2018 Updates on CMS-855 Forms for Hospitals and Clinics

Event Information
Product Format
Prerecorded Event
90 minutes
Product Description

Learn about CMS-855 Forms Changes and Changes in Interpretations of the Forms

Enrolling with the Medicare program involves the various CMS-855 forms. The Medicare program uses a revalidation process to periodically require all healthcare providers to resubmit their various 855 forms in order to assure that compliance is being maintained. 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.

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. In this session, healthcare consultant Duane C. Abbey, Ph.D., will review the Medicare enrollment process through the use of the various CMS-855 forms.

Session Objectives

This session will answer some questions, such as:

  • What are CMS-855 forms?
  • What is the newer CMS-855-POH form?
  • How is enrollment affected by the revalidation process?
  • Why is the Medicare program so sensitive to enrollment?
  • Where can you find the official regulations for Medicare enrollment?
  • Do you have to use PECOS?
  • Are there any problems with the Cycle 2 revalidation process?
  • How can you 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 you supposed to keep a track of all the CMS-855 forms?
  • What are the compliance risks relative to Medicare enrollment?

Session Highlights

This session will discuss:

  • Medicare enrollment process through the use of the various CMS-855 forms
  • Changes to the CMS-855 forms and/or the changes in interpretations of the forms
  • The revalidation process for the various CMS-855 forms
  • The CMS conditions for payment (CoPs)
  • The Medicare concerns surrounding billing and payment for services and supplies
  • Organizational structuring changes such as with provider-based clinics
  • The purpose and use of the six different CMS-855 forms along with the new CMS-855-POH
  • The concept of opt-out physicians and practitioners
  • How opt-out physicians can and/or should enroll in the Medicare program
  • How Part D coverage is impacted by the enrollment process
  • The fuss about ordering/referring physicians
  • The revalidation process and associated challenges
  • How other required reporting, such as the NPIs and provider-based reporting connect with the Medicare enrollment
  • The need to develop organizational resources to maintain multiple CMS-855 forms
  • The proper use of the Internet-based PECOS process
  • Current and anticipated changes for maintaining billing privileges with Medicare
  • Several case studies
  • 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
    • Newer 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 and non-physician practitioners
  • DME suppliers
  • Clinics
  • Cost report personnel and 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
More Events By The Speaker

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