Presented by Eide Bailly with special guest speakers from the Centers for Medicare & Medicaid Services’ Provider Enrollment and Oversight Group
The Medicare Provider Enrollment Compliance Conference (MPECC), is a 3-1/2-day event providing the most comprehensive, in-depth, valuable guidance available on enrolling as a Medicare provider and/or supplier, maintaining enrollment privileges and the compliance risks associated with it.
MPECC features keynote sessions and panel discussions with Centers for Medicare & Medicaid Services (CMS) officials.
MPECC is presented by Dennis Grindle and Gretchin Heckenlively of Eide Bailly, the nation’s foremost experts on Medicare provider enrollment. Special guest speakers include leadership of the CMS Provider Enrollment and Oversight Group. You will get the most up-to-date guidance and hear directly from CMS on the latest changes to Medicare provider enrollment, including the new Final Rule on Program Integrity Enhancement to the Provider Enrollment Process.
This event also provides direct access to CMS officials, representatives from the Medicare Administrative Contractors (MACs), and the PECOS development contractor, at designated stations directly outside the meeting space.
Who Should Attend
► Billing, credentialing, and any other staff, at provider organizations responsible for completing the Medicare provider enrollment forms
► Provider and supplier organizations, including: physician practices, hospitals, home health agencies, SNFs, rural health clinics, federal qualified health centers, ambulatory surgery centers, independent diagnostic testing facilities, and many others
► Physicians and non-physician practitioners
Speakers
Dennis Grindle, CPA
Healthcare Consulting Partner, Eide Bailly
Dennis Grindle specializes in healthcare with specific focus on Medicare provider enrollment (CMS-855 forms), Medicare provider-based regulatory compliance and related Medicare reimbursement and regulatory compliance for all Medicare provider/supplier types. He has spoken on these topics at the local, state and national level with CMS, Medicare contractors and state agencies, for the past 20 years. Dennis serves on the CMS Central Office PECOS Focus and Provider Compliance Focus Groups, and is a member of the American Institute of Certified Public Accountants, Nebraska Society of Certified Public Accountants, Nebraska Chapter of HFMA and the Iowa and Nebraska MGMA organizations.
Gretchin Heckenlively, CPA
Healthcare Consulting Partner, Eide Bailly
Gretchin Heckenlively specializes in healthcare consulting, Medicare and Medicaid provider enrollment, provider-based, reimbursement and billing. She has given numerous presentations on a wide range of healthcare related topics at a local, state and national level and currently serves on the CMS PECOS Focus Group and CMS Provider Compliance Group. She is a member of the American Health Lawyers Association, American Institute of Certified Public Accountants, the Nebraska Society of Certified Public Accountants and an active member of the Healthcare Financial Management Association where she is the past President of the Nebraska Chapter, the Treasurer of HFMA Region 8 and a recipient of the HFMA Muncie Gold Award.
Zabeen Chong
Director, CMS Provider Enrollment and Oversight Group
Zabeen Chong serves as the Director for the Provider Enrollment and Oversight Group in the Center for Program Integrity at CMS. Zabeen is responsible for leading initiatives to streamline provider screening and enrollment for over two million providers and implementing policies and systems to prevent fraud and abuse in the Medicare and Medicaid programs. This includes the development of Medicare and Medicaid provider enrollment operating policy and procedures, enumeration of provider applicants, oversight of the Provider Enrollment Chain & Ownership System, and providing outreach and education to the provider community. She is also responsible for the identification of vulnerabilities and implementation of administrative action processes directed at protecting Medicare and Medicaid provider enrollment. Prior to her current position, she served as the Director of the Website Project Management Group in the Office of Communications at CMS where she led the redesign and implementation of new technologies onwww.medicare.gov and www.cms.gov as well as other web-based initiatives critical to advancing CMS’ mission and operations. Zabeen has a Master’s degree in Information Technology from the Johns Hopkins University and has worked at CMS for over 15 years.
Charles Schalm
Deputy Group Director, CMS Provider Enrollment and Oversight Group
Charles Schalm serves as the Deputy Director for the Provider Enrollment & Oversight Group at the Center for Program Integrity at CMS. He is responsible for overseeing the federal screening, enrollment, and implementation of enforcement actions for over two million providers and suppliers that serve over 60 million Medicare beneficiaries.
