With the recent changes on Medicare provider enrollment requirements, it's difficult to know exactly what to do next, how to do it, and when. And you know a single mistake on your Medicare enrollment could cost you big.
Join expert speaker, Duane Abbey, where he reviews the Medicare enrollment process through the use of the various CMS-855 forms, plus simplifies internet based PECOS process, and discover potential problem areas.
Highlights of The Session:
a. To review the Medicare enrollment process through the use of the various CMS-855 forms.
b. To briefly review the CMS Conditions for Payment (CfPs).
c. To appreciate the Medicare concerns surrounding billing and payment for services and supplies.
d. To review the purpose and use of the six different CMS-855 forms.
e. To understand the common information requirements embedded in the CMS-855 forms.
f. To understand the 5-year cycle revalidation process.
g. To appreciate how other required reporting, such as the NPIs and Provider-Based reporting connect with the Medicare enrollment.
h. To recognize the need to develop organizational resources to maintain multiple CMS-855 forms.
i. To understand the proper use of the Internet-based PECOS process.
j. To appreciate current and anticipated changes for maintaining billing privileges with Medicare.
k. To work through several case studies.
l. To recognize the need to establish contact with knowledgeable personnel at the Fiscal Intermediary, Carrier and/or geographic MAC.
I. Conditions for Payment (CfPs)
a. Definitions – Provider vs. Supplier
b. Claims Filing Process
c. Reassignment of Payments
d. Billing Directives
e. OIG Investigations Concerning Fraudulent Billing
f. Revalidation and Billing Credentialing
g. Opt-Out Physicians and Practitioners
II. CMS-855 Forms
g. How the CMS-855 Forms Relate to Each Other
III. Basic Information Requirements and Concerns
a. Who are you?
b. Where you are located?
c. Who owns you?
d. Who manages (controls) you?
e. Special Considerations
f. How Many 855s Does Your Organization Have?
IV. Revalidation Process
a. 5-Year Cycle
c. Time Frames for Completion
d. Risk Levels
e. On-Site Visits
V. Addressing Organizational Support
b. Provider-Based Status
c. CMS-855 Forms
e. Keeping Information Up-to-Date
f. Anticipating CMS Revalidation
g. Other Related Reporting Requirements
VI. PECOS – Provider Enrollment, Chain and Ownership System
a. What is it?
b. How is it used?
c. Who can use it?
VII. Case Studies
VIII. Future Requirements for Conditions for Payment
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....
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