Updates from the First Annual CMS National Provider Enrollment Workshop

Updates from the First Annual CMS National Provider Enrollment Workshop

Oct 17, 2017
  • Author:
    Dawn Anderson, PESC, CPMSM
    Senior Consultant
    Former VerityStream Employee
    Dawn Anderson is an experienced health care management professional with over 20 years' experience including credentialing, privileging, revenue cycle management, managed care and provider enrollment. She is recognized nationally as an enterprise-wide process redesign expert. She has demonstrated an ability to synthesize workflows into a collective and focused vision endorsed by key stakeholders. She has directed initiatives with outcome-based solutions, interpreting workflows and facilitating integration into software.

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 an 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:

Program Integrity Manual Revamp – Target Completion: Early 2018

  • more user friendly
  • new structure driven by application and provider type
  • remove outdated and inaccurate information
  • consolidate sections identifying similar processes
  • add new and clarify existing policy
    CMS-855R processing guide
  • addendum to PIM chapter 15 on CMS.gov
  • used by MACs and providers
  • includes application completion and processing instructions
    CMS-855O processing guide (coming soon)
  • addendum to PIM chapter 15 on CMS.gov
  • used by MACs and providers
  • includes application completion and processing instructions

MACs not requesting certain documents:

  • MACs should not request a diploma or degree unless education requirements cannot be verified online
  • MACs should not request a SSN card or driver’s license for identification
  • MACs should not request a phone, utility, power bill or lease to validate LBN or DBA
    • Lease only required to validate exclusive use of facility for PT/OT or ambulance suppliers leasing aircraft
  • For applications that require development, MACs shall only request the dated signature of at least one authorized/delegated officials

Moratoria changes:

  • Home Health Agencies and sub units FL, IL, MI, TX July 2017 extended
  • Non Emergency Ambulances and Ambulance Supplies NJ, PA, TX July 2017 Extended
  • Lifted in Texas on August 25, 2017 due to Presidential Disaster Declaration for several counties in the State.

CMS expands management of Medicaid Enrollment:

CMS is expanding its management of Medicaid enrollment, to lessen the burden on the states. States can screen Medicaid providers using Medicare enrollment data. This provides 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:

Approval letters will now list all changed and updated information for change of information submitted.

January 2018 – PECOS Improvements:

  • Supporting Documents List
  • Removal of SSN and Driver’s License from Supporting documents list
  • IDTF Facilities adding a new Base of Operations will no longer require a Fee Payment
  • Returning for Corrections applications will be added to the Application Warnings Section on the My Associations Page.

July  – Medicaid Manage Cart Starts:

  • CMS 2390 - Medicaid Manage Care network providers that furnish, order, refer or prescribe must enroll in Medicaid.


  • It reduces fraud
  • Ensures compliance with enrollment requirements across all programs
  • Ensures services are provided by qualified providers
  • Ensures consistency across CMS programs

PECOS 2.0 Redesign:  Target 2018-2019  Currently in Procurement

  • Ground up redesign
  • Platform for Enrollment
  • Streamlined Interface
  • Modern APIs and Automation
  • Increase Agency and Industry interoperability

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.