Medicare Enrollment: An Update for 2017

Event Information
Product Format
Prerecorded Event
Conference Date
Tue, Sep 27, 2016
90 minutes
Product Description

Demystifying Medicare Enrollment, the CMS-855 and the New CMS-855-POH Forms

Enrolling with the Medicare program involves the various CMS-855 forms. There are now seven different forms that must be used by different providers of healthcare services or products. These forms are long, detailed and sometimes confusing. Not only must they be filed initially for a given provider, they must be maintained and updated as appropriate.

Due to the increasing complexity of healthcare delivery systems, providers, such as integrated delivery systems or large multi-specialty clinics, may have to maintain hundreds of these forms. Also, healthcare providers are required to resubmit their various 855 forms for revalidation in order to ensure complete compliance with the Medicare program. Over time the use and guidance for the enrollment process continues to morph even though there is no change in guidance. This occurs through interpretations and clarifying guidance.

In this session, renowned speaker Duane C. Abbey, Ph.D., will provide guidance on CMS-855 forms and also the new CMS-855-POH form. Find out why is the Medicare Program so sensitive to enrollment, and where to look for the official regulations for Medicare enrollment. The discussion will include the use of PECOS, problems with the Cycle 2 revalidation process, and how you can check to see who needs to be revalidated.

Plus, Dr. Abbey will discuss on-site audits relative to enrollment; what are these opt-out physicians and practitioners; how is Part D coverage involved with these CMS-855 forms; how to keep track of all these CMS-855 forms; and the compliance risks relative to Medicare enrollment.

Session Objectives:

  • Review the Medicare enrollment process through the use of the various CMS-855 forms.
  • Review the CMS Conditions for Payment (CoPs).
  • Medicare concerns surrounding billing and payment for services and supplies.
  • Insights on organizational structuring changes such as with provider-based clinics.
  • Purpose and use of the six different CMS-855 forms along with the new CMS-855-POH.
  • Understand the concept of opt-out physicians and practitioners.
  • How opt-out physicians can and/or should enroll in the Medicare program.
  • Learn how Part D coverage is impacted by the enrollment process.
  • What is the fuss about ordering/referring physicians?
  • Understand the revalidation process and associated challenges.
  • How other reporting requirements, such as the NPIs and Provider-Based reporting connect with the Medicare enrollment.
  • Recognize the need to develop organizational resources to maintain multiple CMS-855 forms.
  • Know the proper use of the Internet-based PECOS process.
  • Review current and anticipated changes for maintaining billing privileges with Medicare.
  • Review and understand through several case studies.
  • Recognize the need to establish contact with knowledgeable personnel at the MAC and/or RO.

Session Agenda:

  • Introduction
    • Conditions for Payment – 42 CFR §424
    • Definitions – Provider vs. Supplier
    • Claims Filing Process
    • Reassignment of Payments
    • OIG Investigations Concerning Fraudulent Billing
    • Revalidation and Billing Credentialing
    • Opt-Out Physicians and Practitioners
  • Review of the CMS-855 Forms
    • CMS-855-A
    • CMS-855-B
    • CMS-855-I
    • CMS-855-O
    • CMS855-R
    • CMS-855-S
    • How the CMS-855 Forms Relate to Each Other
    • New CMS-855-POH – Annual Report Physician Ownership
  • Opt-Out Physicians/Practitioners
    • What Is the Process
    • Why Would a Physician/Practitioner Opt-Out?
    • How do Opt-Out Physicians Affect Hospitals/Clinics?
    • How Does the CMS-855-O Fit Into This Process?
  • Revalidation Process
    • Revalidations Cycles
    • Cycle 1 Process
    • Cycle 2 Process
    • Determining Status and Notification
    • Time Frames for Completion
    • Risk Levels
    • On-Site Visits
  • Addressing Changing Organizational Structuring
    • Impact of Organizational Structuring on Enrollment
    • Integrated Delivery Systems
    • Multi-Specialty Groups
    • Provider-Based Clinics/Operations
    • Maintaining NPIs and TINs
    • Other Related Reporting Requirements
  • Utilizing PECOS versus Manual Submission
  • Case Studies
  • Future Requirements for Conditions for Payment

Who should attend

Claim Filing Personnel, Coding and Billing Personnel, Compliance Personnel, Financial Personnel, Accreditation and Licensing Personnel, Physicians, Non-Physician Practitioners. DME Suppliers, Clinics, Cost Report Personnel, and Other Personnel Interested in Billing Privileges with the Medicare Program

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

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About Our Speaker

Duane Abbey Hospital Coding & Compliance Expert

 Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in healthcare consulting and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. He performs various types of financial analysis involving business structuring, organizational development, enrolment and other financially related concerns of organizations....   More Info
More Events By The Speaker

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