Medicare Enrollment Update: All About Seven CMS-855 Forms, Billing, & Claims Process

*This program has the prior approval of AAPC for 1.5 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

Intermediate to Advanced Level Enrollment Program Concerning Conditions for Payment, Hospital Completion of CMS Form 855-A, Completing the CMS For 855-B, DME and the CMS Form 855-S
Enrolling with the Medicare program involves various CMS-855 forms.  There are now 7 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 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. 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.

Expert presenter, Duane C. Abbey, CFP, in 90 minutes webinar, will address changes to the CMS-855 forms and changes in interpretations of the forms, while working through several practical Case studies.

• What are these CMS-855 forms? What is this newer CMS-855-POH form?


• Who should file the CMS-20134?


• How is enrollment affected by the revalidation process?


• Why is the Medicare Program so sensitive to enrollment?


• Where do I find the official regulations for Medicare enrollment?


• Do we have to use Internet-based PECOS process?


• Are there any problems with the Cycle 2 revalidation process?


• 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?


• What are the compliance risks relative to Medicare enrollment?


• What about Medicare Advantage programs and the 855 forms?

Session Objective and Outcome

• To review the Medicare enrollment process through the use of the seven different CMS-855 forms along with the new CMS-855-POH and CMS-20134.


• To understand the revalidation process for the various CMS-855 forms and associated challenges.


• 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 appreciate how opt-out physicians and practitioners can and/or should enroll in the Medicare program.


• To appreciate how Part D coverage is impacted by the enrollment process.


• Why is the fuss about ordering/referring physicians?


• To appreciate how other required reporting, such as the NPIs and Provider-Based reporting connect with the Medicare enrollment.


• To recognize the need to develop organizational resources to maintain multiple CMS-855 forms.


• To understand how the Medicare Advantage programs (Part C) fit into the CMS-855 forms.

Session Agenda And Highlights

• Definitions – Provider vs. Supplier
  
  
  
  1. Review Conditions for Payment (CfPs) – 42 CFR 424
  
  
  2. Claims Filing Process
  
  
  3. Reassignment of Payments
  
  
  4. OIG Investigations Concerning Fraudulent Billing
  
  
  5. Revalidation and Billing Credentialing
  
  
  
  


• Review of the CMS-855 Forms and inter-relations in forms
  
  
  
  1. CMS-855-A, CMS-855-B, CMS-855-I, CMS-855-O, CMS855-R, CMS-855-S
  
  
  2. Newer CMS-855-POH – Annual Report Physician Ownership
  
  
  3. Newest CMS-20134 for Diabetes Prevention Program
  
  
  4. National Provider Identifiers- NPIs ; Tax Identification Numbers - TINs
  
  
  
  


• Opt-Out Physicians/Practitioners Process
  
  
  
  1. Why Would a Physician/Practitioner Opt-Out?
  
  
  2. How do Opt-Out Physicians Affect Hospitals/Clinics?
  
  
  3. How Does the CMS-855-O Fit Into This Process?
  
  
  
  


• Revalidation Process
  
  
  
  1. Revalidations Cycles: Cycle 1 Process, Cycle 2 Process
  
  
  2. Determining Status and Notification
  
  
  3. Time Frames for Completion
  
  
  4. Risk Levels, and On-Site Visits
  
  
  
  


• Addressing Changing Organizational Structuring
  
  
  
  1. Impact of Organizational Structuring on Enrollment
  
  
  2. Integrated Delivery Systems
  
  
  3. Multi-Specialty Groups
  
  
  4. Provider-Based Clinics/Operations
  
  
  5. Maintaining NPIs and TINs
  
  
  6. Medicare Advantage Programs
  
  
  
  


• Utilizing PECOS versus Manual Submission


• 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

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

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