Can Insurance Agents Prospect for Maine Medicare Provider Customers?

Maine conveniently provides a public database to search for active Medicare providers in the state. The database can be accessed here. Contact BondExchange for additional marketing resources. Agents can also leverage our print-mail relationships for discounted mailing services.

2022-03-10T16:22:13-05:00