Prior to joining CMS, Charles spent over ten years as a Program Integrity Director for Medicare and Medicaid, and eight years in the private sector working with Medicaid managed care organizations in Pennsylvania and Michigan. Charles graduated from Duquesne University in Pittsburgh, PA where he studied business and forensic investigation. He previously served on the Medicare/Medicaid Healthcare Drug Taskforce where federal agencies and private organizations came together to tackle the onset of the opioid epidemic.
Vani Annadata
Director for the Division of Enrollment Systems, CMS Provider Enrollment and Oversight Group
Vani Annadata serves as the Director of the Division of Enrollment Systems within the Provider Enrollment and Oversight Group in the Center for Program Integrity at CMS. She is responsible for overseeing the National Medicare Provider Enrollment System (PECOS), the National Plan & Provider Enumeration System (NPPES) and the provider enrollment screening system. Vani has been with CMS for over eleven years. She has an extensive background in software and systems development for over 15 years in private sector and holds a degree in Engineering.
Joseph Schultz
Deputy Director for the Division of Enrollment Policy & Operations, CMS Provider Enrollment and Oversight Group
Joseph Schultz serves as a Deputy Director of the Division of Enrollment Policy and Operations within the Provider Enrollment and Oversight Group in the Center for Program Integrity at CMS. Mr. Schultz is responsible for developing enrollment policies and working with the Medicare Administrative Contractors (MACs) and other stakeholders on provider enrollment and program integrity related issues. He has over 12 years’ experience in Medicare for both the public and private sector. Joseph has a Master’s degree in Healthcare Administration from Utica College in NY and undergraduate degree from the State University of New York at Cortland.
Adam Rubin, Esq.
Senior Technical Advisor, CMS Provider Enrollment and Oversight Group
Adam Rubin serves as a senior technical advisor in the Provider Enrollment & Oversight Group in the Center for Program Integrity at CMS. He is responsible for assisting in the development of new program integrity regulations and statutes to further bolster CMS’s mission of curbing fraud, waste, and abuse in the Medicare and Medicaid programs. Prior to joining CMS in 2016, Adam practiced as an Estates and Trusts attorney in Towson, MD. As a certified mediator, he has mediated workplace disputes under the umbrella of the Federal Shared Neutrals program. Adam received his J.D. from the University of Maryland Francis King Carey School of Law.
Conference Schedule
Agenda is subject to change
April 24, 2023 5:00 - 6:00 pm
Registration and Check-in
Beat the rush in the morning and drop by the North Ballroom Lobby to register or check-in and pick up your badge.
Registration and Check-In
Welcome
Dennis Grindle
Medicare Provider Enrollment Basics
Gretchin Heckenlively
Whether you are a Medicare Provider Enrollment novice or a seasoned veteran, a refresher on knowing the Medicare Provider Enrollment Basics is essential for not only preparing new enrollments, completing revalidations or maintaining proper enrollment disclosures. This session will provide an introduction to the Medicare Enrollment process by reviewing key definitions and acronyms, the CMS Enrollment Forms available for the different provider and supplier types, differing types of business structures that impact form disclosures and NPI enumeration considerations. This session will conclude with a review of a frequent enrollment scenario so you can build your own internal list of items necessary for completion.
– Discuss the overall Medicare enrollment process and resources available to assist with proper disclosures.
– Define which provider/suppliers are eligible to enroll in the Medicare program and the types of enrollment forms which should be utilized.
– Summarize the provider, enrollment, chain, and ownership system (PECOS) and how use of the online system will improve the accuracy of enrollment submissions and faster processing timelines.
– Examine how the type of organizational structure impacts reporting disclosures for organizational and individual control/ownership.
Coffee Break
Medicare Provider Enrollment Basics (continued)
Gretchin Heckenlively
Lunch (on your own)
Know the Enrollment Risks and Consequences – and How to Mitigate Them
Dennis Grindle and Gretchin Heckenlively
Once you have an understanding of the Medicare Enrollment Basics and are ready to start preparing forms, the next step is knowing when applications must be submitted, supporting documents to be included, etc. to secure the enrollment effective date desired. This session will walk through the Medicare Enrollment process by provider/supplier type and considerations needed for each, so you know when to expect to bill and be reimbursed for services rendered.
– Identify the timelines for submission of the CMS enrollment forms and how effective dates are established.
