www.ama-assn.org/go/psa-webinars

Medicare Physicians Must Begin to Revalidate Enrollment By March 2013

     All physicians who enrolled in the Medicare program prior to Friday, March 25, 2011, will be required to revalidate their enrollment under new risk screening criteria required by the Affordable Care Act (section 6401a).  (Physicians who enrolled on or after Friday, March 25, 2011 have already been subject to this screening, and need not revalidate at this time.)

     In the continued effort to reduce fraud, waste, and abuse, CMS implemented new screening criteria to the Medicare physician enrollment process beginning in March 2011.  Newly-enrolling and revalidating physicians are placed in one of three screening categories - limited, moderate, or high - each representing the level of risk to the Medicare program for the particular category of physician, and determining the degree of screening to be performed by the Medicare Administrative Contractor (MAC) processing the enrollment application.

     Between now and March 2013, MACs will be sending notices to individual physicians; please begin the revalidation process as soon as you hear from your MAC.  Upon receipt of the revalidation request, physicians have 60 days from the date of the letter to submit complete enrollment forms.  Failure to submit the enrollment forms as requested may result in the deactivation of your Medicare billing privileges.  The easiest and quickest way to revalidate your enrollment information is by using Internet-based PECOS (Provider Enrollment, Chain, and Ownership System), at  https://pecos.CMS.hhs.gov.

     Section 6401a of the Affordable Care Act requires institutional physicians to pay an application fee when enrolling or revalidating ("institutional provider" includes any provider or supplier that submits a paper Medicare enrollment application using the CMS-855A; CMS-855B, not including physician and non-physician practitioner organizations; CMS-855S; or associated Internet-based PECOS enrollment applications); these fees may be paid via  www.Pay.gov.

     In order to reduce the burden on the physician, CMS is working to develop innovative technologies and streamlined enrollment processes - including Internet-based PECOS.  Updates will continue to be shared with the physician community as these efforts progress.

     For more information about physician revalidation, review the Medicare Learning Network's  Special Edition Article #SE1126, titled "Further Details on the Revalidation of Provider Enrollment Information

CMS Begins New Medicare Fraud Prevention Program

     If you help people with Medicare, Medicaid and the Children's Health Insurance Program (CHIP), you should know about an expanded federal government effort to reduce fraud and other improper payments in these health care programs to help ensure their long-term viability. 

     Significant progress in the fight against health care fraud has already been made as shown by the federal government's recovery of a record $4 billion last year from people who attempted to defraud seniors and taxpayers.  The Affordable Care Act provides additional resources and tools to enable the Centers for Medicare & Medicaid Services (CMS) to expand efforts to prevent and fight fraud, waste and abuse. The CMS Fraud Prevention Initiative aims to ensure that correct payments are made to legitimate providers for covered appropriate and reasonable services in all federal health care programs. 

     Fraud prevention efforts focus on moving CMS beyond its former "pay and chase" recovery operations to a more proactive "prevention and detection" model that will help prevent fraud and abuse before payment is made.  A good example is the recent CMS announcement that for the first time, through the use of innovative predictive modeling technology similar to that used by credit card companies, the agency will have the ability to use risk scoring techniques to flag high risk claims and providers for additional review and take action to stop payments and remove providers from the program when necessary.  

     Yet, as important as these aggressive new initiatives are, the first and best line of defense against fraud remains the health care consumer.  You can help by making sure that Medicare beneficiaries have the information they need to identify and report suspected fraud.  This information is available in the CMS Fraud Prevention Toolkit on the web at https://www.cms.gov/Partnerships/04_FraudPreventionToolkit.asp#TopOfPage

     The web site contains materials to help you inform Medicare beneficiaries about how to protect themselves from becoming a victim of fraud and how to report it.

National Provider Call on Medicare FFS Implementation of HIPAA Version 5010 and D.0 Transactions - Save the Date- Wednesday, August 31, 2011  2-3:30pm ET

     CMS will host its eighteenth national education call regarding Medicare FFS's implementation of HIPAA Version 5010 and D.0 transaction standards on Wednesday, August 31, 2011.  This national call will include a Medicare Administrative Contractor (MAC) Panel Question & Answer Session comprised of a Medicare FFS 5010 status update, as well as brief status updates provided from all MACs.  In addition, a robust question and answer session will be provided giving participants the opportunity to ask their MAC specific questions related to 5010 implementation.

     Target Audience:  Vendors, clearinghouses, and providers who need to make Medicare FFS-specific changes in compliance with HIPAA Version 5010 requirements.  The agenda will include:

• Review of 5010/D.0 readiness for Medicare FFS
• Review of 5010/D.0 readiness for HETS Eligibility Transaction System (270/271)
• Review of 5010/D.0 readiness for Coordination of Benefits Contractor (COBC)
• Review of 5010/D.0 readiness from Medicaid
• Soliciting of feedback regarding questions and concerns with 5010 and/or Medicare FFS implementation of 5010

     If you would like to submit a question related to this topic in advance of, during, or following the call, please email your inquiry to our new 5010 FFS Information resource mailbox at 5010FFSinfo@cms.hhs.gov.  Please note that this resource will only accept emails the day before, the day of, and the day after this call; your emailed questions will be answered as soon as possible, and may not be answered during the call.

     Registration Information:  In order to receive the call-in information, you must register for the call.  Registration will close at 2pm on Tuesday, August 30th or when available space has been filled; no exceptions will be made, so please register early.  For more details, including instructions on registering for the call, please visit http://www.CMS.gov/Versions5010andD0/V50/itemdetail.asp?itemID=CMS1250932.

     Webinar:  CMS will make use of a webinar as part of this National Provider Call.  This feature will allow participants to follow the presentation online as it is given, though will not have any effect on those participants who are only dialing in to the audio portion of the call.  Those who are not participating in the webinar should be sure to download the presentation for the call in advance from the registration page, detailed above.