The process of enrolling with Medicare and Medicaid Managed Care as a provider/organization can be incredibly tedious and time-consuming. The number of new Medicare and Medicaid enrollment applications continues to decline due to the enormous complexities surrounding enrollment application requirements. The cost of getting these enrollment application submissions wrong can have systemic consequences on an organization, including cash flow delays, credentialing issues, coding issues, claims backlogs, denial management issues, patient satisfaction, and even impact quality scores. In 2024, Medicare opened the enrollment gates for new mental health providers (MFTs and MHCs) that had previously been excluded from providing services to Medicare beneficiaries. In today's webinar, we discuss the submission options, which providers are eligible for Medicare and Medicaid enrollment, each enrollment type, how to navigate the enrollment process, key terminology, what ancillary documentation is needed with enrollment submission, applicable fees, linkage issues with PTAN numbers, most common errors, and best practice tips for successfully completing the Medicare and Medicaid enrollments in 2024. Learning Objectives Understand the CMS 855 enrollment submission process for 2024. Recall CMS 855A, 855B, and 855I Application requirements for 2024. Recall the most complicated sections on the 855 applications for 2024. Recall strategies to complete 855 forms accurately for 2024. Recall ancillary documentation required with 855 enrollment submissions for 2024. Avoid common rejections and errors with 855 form submissions. Recall best practice tips for 855 form submissions for 2024. Areas Covered Dissect the various Medicare and Medicaid enrollment types in 2024. Outline a sample workflow for completing Medicare enrollment. Outline a sample workflow for completing Medicaid Managed Care enrollment. Review enrollment forms for Medicare and Medicaid. Discuss the most challenging Medicare and Medicaid enrollment sections for 2024. Discuss strategies to complete the Medicare and Medicaid enrollment forms accurately for 2024. Review the process of reassigning Medicare benefits to organizations for 2024. Review the ancillary documentation required with Medicare and Medicaid enrollment submission for 2024. Discuss the most common rejections and errors with Medicare and Medicaid enrollment form submissions for 2024 Register Now, https://conferencepanel.com/conference/medicare-and-medicaid-managed-care-enrollments

1. Medicare and Medicaid
Managed Care Enrollments
in 2024
PRESENTED BY:
TONI ELHOMS, CCS, CPC, CPMA, CRC,
CEMA, AHIMA-APPROVED ICD-10-CM / PCS
TRAINER
1

2. Toni Elhoms, CCS, CRC, CPC, CPMA,
CEMA, AHIMA Approved ICD-10-
CM/PCS Trainer
❑ CEO – Alpha Coding Experts
❑ Podcast Host – Alpha Coding Podcast
❑ National Speaker - Coding, Compliance, and
Reimbursement SME
❑ Former President of Orlando, FL AAPC Chapter
❑ Expert Witness
❑ Published Author
❑ Consultant/Educator/Trainer
2

3. Agenda
High-level overview of Medicare and Medicaid Programs
Discuss the 2024 Medicare and Medicaid Enrollment Updates
Review common enrollment challenges with Medicare and Medicaid
Compliance Considerations
Q&A at the end
3

4. Medicare
❑ Federal Healthcare Program
❑ Signed into law in 1965 under the Social Security
Administration
❑ Primarily for US Citizens ages 65+
❑ Initial enrollment typically starts three months before turning 65
❑ Also includes younger individuals and certain
disabilities, including end-stage renal disease (ESRD) or
amyotrophic lateral sclerosis (ALS)
❑ 58 Million People enrolled in Medicare
❑ Reimbursement based on bundled care rates, fee-for-
service, risk adjustment, alternative models, etc.
4

5. Medicare
❑ Medicare has 4 distinct types of coverage with
varying rules, code sets, regulations, payment
methodologies, etc.
❑ Part A – Facility Inpatient Care
❑ Part B – Traditional Outpatient Care
❑ 53% of Medicare Beneficiaries
❑ Part C – Medicare Advantage
❑ 47% of Medicare Beneficiaries
❑ Part D – Prescriptions
❑ Participation-based enrollment for Part A and B
❑ Highly regulated federal healthcare program
5

6. Medicaid
❑ Federal Healthcare Program but administered at the
State Level
❑ Primarily for low-income and indigent populations
❑ Participation-Based Enrollment
❑ Reimbursement is a blend of fee-for-service and
managed care organizations
❑ Highly regulated federal healthcare program
6

7. Workflow for Enrollment
Gather all provider
contact information
and credentialing
documentation
Login/Register for
NPPES – National
Plan and Provider
Enumeration System
Provider/Practice
NPI – National
Provider Identifier
Number
PECOS - Provider
Enrollment, Chain,
and Ownership
System OR CMS 855
Forms
7

8. Methods for Medicare
Enrollment
• Submit appropriate
paper CMS 855 Form
• Mail supplemental docs
with paper application
CMS 855
Paper
Forms
• Surrogate or Provider
NPPES login
• Include supplemental
docs as attachments
PECOS
online
portal
8

9. CMS-855
Enrollment
Types
855 A -
Institutional
providers
855 B -
Clinics/group
practices
and certain
other
suppliers
855 I -
Physicians
and non-
physician
practitioners
855 O –
Ordering and
Certifying
9

10. 2024 Medicare Enrollment
Update
❑ CMS will allow MFTs and MHCs to enroll in Medicare
and bill as mental health professionals – greatly
expanding access to BH Providers
❑ 400,000 LMFT and MHCs professionals are now able to
get paid and render services to Medicare Beneficiaries
❑ Goes into effect on January 1, 2024
❑ Requires 2 years of clinical supervised experience to
enroll in Medicare
❑ Make sure the NPI Number is linked to the correct
Taxonomy code
10

11. Most Common Errors
Missing Signatures
Missing Dates
Signatures must be original and signed in
BLUE INK
E-sign or copied signatures
11

12. Most Common Errors
Person signing the form is not a Delegated or
Authorized Party
Wrong CMS 855 Form Type
Providers / Groups don’t terminate their
reassignments
Missing Revalidation Deadline because letter
went to provider’s home
12

13. Best Practice Tips
Attention to detail is imperative and staying organized
Have someone else review the application several times over
Include all supporting documentation required
Vet your vendors if outsourcing/proper training if insourcing
Setup Tickler system to remind you of Revalidation Due Dates
13

14. Best Practice Tips
Information must be accurate and consistent
Typed Answers and Live Signatures
Respond timely to information requests
Don’t miss revalidation deadlines
14

15. Compliance Considerations
❑ Are you using a billing company?
❑ Section 8
❑ Are your NPPs billing incident to your physicians?
❑ All NPPs need to be enrolled
❑ Do you have specialists or multi-specialty?
❑ Specialty designations
❑ Taxonomy linkage between NPPES and CMS
❑ Providers who opted out of Medicare or enrolled solely to
order, certify, and prescribe do not have to revalidate
15

16. Medicare and
Medicaid
Managed Care
Enrollments in
2024
16