– Explore the difference between Provider and Participation Agreements and in which situations they apply to ensure full reimbursement from the Medicare program.
– Analyze the timeframes for reporting Medicare enrollment updates once applications are approved.
– Assemble a listing of errors common to the preparation of each Medicare 855 enrollment form so you do not fall victim to the same mistakes.
Afternoon Refreshment Break
Uncover Medicare Billing Compliance Pitfalls Hidden in Enrollment Forms
Dennis Grindle
The Medicare enrollments are not just forms to be completed by anyone willing to pick them up. There are hidden compliance risks throughout the forms which can put you and your organization at risk if not addressed during the preparation process. This session will set forth some of the hidden compliance risks within the forms and how to address when planning for your next submission.
– Assess the Medicare reassignment rules, accepting assignment and who can accept payments. This includes the common questions on billing for locums coverage (now called Fee-For-Time Compensation Arrangements).
– Classify Medicare’s “Incident To” rule and where and when it can be applied.
– Define the relationships between Medicare’s place of service codes and how practice locations are disclosed.
– Explain how reporting of organizational control/ownership on the enrollments impact Medicare’s 3-day payment window.
Q&A Session
Registration and Check-In
Welcome to CMS Officials
Dennis Grindle
CMS Keynote: Present and Future of Provider Enrollment
Zabeen Chong and Charles Schalm
The best part of starting your day is with a keynote address from the Directors of the CMS Provider Enrollment and Oversight Group. You won’t want to miss all of the updates and insights they will provide. We haven’t received an update from this group since 2019, so there is plenty to share. Expect this presentation to provide an overall State of the Medicare Provider Enrollment program, including changes made as a result of the public health emergency and what to expect once it ends. CMS will also share the most recent changes they have been working on, including rollout of the PECOS 2.0 platform.
– Explore with CMS on recent changes to the Medicare Provider Enrollment program, including updates to the Medicare Program Integrity Manual
– Summarize the provider enrollment initiatives CMS has been working on and when to expect full implementation of activities once the COVID-19 PHE ends.
– Theorize the status of the PECOS 2.0 platform and when CMS expects rollout.
Meet with Your Medicare Administrative Contractor (MAC), CGI Federal (PECOS), and CMS
CMS Keynote (Continued)
Zabeen Chong and Charles Schalm
Lunch (on your own)
Guidance on Program Integrity Enhancements to the Provider Enrollment Process
Adam Rubin
CMS has issued a number of provider enrollment regulations over the last several years. Some of the regulations involve measures CMS put in place to address the COVID-19 public health emergency (PHE). Others reflect permanent changes that will continue to impact providers and suppliers in a post-PHE world. Hear from CMS on key regulations that have been promulgated since early 2019.
– Explain changes to the enrollment procedures, provider-specific policies, administrative actions and more.
– Define how the new regulations pertain to you as a practitioner, organization compliance specialist, or other professional in the healthcare arena.
Medicare Revalidations: Steps to Take to Protect Your Medicare Billing Privileges
Gretchin Heckenlively and Joseph Schultz
Prior to the COVID-19 PHE, Medicare revalidations were nearing the end of Cycle II of the revalidation process, with many more revalidations yet to be requested. For a brief time during 2020, Medicare revalidations were put on hold. During the PHE, CMS is requesting revalidations to be completed, but is not taking any enforcement actions for those revalidations which are missed or are submitted late. This presentation will discuss the current state of the Medicare revalidations and what to expect once the COVID-19 PHE ends so you can prepare your organization for the upcoming/continued revalidation requests.
– Define the current Medicare revalidations requirements and enforcement policies to ensure your Medicare enrollments remain active and pay-holds are avoided.
– Examine the plans for finalizing the Cycle II revalidation process and the impact of the on future revalidation phases, directly from CMS.
– Discuss the online tools available to monitor when revalidations may come due for your organizations and practitioners.
