Medicare Enrolment Update for 2019

Event Information
Product Format
Prerecorded Event
90 minutes
Product Description

Master the Medicare Enrolment Process through the Various CMS-855 Forms

If your facility treats Medicare patients, you know what it’s like to fill out the seven different versions of the CMS-855 forms. Filling out these long, detailed, and confusing forms is a job in itself, not to mention maintaining and updating them when required. What’s more, providers such as integrated delivery systems and large multi-specialty clinics may have to maintain hundreds of these forms, and periodically resubmit them as part of Medicare’s revalidation process. And even if there is no formal change in guidance, the interpretations of and guidance for the enrolment process continue to evolve—and leave you guessing.

Let expert speaker Duane C. Abbey show you exactly what CMS requires in this information-packed audio conference, as he reviews the Medicare enrolment process through the use of the various CMS-855 forms. Abbey will explain why the Medicare Program is so sensitive to enrolment; what are the compliance risks relative to Medicare enrolment; where you can find the official regulations for Medicare enrolment, and much more.

After attending this insightful session, you will be thoroughly familiar with the entire Medicare enrolment process. You will know how to use of the various CMS-855 forms to file your claims properly, and get paid by Medicare.

Session Highlights

This session will cover the following topics:

  • What are CMS-855 forms?
  • What is the newer CMS-855-POH form?
  • How is enrolment affected by the revalidation process?
  • Why is the Medicare Program so sensitive to enrolment?
  • Where do I find the official regulations for Medicare enrolment?
  • 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 enrolment?
  • 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 enrolment?
  • What about Medicare Advantage programs and the 855 forms?

Conference Objectives

  • To review the Medicare enrolment process through the use of the various CMS-855 forms.
  • To address changes to the CMS-855 forms and/or changes in interpretations of the forms.
  • To discuss the revalidation process for the various CMS-855 forms.
  • To briefly review the CMS Conditions for Payment (CfPs).
  • To appreciate the Medicare concerns surrounding billing and payment for services and supplies.
  • To review organizational structuring changes such as with provider-based clinics.
  • To review the purpose and use of the six different CMS-855 forms along with the new CMS-855-POH.
  • To understand the concept of opt-out physicians and practitioners.
  • To appreciate how opt-out physicians can and/or should enrol in the Medicare program.
  • To appreciate how Part D coverage is impacted by the enrolment process.
  • Why are the fuss about ordering/referring physicians?
  • To understand the revalidation process and associated challenges.
  • To appreciate how other required reporting, such as the NPIs and Provider-Based reporting connect with the Medicare enrolment.
  • To recognize the need to develop organizational resources to maintain multiple CMS-855 forms.
  • To appreciate the proper use of the Internet-based PECOS process.
  • To appreciate current and anticipated changes for maintaining billing privileges with Medicare.
  • To understand how the Medicare Advantage programs (Part C) fit into the CMS-855 forms.
  • To work through several case studies.
  • To recognize the need to establish contact with knowledgeable personnel at the MAC and/or RO.

Conference Outline/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 enrolment
    • Integrated delivery systems
    • Multi-specialty groups
    • Provider-based clinics/operations
    • Maintaining NPIs and TINs
    • Other related reporting requirements
    • Medicare advantage programs
  • 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
  • Finance personnel
  • Accreditation and licensing personnel
  • Physicians and non-physician practitioners
  • DME suppliers
  • Clinics
  • Cost report personnel
  • Other personnel interested in billing privileges with the Medicare program

Ask a question at the Q&A session following the LIVE event and get advice unique to your situation, directly from our expert speaker.

Order Below or Call 1-844-384-4744 Today

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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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