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.
Finalizing this rule has been a long drawn-out process, as it was first proposed in 2016. CMS cites provider burden concerns voiced during the proposed rule’s comment period as one of the reasons for the delay.
The new law which takes effect on November 4, 2019, greatly expands CMS’s ability to address fraud. Currently limited to a reactive mode by primarily recovering fraudulent payments after they are issued, the new process will actually allow CMS to block potential fraudsters from participating in these plans, thereby preventing fraud before it even begins.
Providers must gather documents about their affiliations in order to comply with the new rule.
Providers and Suppliers Must Disclose Certain Affiliations
Medicare, Medicaid and CHIP providers must disclose any current or former, direct or indirect affiliations with any provider that:
Has been or currently is excluded from Medicare, Medicaid or CHIP by the U.S. Department of Health and Human Services’ Office of Inspector General,
Has been or currently is subject to suspension of payments under a federal health care program,
Has had its Medicare, Medicaid or CHIP billing privileges denied or revoked, or
Has uncollected debt.
The same process applies to Medicare, Medicaid and CHIP suppliers.
The rule also allows CMS to revoke or reject a provider’s or supplier’s Medicare, Medicaid or CHIP enrollment based on their affiliations with an organization that has had its enrollment revoked.
Final Rule Imposes Additional Rules on Medicare Enrollment
Under the new rule, CMS can deny or revoke Medicare enrollment if a provider or supplier:
Reenrolls or attempts to re-enroll in Medicare under a different name in order to bypass Medicare rules,
Bills for services or items from non-compliant locations,
Shows a pattern or practice of abusive ordering or certifying of Medicare Part A or Part B drugs, items or services, or
Owes an outstanding debt to CMS from an overpayment that was referred to the U.S. Department of the Treasury.
There are additional components to the final rule that apply to providers or suppliers that have submitted false or misleading information in their Medicare applications and the period of time that CMS can bar fraudulent providers from re-entering Medicare.
CMS states that it would have saved more than $20 billion over the last five years if these rules had been in place. The agency estimates that 2,600 providers will withdrawal from federal health programs which will save more than $4 billion over 10 years.
Let Us Manage All Your Payer Enrollment and Credentialing 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, Vice President of Credentialing, 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 to put you on the right track. 1ˢᵗ Credentialing includes payor enrollment for all insurance networks. Don’t wait another minute, contact our team today!