Meet with Your Medicare Administrative Contractor (MAC), CGI Federal (PECOS), and CMS
Panel Q&A: Ask Your Toughest Questions
Zabeen Chong, Charles Schalm, Dennis Grindle, and Gretchin Heckenlively
Welcome Reception
PECOS I&A Surrogacy Access: What You Need to Know to Get Your Organization and Practitioners Established
Gretchin Heckenlively and Vani Annadata
Breakout Session: Room North 120A
Are you utilizing a practitioner’s individual login when accessing NPPES and PECOS to create or maintain their Medicare enrollment information? CMS has been very clear that only the practitioner, no one else, should be using their login and all other individuals or organizations assisting the practitioner with these updates should be utilizing their own individual login. With regulatory requirements to add endpoints to practitioners’ NPIs, Medicare Advantage plans utilizing NPIs as provider directories and implementation of the Multi-Factor Authentication in PECOS, now is the time to properly set up your organization to manage your practitioner enrollments/NPIs as a surrogate. This presentation will walk you through the PECOS Identity & Access roles available, proper set up for your organization and how to request and receive approval for surrogacy to easily manage enrollments/NPIs of practitioners or other organizations.
– Analyze the PECOS Identify & Access Management System and the proper roles for compliant set up of your organization
– Examine how to create your own individual PECOS I&A login and how to request surrogacy access on behalf of practitioners
– Identify how to compliantly manage multiple practitioner Medicare enrollments and NPIs under your single login
– Demonstrate how to access your organization or practitioner Medicare enrollments to easily make required updates, establish reassignments or revalidate an enrollment record
– Explain how to easily add, remove or manage staff in PECOS I&A to ensure only the proper individuals have access
Medicare’s Provider-Based Regulations
Dennis Grindle
Breakout Session: Room North 120B
What does provider-based mean and what are its benefits? What types of providers does this apply to? What are the requirements that must be met? Can you still establish new provider-based hospital outpatient departments? What are the reimbursement considerations? How are the 855A and 855B forms impacted? This and much more will be covered during this session.
– Critique the provider-based terminology and how to hang on regulatory language that impacts what criteria must be satisfied
– Discuss the types of providers that can benefit from this regulation but also those that cannot.
– Analyze the provider-based definitions of on and off-campus but also how those definitions differ for section 603 payment purposes.
– Identify the requirements which must be met.
– Explore the consequences to a critical access hospital if they do not understand their CoP location requirements when establishing separately addressed off-campus hospital outpatient
Meet with Your Medicare Administrative Contractor (MAC), CGI Federal (PECOS), and CMS
Medicare Enrollment Considerations related to Telehealth, Telemedicine, Tele-what?
Dennis Grindle and Gretchin Heckenlively
Both organizations and patients are looking for more efficient ways to provide and receive healthcare services. Telehealth is becoming a popular option especially due to the location and geographic waivers which have been allowed by CMS during the COVID-19 PHE. There is an increasing trend of telemedicine practitioners providing professional services from their homes. Did you know that Medicare claims must be submitted to the MAC for the service area where the distant site practitioner is located? This session will walk you through the Medicare enrollment and billing considerations when distant site telehealth or telemedicine services are performed in other than your home state.
– Summarize the CMS jurisdiction rules and submission of enrollments and claims for telehealth or telemedicine distant site practitioners
– Illustrate how telehealth and telemedicine services can impact global billing
– Assemble the unique considerations for each State’s Medicare Physician Fee Schedule pay localities, reasonable charge localities and how, in some cases, CMS MAC contracts can impact the PTANs assigned by practice location.
Lunch (on your own)
Expert Guidance on Completing Form CMS-855B
Dennis Grindle, Gretchin Heckenlively and CGI representative
This presentation will walk you through each section of the paper Form CMS-855B and provide you guidance and tips for completion using real life situations and scenarios, while CGI Federal simultaneously shows how to complete online in PECOS. Whether you complete your enrollments only on paper or would like to try your hand at completing in PECOS, both the paper and online versions will be demonstrated. Throughout the presentation, you will hear the most current tips for getting your enrollments processed the first time to avoid development requests and cash flow delays.
– Examine which types of suppliers complete the Form CMS-855B and which sections are appliable to each.
– Generalize how to review your organizational documents to determine how to report organization and individual ownership/control by enrollment type.
– Discuss what supporting documentation may be required for submission with the Medicare enrollment in order to processed by the MAC
*Please note sections which are similar between the various enrollment forms will not be demonstrated in later sessions. i.e. practice locations, organizational control, individual control, etc.
