PDF Medicare & Medicaid Provider Enrollment
Medicare & Medicaid
Provider Enrollment
Presented by Zabeen Chong, Director Provider Enrollment & Oversight Group Center for Medicare & Medicaid Services
Charles Schalm, Deputy Director Provider Enrollment & Oversight Group Center for Medicare & Medicaid Services
Session Overview
? How Enrollment Works ? Medicare Policy Updates ? Medicaid Enrollment ? Revalidation ? Our Enrollment Systems ? Protecting the Program ? Enforcement Actions
2
First thoughts
1
2
3
Listening to you
Finding a balance
We hear you, and we've learned a lot from you.
We believe enrollment should be easy for most providers, and hard for bad actors.
Always improving
We will keep refining our systems, policies, transparency, and our vision.
3
How enrollment works
4
How enrollment works
Submission
1
Intake
2
Processing, Screening & Verification
Submit to MAC
855Form 60 days*
? MAC mail room
? Manual data entry
3
PECOS
Medicare
Online
Providers &
45 days*
Suppliers (w/NPI)
Direct Input
4
Finalization & Claims Update
Update claim system MAC updates claim
system (1-2 days)
Provider not approved 6 until claims updated
MAC Recommendation to State /RO Certified providers/suppliers MAC recommends to RO RO performs in 3-9 mo
5
Development Letter
* If the app is complete, and no site visit
Pre Screening signed + dated app fee (or waiver) supporting docs all data elements
5
Verification
Name / LBN SSN / DOB NPPES Address License Adverse Actions
Risk Based Fingerprints Site Visits
What causes delays?
30-35%
delayed
need at least 1 round of corrections
missing documents
IRS documents, CMS 588 EFT, voided check, bank letter, education documentation, par agreement, cert term page, org charts
missing fields missing signature/date wrong signature (paper) incorrect information missing application fee
How the MAC develops for missing information
Contacts the...
1. Contact person (sec 13) 2. Individual provider (sec 2) 3. Auth or Del Official (sec 15/16)
By...
email fax phone letter
6
30
days to respond
No response?
delays rejections later effective date
MAC Notification Letters
Who is listed on MAC notification letters?
MAC analyst is the point of contact listed on the letter
MAC call center is the point of contact listed on the letter
7
Medicare effective dates | Part B
Effective date is the later of: Application Receipt Date Date of first services at a new location (up
to 30 days prior to application receipt)
MAC
Option A: Early Submission Physicians / Groups can apply 60 days prior **
receives app APR 1
MAC approves MAY 15 (w/ effective June 1)
Provider seeking effective date JUNE 1
Provider performs service JUNE 1
MAC PROCESSING
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
Option B: Late Submission Physicians / Groups effective date up to 30 days prior to submission date ***
Provider performs service JUNE 1
MAC PROCESSING
MAC receives app JULY 1
MAC approves SEPT 1 (w/ effective June 1)
** Must be in compliance at requested effective date (operational, licensed)
8
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- pdf why does the u s have capital punishment state
- pdf spill prevention control and countermeasure spcc
- pdf three rules for compensation controls
- pdf compensation mit flow cytometry core facility
- pdf do i need to have a spill prevention control and
- pdf alaska obesity facts physical education policies practices
- pdf final integrating literacy into physical education
- pdf answer key for strawberry dna lab prince edward island
- pdf strategies to improve the quality of physical education
Related searches
- meridian illinois medicaid provider portal
- aarp medicare supplement provider number
- aarp medicare supplement provider portal
- wyoming medicaid provider enrollment
- meridian medicaid provider portal
- aarp medicare complete provider list
- texas medicaid provider services
- wyoming medicaid provider portal
- medicare advantage provider requirements
- medicare dme provider list
- medicare part b enrollment form
- medical assistance provider enrollment pa