The contractor shall adhere to all of the instructions in this chapter 15 (hereafter generally referred to as “this chapter”) and all other CMS provider enrollment directives (e.g., Technical Direction letters). The contractor shall also assign the appropriate number of staff to the Medicare enrollment function to ensure that all such instructions and directives - including application processing timeframes and accuracy standards - are complied with and met.
A. Training
The contractor shall provide (1) training to new employees, and (2) refresher training (as necessary) to existing employees to ensure that each employee processes enrollment applications in a timely, consistent, and accurate manner. Training shall include, at a minimum:
• An overview of the Medicare program
• A review of all applicable regulations, manual instructions, and other CMS guidance
• A review of the contractor’s enrollment processes and procedures
• Training regarding the Provider Enrollment, Chain and Ownership System (PECOS).
For new employees, the contractor shall also:
• Provide side-by-side training with an experienced provider enrollment analyst
• Test the new employee to ensure that he or she understands Medicare enrollment policy and contractor processing procedures, including the use of PECOS
• Conduct end-of-line quality reviews for 6 months after training or until the analyst demonstrates a clear understanding of Medicare enrollment policy, contractor procedures, and the proper use of PECOS.
B. PECOS
The contractor shall:
• Process all enrollment actions (e.g., initials, changes, revalidations) through PECOS
• Deactivate or revoke the provider or supplier’s Medicare billing privileges in the Multi-Carrier System or the Fiscal Intermediary Shared System only if the provider or supplier is not in PECOS
• Close or delete any aged logging and tracking (L & T) records older than 120 days for which there is no associated enrollment application
• Participate in user acceptance testing for each PECOS release
• Attend scheduled PECOS training when requested
• Report PECOS validation and production processing problems through the designated tracking system for each system release
• Develop (and update as needed) a written training guide for new and current employees on the proper processing of Form CMS-855 applications and the appropriate entry of data into PECOS.
C. Validation and Processing
The contractor shall:
• Review the application to determine whether it is complete and that all information and supporting documentation required for the applicant's provider/supplier type has been submitted on and with the appropriate enrollment application. Unless stated otherwise in this chapter or in another CMS directive, the provider must complete all required data elements on the Form CMS-855 via the application itself.
• Unless stated otherwise in this chapter or in another CMS directive, verify and validate all information collected on the enrollment application
• Coordinate with State survey/certification agencies and regional offices (ROs), as needed
• Collect and maintain the application's certification statement (in house) to verify and validate Electronic Funds Transfer (EFT) changes in accordance with the instructions in this chapter and all other CMS directives.
• Confirm that the applicant, all individuals and entities listed on the application, and any names or entities ascertained through other sources, are not presently excluded from the Medicare program by the HHS Office of the Inspector General (OIG) or through the System for Award Management.
D. Customer Service
Excluding matters pertaining to application processing (e.g., development for missing data) and appeals (e.g., appeal of revocation), the contractor is encouraged to respond to all enrollment-related provider/supplier correspondence (e.g., e-mails, letters, telephone calls) within 30 business days of receipt.
A. Training
The contractor shall provide (1) training to new employees, and (2) refresher training (as necessary) to existing employees to ensure that each employee processes enrollment applications in a timely, consistent, and accurate manner. Training shall include, at a minimum:
• An overview of the Medicare program
• A review of all applicable regulations, manual instructions, and other CMS guidance
• A review of the contractor’s enrollment processes and procedures
• Training regarding the Provider Enrollment, Chain and Ownership System (PECOS).
For new employees, the contractor shall also:
• Provide side-by-side training with an experienced provider enrollment analyst
• Test the new employee to ensure that he or she understands Medicare enrollment policy and contractor processing procedures, including the use of PECOS
• Conduct end-of-line quality reviews for 6 months after training or until the analyst demonstrates a clear understanding of Medicare enrollment policy, contractor procedures, and the proper use of PECOS.
B. PECOS
The contractor shall:
• Process all enrollment actions (e.g., initials, changes, revalidations) through PECOS
• Deactivate or revoke the provider or supplier’s Medicare billing privileges in the Multi-Carrier System or the Fiscal Intermediary Shared System only if the provider or supplier is not in PECOS
• Close or delete any aged logging and tracking (L & T) records older than 120 days for which there is no associated enrollment application
• Participate in user acceptance testing for each PECOS release
• Attend scheduled PECOS training when requested
• Report PECOS validation and production processing problems through the designated tracking system for each system release
• Develop (and update as needed) a written training guide for new and current employees on the proper processing of Form CMS-855 applications and the appropriate entry of data into PECOS.
C. Validation and Processing
The contractor shall:
• Review the application to determine whether it is complete and that all information and supporting documentation required for the applicant's provider/supplier type has been submitted on and with the appropriate enrollment application. Unless stated otherwise in this chapter or in another CMS directive, the provider must complete all required data elements on the Form CMS-855 via the application itself.
• Unless stated otherwise in this chapter or in another CMS directive, verify and validate all information collected on the enrollment application
• Coordinate with State survey/certification agencies and regional offices (ROs), as needed
• Collect and maintain the application's certification statement (in house) to verify and validate Electronic Funds Transfer (EFT) changes in accordance with the instructions in this chapter and all other CMS directives.
• Confirm that the applicant, all individuals and entities listed on the application, and any names or entities ascertained through other sources, are not presently excluded from the Medicare program by the HHS Office of the Inspector General (OIG) or through the System for Award Management.
D. Customer Service
Excluding matters pertaining to application processing (e.g., development for missing data) and appeals (e.g., appeal of revocation), the contractor is encouraged to respond to all enrollment-related provider/supplier correspondence (e.g., e-mails, letters, telephone calls) within 30 business days of receipt.
No comments:
Post a Comment