Meet with Your Medicare Administrative Contractor (MAC), CGI Federal (PECOS), and CMS
Expert Guidance on Completing Form CMS-855S
Dennis Grindle, Gretchin Heckenlively and CGI representative
This presentation will walk you through sections unique to the Form CMS-855S and provide you guidance and tips for completion using real life situations and scenarios, while CGI Federal simultaneously shows how to complete online in PECOS. Throughout the presentation, you will hear the most current tips for getting your enrollments processed the first time to avoid development requests and cash flow delays.
– Determine when a DMEPOS enrollment may be needed in order to bill product and services
– Demonstrate when licensure, accreditation, surety bond and other requirements must be met prior to applying as a DMEPOS supplier.
– Summarize recent changes to the DMEPOS enrollment MACs and know which jurisdiction is applicable for your organization for proper submission of enrollments.
– Identify what supporting documentation unique to DMEPOS enrollments may be required for submission in order to processed by the MAC
Panel Q&A: Ask Your Toughest Questions
Zabeen Chong, Charles Schalm, Dennis Grindle, and Gretchin Heckenlively
Expert Guidance on Completing Form CMS-855I&R
Dennis Grindle and Gretchin Heckenlively
This presentation will walk you through how to complete the Form CMS-855I and Form CMS-855R for practitioners, including guidance and tips for completion using real life situations and scenarios, while simultaneously demonstrating how to complete online in PECOS. Throughout the presentation, you will hear the most current tips for getting your enrollments processed the first time to avoid development requests and cash flow delays.
– Determine when to complete a Form CMS-855I and/or a Form CMS-855R based on the type of practitioner or based on how the practitioner is currently enrolled in the Medicare program.
– Explore considerations for sole proprietors, sole owners and practitioners only reassigning their rights to bill impacts the completion of the Form CMS-855I.
– Identify multiple ways to complete practitioner reassignments within the PECOS program
Coffee Break
Expert Guidance on Completing Form CMS-855A
Dennis Grindle and Gretchin Heckenlively
This presentation will walk you through sections unique to the Form CMS-855A and provide you guidance and tips for completion using real life situations and scenarios, while simultaneously demonstrating how to complete online in PECOS. Throughout the presentation, you will hear the most current tips for getting your enrollments processed the first time to avoid development requests and cash flow delays.
– Define which types of providers and certified suppliers complete the Form CMS-855A and which sections are applicable to each.
– Differentiate the compliance risks areas hidden within the form.
– Analyze the interrelationship between the Form CMS-855A and the Form-855B when practice locations become hospital outpatient departments.
– Explain what supporting documentation may be required for submission with the Medicare enrollment in order to processed by the MAC
Adjourn
Registration
$ 1,495
Regular Registration
After March 24, 2023
Plan Your Trip
The Medicare Provider Enrollment Compliance Conference will be held at the Phoenix Convention Center, North Building, in downtown Phoenix, Arizona. The General Sessions will be held in the North Ballroom – 120A. Breakout Sessions will be in the North Ballroom – 120A and 120B.
Venue
Phoenix Convention Center
The convention center is just four miles from Sky Harbor International Airport. You’ll have multiple transportation options, including shuttles, taxis, sedans or the Metro Light Rail, which has dedicated stops at the Convention Center.
Once you’re here you can walk to almost everything you’ll need. Walk a few blocks in any direction and you’ll find dining, entertainment, shops and cultural attractions. You’ll find downtown Phoenix a walkable welcoming city.
100 N 3rd St Phoenix, AZ 85004
Nearby Accomodation
Hotels
We do currently have a small block of rooms at the Sheraton Phoenix Downtown. If you would like to stay at the Sheraton please feel free to click here and make a reservation while supplies last.
There are more than 3,000 hotel rooms in downtown Phoenix that are within walking distance of our front doors and more than 6,000 hotel rooms located along the light rail system. Getting to your hotel via the Light Rail is fast and easy as it directly serves the Convention Center and Sky Harbor International Airport.
When you register for the conference, be sure to book your hotel. We recommend using a website, such as TripAdvisor, to search for the hotels nearest the Convention Center.
100 N 3rd St Phoenix, AZ 85004
Dining
There are more than 150 restaurants within walking distance of the convention center. A half dozen restaurants within walking distance have appeared on national food shows. Plus, you’ll find some local gems serving fresh farm to table options. Ask an Ambassador or Venue Host for suggestions to one of the many options available.