Author: Dawn Anderson, PESC, CPMSM, Senior Consultant, VerityStream
The Center for Medicare and Medicaid Services (CMS) held their first annual National Provider Enrollment Workshop in Charleston, South Carolina September 6 and 7. Palmetto GBA hosted the conference where every Medicare Administrative Contractor (MAC) was present to assist attendees with any issues they were having with provider enrollment. This conference was well attended with 538 people registered to attend. (Editor’s Note: The following two individuals from Echo/Morrisey Client Success Services/Consulting attended this conference: Dawn Anderson, PESC, CPMSM who authored this article and Meghan Kurtz, CPCS)
The conference opened with a welcome from Zabeen Chong, Director of Provider Enrollment and Oversight Group for CMS and Charles Schalm, Deputy Director of Provider Enrollment and Oversight Group for CMS. Ms. Chong and Mr. Schalm discussed the conference format which included sessions on how enrollment works, Medicare policy updates, Medicaid enrollment, revalidation, improving the online enrollment systems, protecting the program from bad actors and enforcement actions.
Highlights of the conference include changes in how the MAC will communicate with providers, changes to the Program Integrity Manual, MACS not requesting certain documents, changes to the moratoria’s that are in place, CMS expanding its management of Medicaid enrollment, approval letters will now list all changed and updated information for change of information submitted, and PECOS improvements.
Details related to some of the information received during the conference:
“Communications regarding the processing of the CMS-855R shall be sent to the contact person listed. If multiple contact persons are listed, the MAC shall contact the first person listed on the application. If they are not available, the MAC shall contact the other person(s) listed, unless the individual practitioner indicates otherwise via any means.”
Any contact listed on enrollment record may request a copy of approval and revalidation letters.
MACs should not call to speak directly to providers reporting a change in specialty
Program Integrity Manual Revamp – Target Completion: Early 2018
CMS expanding its management of Medicaid enrollment, to lessen the burden on the states. States can screen Medicaid providers using Medicare enrollment data. This providers more consistency among states with clearer sub-regulatory guidance. Each states has a CMS point-of-contact.
Medicaid Provider Enrollment Compendium (MPEC) was created. This is similar to the Medicare Program Integrity Manual and is intended to function the same way to provide guidance to the state and to the providers. MPEC was updated in June of 2017.
Some of the State Medicaid Agencies (SMAs) participate in data compare services that leverage Medicare screening data to comply with ACA requirements. CMS works with these SMAs to identify dually enrolled providers who have already screened in Medicare to assist them in completing their revalidation and screening requirements with the state.
CMS has been conducting State Visits to try to build relationships with the State Medicaid Agencies, streamline processes, and review MPEC guidance, brainstorm opportunities and tackle challenges and barriers. Participation for the states is voluntary.
Some of the States that have been identified as having best practices when utilizing data compare and working with Medicare are as follows.
Oregon’s use of CMS Data Compare Service enables Oregon to leverage Medicare screening complete state revalidation for 90% of their providers.
Connecticut Automated checks of the Death Master File by building it into their online application thereby identifying inaccurate data in real time and preventing application submission.
Indiana is able to process enrollments within 15 days or less by leveraging the Medicare data.
Wisconsin established a 24 hour auto-enrollment process by utilizing the Medicare data. Virginia established a 100% online enrollment process.
Alabama compares ownership data against Medicare data in PECOS to identify potentially outdated or fraudulent data and returns the application if there are mismatches.
These are just some examples of how the relationship between Medicare and Medicaid continue to improve to benefit the providers.
Approval letters will now list all changed and updated information for change of information submitted.
Attendees were told that CMS intends to hold these conferences annually. My assessment: this is a conference that is interactive and informative. It offers an opportunity to face time with your MAC and presents a chance for complex enrollment issues to be resolved.