CMS Pilot Screening Process for Provider Enrollment Looks Promising

9056388_S_Doctors_Nurses_Doctors Office.jpg

In an effort to make it easier for doctors to enroll in Medicare and Medicaid, the Centers for Medicare & Medicaid Services (CMS) is launching a pilot program designed to streamline the screening process.

CMS Administrator Seema Verma explained that the pilot will offer provider screening for state Medicaid agencies on an opt-in basis. The screening process will use the same methods now used for Medicare.

This move should really make sense from a provider perspective. Providers will be able to go to just one agency for approval, and once approved, it will apply to both Medicaid and Medicare. 

CMS projects potential enrollment savings in the millions every year for hospitals and medical practices. Payer enrollment can be costly; it’s estimated that doctor practices spend as much as $83,000 annually – per physician– on administrative costs. 

But money will not be the only savings. With the current process, physicians can wait as long as 6 months to go through the Medicaid coverage credentialing process. Time spent on administrative tasks is time taken away from patient care. And new doctors are delayed in treating patients as many employers require that they already are enrolled in Medicare and Medicaid.

Another potential benefit to the streamlined screening process is the reduction in improper Medicaid payments, which hit a whopping $36 billion – a 24% increase over the prior year – in 2016. Improper payments include payments with insufficient documentation, fraudulent claims, payments made to the wrong or ineligible recipient and incorrect amounts.

All in all, the proposed new screening process looks like a win-win for both state Medicaid programs and enrolling health care providers.

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.