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GAO Report

The recent decision by CMS to initiate new steps in strengthening provider environment screening is receiving good appreciation from the healthcare industry. CMS announced its decision through a blog post that was published in February 22, 2016.

In the blog post, CMS clearly tells that it has come up with a number of new strategies that would not only strengthen thing provider screening activities, but also make the entire process more transparent and acceptable to every organization or individuals taking part in it. Some of the strategies in the plan are intended to combat abuse and fraud. Likewise, the tight screening would stop fraudulent providers from registering as Medicare providers.

According to some sources, CMS went to the extent of tightening the screening after it analyzed the GAO report. The report contained multiple suggestions to CMS on improving its provider enrollment screening practices. The original blog post by CMS on the strategically improvements of the provider enrollment screening practices include the following points:

  • Ensure frequent data monitoring
  • Disqualify healthcare providers and suppliers that are not billed in the last 13 months
  • Increase the frequency of site visits

Besides these, CMS has come up with another announcement, which contains the updated list of Medicare Free-for-Service. It said that there would be frequent updates about the providers and suppliers. Only they can bill the Medicare.

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CMS Strategies

CMS has also taken necessary steps to ensure more transparency in the healthcare industry. It says that it will enable the public to identify legitimate providers. As of now, only those services that are enrolled as Medicare providers are legitimate. It is quite hard for customers to verify these services, because there are no transparent processes for that.

The preliminary data collected from the customers and healthcare providers mainly focus on individual and organization providers. The data will be analyzed by the Provider Enrolment and Chain/Ownership System (PECOS). Basically, they would include the following details.

  • NPI
  • Provider or Supplier Specialty
  • Gender
  • Enrollment ID and PECOS Unique IDs
  • Limited address information (ZIP code, State and City)
  • First and last name/legal business name of the provider or supplier

CMS also mentioned about the info collected from two public data sets on the blog. Some of those are regarding the use and availability of services provided to Medicare beneficiaries.

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