Medicare for Geeks

Protecting PECOS

Avoiding Rejected Applications – Correct Form Version?

For providers and suppliers that utilize the Medicare enrollment application forms, in lieu of Internet PECOS, it is important to confirm the current version of each form prior to its completion and submission. This can be particularly important when completing forms in advance of a pending transaction or the opening of a new business, especially when delays affect timing for submitting the application packet.

For example, effective January 1, 2017, CMS requires the use of the May 2016 version of the CMS 855S form. read more…

Hospital Payment Delays for Unreported Practice Locations

The revalidation process and increased sanctions for non-compliance with the requirements to update Medicare enrollment has not succeeded in ensuring all providers understand the importance of having accurate Medicare enrollment data. And, some providers mistakenly believe that all of the provider’s practice locations must have been reported since claims were being paid.  CMS’ historic purposeful separation between Medicare enrollment data in PECOS and claims data in FISS facilitated that misunderstanding.  Effective as of January 1, 2017, that will change. read more…

Understanding Medicare Corrective Action Plans

For Medicare enrollees denied enrollment or current providers or suppliers that had billing privileges revoked, CMS established the option to file a Corrective Action Plan (CAP). Filing a CAP provides the opportunity to “correct” the deficiencies that resulted in the denial or revocation.

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Don’t Hesitate — Revalidate

Revalidation efforts are underway again, but this time for all providers and suppliers. When CMS revised the Medicare enrollment rules in June 2006, one change was to require each provider or supplier to revalidate its enrollment at least every 5 years. The initial revalidation efforts, which began in 2007, focused on providers and suppliers that had enrolled prior to 2003, when CMS had fully implemented the PECOS database for maintaining Medicare enrollment data. This article contains information on the revalidation process and tips for preparing revalidation forms.

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Application Fees

To help offset the costs of the screening required under the program safeguard rules for Medicare-enrolled providers and suppliers, an application fee was implemented.   With the annual update factor, the current fee for $505.00 for 2011 and $523.00 for 2012.

Application fees are assessed at the time of the initial Medicare enrollment, when a practice location is added, and when responding to a revalidation request.  With the exception of individuals (physicians and non-physicians practitioners) and group practices, all other providers and suppliers are assessed the application fee.

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New Medicare and Medicaid Enrollment Rules Take Effect Today

Significant changes effecting Medicare- and Medicaid-enrolled providers and suppliers take effect today, March 25, 2011.  The new regulations are in response to provisions in the recent health care reform legislation designed to enhance the enrollment procedures to protect against fraud.  All Medicare-enrolled providers and suppliers were grouped into one of three categories “limited,” “moderate,” or “high” risk, with delineated enrollment screening procedures for each category.  The greater the perceived risk of fraud, the more scrutiny for the applicant or enrollee.

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60-Day Comment Period for New Medicare and Medicaid Enrollment Rules Ends November 16, 2010

Do not lose this opportunity to submit comments to the proposed changes in the Medicare and Medicaid enrollment rules, whether submitted individually or in conjunction with professional or trade associations.

Enrollment screening procedures would be increasing more rigorous based upon the provider’s or supplier’s placement into the “limited,” “moderate,” or “high” risk category.

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ABOUT

Donna Senft

Medicare for Geeks is written by Donna J. Senft, an attorney and shareholder in Baker Donelson's Health Law Group. Donna has nearly a decade of experience in advising enrolled providers to maintain complete PECOS data and complete revalidations to avoid deactivation or revocation of billing privileges, and to file CAPs and appeals when privileges are lost. She also helps providers with coding and payment issues, peer review and professional standards, and professional disciplinary matters.

Baker Donelson's Health Law Group dates back nearly 35 years, to the beginnings of health law as a recognized practice area. The Group is a leader in providing premier legal services to academic and community hospitals, health systems, long-term care facilities, clinical laboratories, institutional pharmacies, physicians and physician organizations.

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