Friday, November 2, 2012

Medicare Revalidation in Full Swing for Ambulance

What is Revalidation? 

Just about one year ago we blogged concerning the CMS call for Medicare revalidation. CMS mandated at that time for every Medicare provider/supplier to be subject to revalidation. Basically revalidation is like hitting the reset button with Medicare. CMS is requiring that every provider/supplier provide a complete set of information using either electronic or paper submission, providing the government agency via the Medicare Administrative Contractors (MAC’s) with verifiable information about each entity that receives reimbursement from the Medicare program.

While on the surface this may not seem to be a big deal, it can become a big deal when completing the application and submitting it for review. This month it appears that CMS chose ambulance services over a wide swath of the east coast of the United States for review. Approximately ninety percent of our clients received request notices in the mail, mostly within the last few weeks.

The process involves submitting key information and supporting documentation to back-up that information using one of the applicable CMS approved application forms. For ambulance companies this most likely will mean the completion of the CMS-855B Medicare application or the submission of information using the PECOS Web online tool.

There is a Deadline 


The tricky part is understanding that there is a deadline imposed by CMS to produce this information via application. The notice is dated and the clock began ticking on that date. All revalidation applications must be returned to the MAC making the request within sixty (60) days of the date on the notice.

But don’t wait until the last minute! The application takes time to prepare and there is a considerable amount of information that you must gather in order to properly complete the document prior to submission.

If a provider/supplier fails to meet that deadline, the MAC is under direction to “deactivate” the Provider Transaction Account Number (PTAN/Provider Number) for that ambulance company and basically this shuts down the Medicare billing privileges for that ambulance company and brings the flow of Medicare reimbursement dollars to a complete stop!

MAC’s are Overwhelmed 


The problem with this stoppage, if it occurs, resides in the sheer fact that the MAC’s are overwhelmed by the number of applications they must process. Once the PTAN is deactivated it could literally take as high as eight or nine months for the application to finally be processed when it is submitted.

The process also became bottlenecked because CMS chose one contractor, nationwide, to complete the required site visit.

Oh yeah, that’s another part of the equation. Someone will visit each ambulance company station to verify that it is an ambulance station. We’ve learned that pretty much means that someone stops by, snaps a picture to verify that there’s a building with ambulance vehicles as represented in the application.

But, that seemingly simple task has held up the process enormously in our experience of past revalidations because there just aren’t enough representatives to make this happen. So, the applications are stalled while awaiting confirmation of the site visit.

The Good News… 

For those who complete the application and submit it within the required sixty-day deadline, the good news is the ambulance company’s Medicare PTAN stays active and reimbursement dollars continue to flow as normal while the application is being processed with absolutely no interruption.

With that in mind, no one really cares how long it takes the MAC to complete the process as long as the dollars continue to flow. So, bottom line….it is enormously important that the application be submitted ON TIME!!

There is a Fee ($$) 

To make all this happen, the ambulance company will need to pay CMS a fee of $523.00. Apparently this takes care of paying for the site visit ($523.00 to drive to an ambulance station and take a picture? – Wow!)

This fee can only be paid using an online payment system set-up by CMS. The fee must be paid via credit card or it can be withdrawn via ACH from the bank account of choice. It is important, though, that the name of the company matches exactly with the name as submitted on the CMS-855B form in order that the payment can be matched upon arrival of the application in the MAC’s hands.

When making the payment it is important that the payment confirmation be printed, including both the screen acknowledgement at the end of the process and the e-receipt that is returned via e-mail following the online payment submission process.

The Unwritten Part 

The application itself doesn’t appear to be daunting, on the surface. However, it’s the unwritten part of the process that trips up most application preparers.

Lost in the “small print” of the process, if you will, are all the little quirky requirements that go along with the application process. It’s these things that cause the application to initially be rejected and notification returned from the MAC for “development” to obtain these bits of information and items.  This is not only the “stuff” that will take the most time to gather but failure to produce the items in a timely fashion can cause the application to either drag on for what seems like forever or ultimately to be rejected and then comes the dreaded “deactivation” process once again.

Seek Help 

You need help if you’ve never completed one of these applications in the past. Enhanced clients have the benefit of our experienced staff which will gather and complete the application process on behalf of all of our clients.

If your billing contractor isn’t helping you; you need to find one that will.

Don’t mess with this process if you are unsure about what you are doing.

If you bill in-house and don’t outsource to a contractor, seek outside help if you’re unsure about the process.  If you don’t get this right, the worst will happen and your Medicare dollars will come to a screeching halt. In addition, you want to be sure that you fulfill all of the requirements completely and accurately.

Your Medicare information profile supports your ability to bill and fulfill compliance regulations across your entire Medicare experience. Information that doesn’t match-up or correlate with other company filings (IRS, NPPES, State, Local Government) can cause big problems down the road for your ambulance company.

We’re Here 

Our current clients can expect to receive a packet via e-mail to assist you in providing Enhanced with the information we need to complete the process on your behalf. Just watch your e-mail inbox.

If you’re not an Enhanced client, what are you waiting for? Drop me an e-mail today at chumphrey@enhancedms.com or visit our website at www.enhancedms.com  to contact us. We’ll guide you through the process and spec out a top-notch, cutting-edge billing program for your ambulance company that will propel your organization into the future.
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