Description:-

• What does CMS really want to know about physician practices in order to enroll?
• Why do physicians and practitioners have to concern themselves with multiple forms?
• What is this revalidation program?
• What if our group practice is a partnership of professional corporations?
• Why are these CMS 855 forms so long?
• Where can we obtain guidance on how to complete and file these forms?
• How long does it take to enroll a new physician at our clinic?
• Are non-physician practitioners treated different relative to the CMS-855 forms?
• Who should be updating and maintaining our CMS-855 forms at our clinic?
• Why are provider-based clinics different relative to the CMS-855-B?
• How does incident-to billing affect the CMS-855-B?

Objectives of the session:

1. To understand the overall process of obtaining and maintaining billing privileges for Medicare
2. To appreciate the CMS Form 855-B and the different variations of the CMS-855 forms.
3. To review the data elements and information required for the CMS-855-B.
4. To understand how the CMS 855-B relates to the other CMS-855 forms, particularly the CMS 855 –I and CMS 855-O.
5. To appreciate differing requirements for free-standing and provider-based clinics.
6. To recognize the need for CMS to gather appropriate information concerning ownership, management, and operations for billing purposes
7. To recognize the need to develop organizational resources to maintain multiple CMS Form 855-B forms.
8. To understand how the NPIs and other reporting requirements affect the CMS-855-B.
9. To appreciate the use of PECOS for an Internet-based filing of the CMS-855 forms.
10. To appreciate current and anticipated changes for maintaining billing privileges with Medicare.
11. To work through several case studies involving different organizational structuring.

Agenda of the session:

1. CMS Billing Privileges
   1. Overview of 42 CFR §424
   2. CMS Concerns Surrounding Billing Privileges
   3. Revalidation Program
   4. OIG Investigations Concerning Fraudulent Billing
2. The CMS Form 855
   1. Six Different Forms
   2. Use and Relationship of Forms
   3. Basic Information Required
3. Organizational Structuring for Clinics
   1. Different Forms of Business
   2. Freestanding vs. Provider-Based Clinics
   3. Non-Physician Practitioners and Incident-To Billing
4. The CMS Form 855-B
   1. Clinic and Group Practice Billing Privileges
   2. Key Information
      1. Type of Entity
      2. Ownership
      3. Management Control
      4. Financial Control
   3. Need to File and Maintain Multiple CMS 855 Forms
   4. Organizational Structuring to Report Changes and Maintain the CMS-855 Forms
5. NPIs (National Provider Identifiers)
   1. Intents and Benefits of the Program
   2. Analyzing Business Structures
   3. Tax Identification Numbers
6. Related Issues
   1. Ambulatory Surgical Centers (ASCs)
   2. Ambulance Services
   3. Relationship to 855-I, 855-O, and 855-R
   4. Verification Processes
   5. Common Problem Areas
7. Future Requirements for Conditions for Payment
   1. Use of PECOS (Provider Enrollment, Chain and Ownership System)
   2. Special Compliance Concerns

         8. Case Studies and Examples

Who will benefits:

• Clinic Managers
• Clinic Administrators
• Hospital Provider-Based Clinic Personnel
• Claim Filing Personnel
• Coding and Billing Personnel
• Compliance Personnel
• Financial Personnel
• Accreditation and Licensing Personnel
• Other Personnel Interested in Billing Privileges with the Medicare Program