The American Health Lawyers listserv released yesterday, there are numerous revocations across physician, physician groups, and DME providers for failure to respond to 855 validation or update requests or the provider was not open or available during a sight visit. Please ensure you or your staff open mail in a timely manner! Be sure you take immediate action on any requests from Medicare. Medicare periodically requests for updates, validation or new 855 payor applications be completed. If the Medicare contractor does a sight visit, you must have hours posted and the door must be unlocked and the person greeted, if it is during your business hours. Likewise, if you are closed for vacation, post a sign on the door & answering service vacation dates and who patients should see in an emergency. This may have come as a PECOS notice. Think of PECOS as your online 855 submission and application management. Educate your staff to review mail timely and notify you immediately of any requests from Medicare for any response, forms, documentation. You as the business owner need to review it or have it reviewed.
It seems every time we turn around there is bad news to deliver to health care providers. This is a very scary time from audits, revocations, reimbursement cuts along with legible documentation and getting patients to come into the office for an in-person visit when they are physically not capable. The industry is facing challenges.
Medicare must be notified if you move because they mail requests to the address on file. Remember, an invalid telephone number or area code can result in revocation as well. Likewise, the post office does not always deliver the mail and they do not send communication with a tracking number!
You have 30 days to submit a corrective action plan, but be proactive and do it immediately! The Corrective Action Plan form can be located via the MAC contractor website. If the Correction Action Plan is denied, there is no appeal!
It is crucial for you to keep your provider number because without it you will not be reimbursed and are subject to loosing other payor contracts. You have to get your number placed in good standing, but this can be a long process. They also do not have to activate it back to the date it was turned off. If you need help completing or validating the 855 application or working an appeal, we can help you in a cost effective manner. We work with several health care law firms that can assist you also. Be sure no matter who you have help you, they have experience with the application process, understand the health care industry and/or are health care attorneys.
I feel like I need to have a drink or joke of the week blog so I can bring some good uplifting news.
Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, auditing, billing, collections and HIPAA for over 18 years. Ms. Miller has made it the focus of the business to help providers run their businesses efficiently, collect money, and maintain compliance with federal and state regulations and coverage criteria. Ms. Miller is very experienced with Medicare & Payer audits. Ms. Miller ran a very successful compliance program for over 5 years for the largest private held HME/Pharmacy provider in the US at the time. Ms. Miller also works as a contract compliance officer to provide an avenue to compliance training to staff, implementation of policies, as well as handling anything that affects cash flow from the initial intake to back-end collections. You can visit our website at Medical Auditing Solutions LLC.
