Sandie Lourash's Favorite Credentialing Links and Information
Report: CMS (Centers for Medicare & Medicaid Services) 855 Conference
The purpose of attending this conference was to learn how to save time and reduce compliance risks for the facilities and physicians.
The first item on the agenda
was titled "Review of Medicare reimbursement and compliance risk areas
embedded within the CMS-855 forms." I found this area the most interesting
due to the amount of reimbursement that is not allocated correctly and the risk
facilities and physicians face if billing is done incorrectly.
The area that were discussed were:
· Reassignment rule
- This rule deals with the reassignment of benefits of the supplier. Which all
our physicians are required to do for each of the facilities in order for the
facilities to bill Medicare. This is done by filling out an 855B for non-established
physicians and an 855R for established physicians. Medicare will be looking
closely at how many reassignments each physician has and how often it is used.
I purpose that all the facilities revalidate their DBA "Doing Business
As" name and each supplier number they wish to have linked with their Tax
ID number. This will be easier for the facilities to monitor their different
reassignments.
· "Incident to" rule - This rule entitles the facility to bill
Medicare for any services or supplies used by a physician within the assigned
hospital. (Including PAs "incident to" The physician's supervision.)
· Carrier Jurisdiction rules - This rule states all Medicare claims be
covered if not covered by DME or Railroad Medicare.
· Site-of-Service rule - This rule will link individual service with
site of service.
· Three Day Payment rule - This rule is a way to determine how far back
you can bill for a diagnostic service before a patient's admission to the hospital.
We then moved onto the correct way to complete the 855 forms. The following is a condensed version of each form:
· HCFA-460 - is an
agreement between Medicare and the physician or supplier.
· HCFA-588 - is the agreement that authorizes electronic funds transfer.
· CMS 855A - application for health care providers that bill Medicare
fiscal intermediaries.
· CMS 855B - application for health care suppliers that will bill Medicare
carriers.
· CMS 855I - application for individual health care practitioners.
· CMS 855R - application for individual health care practitioners to
reassign Medicare benefits.
· CMS 855S - application for durable medical equipment, prosthetics,
orthotics, and supplies (DMEPOS) suppliers.
Starting January 1, 2002, we will be using the 855B for non-established physicians, the 855R for established physicians and the 855I for physician assistants.
During the conference I noticed a lot of attention was focused on two areas. First was making sure the physician rosters between the facility and Medicare are current. Second was the facility's DBA "Doing Business As" address was the same as the address they use for tax purposes. Revalidation will be the key to elevate any questions Medicare may have with the facilities and their physicians.
Informational packets will be going out to each of our participating facilities to inform them of all the changes and to start the revalidation process. Once the clean up process is completed and the new process for filing is on line, we will be glad for the changes that have been made.
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