Understanding CMS-855 Forms Including the New CMS-855-POH for Hospitals and Clinics

Event Information
Product Format
Prerecorded Event
90 minutes
Product Description

Using the CMS-855 Forms, Revalidation, and Future Requirements for Conditions for Payments

Enrolling in 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. Over time the use and guidance for the enrollment process have continued to morph even though there is no change in guidance.

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. The Medicare program also uses a revalidation process that periodically requires all healthcare providers to resubmit their various 855 forms in order to assure compliance.

Join expert speaker Duane C. Abbey, Ph.D. as he gives an overview of CMS-855 forms and how they relate to each other. He will also discuss the role of opt-out physicians/practitioners and the way CMS-855-O fits into this process. Duane will review the revalidation process, address changing organizational structures, and discuss future requirements for Conditions for Payments among other topics in this session.

Session Highlights:

  • What are these CMS-855 forms?
  • What is this newer CMS-855-POH form?
  • Why is the Medicare Program so sensitive to enrollment?
  • Where do I find the official regulations for Medicare enrollment?
  • Do we have to use PECOS?
  • Are there any problems with the Cycle 2 revalidation process?
  • How can we check to see who needs to be revalidated?
  • Are there really 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 are we supposed to keep track of all these CMS-855 forms?
  • What are the compliance risks relative to Medicare enrollment?
  • What is the fuss about ordering/referring physicians?

Session Objectives:

  • Review the Medicare enrollment process through the use of the various CMS-855 forms
  • Briefly review the CMS Conditions for Payments (CfPs)
  • Identify the Medicare concerns surrounding billing and payment for services and supplies
  • Review organizational structuring changes such as with provider-based clinics
  • Review the 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
  • Learn how opt-out physicians can and/or should enroll in the Medicare program
  • Know how Part D coverage is impacted by the enrollment process
  • Understand the revalidation process and associated challenges
  • Know how other required reporting, 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
  • Understand the proper use of the Internet-based PECOS process
  • Determine current and anticipated changes for maintaining billing privileges with Medicare
  • Work 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
    • National Provider Identifiers- NPIs
    • Tax Identification Numbers - TINs
  • 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
  • Other Personnel Interested in Billing Privileges with the Medicare Program

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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
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