At 1ˢᵗ Credentialing we know that when our clients place their trust in us, we take that responsibility seriously by communicating with our clients to create a transparent and collaborative partnership.
Healthcare organizations of every size realize that hiring 1ˢᵗ Credentialing is the most economical and efficient way to solve their credentialing needs. We have the training, expertise and commitment it takes to keep a complex process moving forward at all times.
1ˢᵗ Credentialing supports healthcare practices of all sizes - from health systems, to community hospitals, to large group practices, to smaller organizations. We help get your providers up and practicing as fast as possible.
Learning more about the credentialing process benefits us and our clients. 1ˢᵗ Credentialing offers regular videos and newsletter updates to bring our clients and those interested in innovations in credentialing up to speed.
Upcoming Change to Medicare Enrollment Requirement for Medicare Parts C and D Providers
The Centers for Medicare & Medicaid Services (CMS) has announced a change in the requirement that providers and suppliers contracting with Medicare Advantage (MA) plans (Medicare Part C), and those who prescribe drugs covered by Medicare Part D programs, must be enrolled in Medicare.
Effective January 1, 2019, the regulations specify that CMS rely on a “Preclusion List” to eliminate those providers, prescribers and suppliers who are ineligible to provide services or items under the programs.
The requirement that prescribers be enrolled in Medicare if they want to prescribe medications for covered Part D drugs goes back to 2014. Then in 2016 CMS implemented another rule that mandated that all providers and suppliers furnishing health care services or items to MA plan members be enrolled in Medicare by 2019.
Impact of the Medicare Advantage Final Rule
In the MA Final Rule, released on April 2, this requirement is eliminated. The new regulations prohibit MA plans from paying for services provided by health care providers and suppliers that are included in a “Preclusion List,” and also require that a pharmacy claim for a Part D drug be rejected if the prescriber is on the “Preclusion List.”
The “Preclusion List” will be compiled by CMS and will be separate and distinct from the OIG Exclusion List. Basically, those on the “Preclusion List” will be providers and suppliers who are currently revoked from Medicare orwho have engaged in behavior that might have caused revocation, and those whose conduct is detrimental to the best interests of Medicare as determined by CMS.
The impact of the new rule should be positive, including greater flexibility to those providers, suppliers and prescribers not enrolled in Medicare by allowing them to provide services to MA plan members. The burden of enrollment will be somewhat eased as well.
Let Us Manage All Your Payer Enrollment Services
If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.
Our credentialing experts are here to help you assess exactly which solutions you need and let you know how inexpensively we could put you on the right track. 1ˢᵗ Credentialing includes primary source verification and payor enrollment for all insurance networks including Medicare, Medicaid, Medi-Cal and insurance networks. Don’t wait another minute, contact our terrific team today!