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Medicare 855I, 855B, and 855R Documents
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The Medicare 855I document -the application
process to receive a Medicare Individual Provider number- is a very detailed and lengthy process as well. This multiple paged application 855B- The name
of the Medicare provider application for a group of providers, or the 855I- The name of the Medicare provider application for an individual provider, or the 855R-
The name of the Medicare application to reassign payable benefits of a Medicare provider to another group or entity and their related documents are quite time
consuming to complete. If even a minor appearing item is not completed or answered correctly, the entire application will be returned to the provider for correction or
attachment of additional items. Once the documents are returned to the individual or entity that submitted the application, the documents can NOT be returned to Medicare
without the proper re-certification statement attached as well. Once returned, the application is then accepted in the order it was received. It is not uncommon for the
855I, 855B, or the 855R to take up to 8-12 weeks to be processed by the Medicare carrier once the payer has received the Medicare Provider Application. The 855I requires
numerous attachments that include provider's license, certification, and diplomas. Also remember that certain business structure documents must accompany the 855B and
related documents when requested. Documents such as Tax Identification assignment documents from the IRS, partnership agreements, billing services agreements, as well as
Articles of Incorporation for corporate entities to name a few. The next challenge on the Medicare providership horizon becomes reality in May 2005. All providers will
be required to enroll for an unique national provider number, the applications above will soon be a thing of the past and be replaced by a universal application. Once
the universal application is processed with a unique number or PIN# it is anticipated that this unique provider ID will be then adopted by all payers to identify each
provider. At the present time, the unique provider ID applications are not scheduled to be available until shortly before May 2005.
As a part of the Practice Management Services clientele, BCS takes the majority of the "pain" out of these processes by preparing these documents in part for you and your
group. BCS is the only complete alternative. This is why we say, ...BCS truly does it all!
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Credentialing / Re-Credentialing / Contracting with Non-Medicare Payers
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Since BCS is the only complete and totally comprehensive Practice
Management Firm of its kind... the phrase credentialing and re-credentialing of providers is more than likely a part of every day's discussion at BCS. These terms refer
to the lengthy pre-application/application/contracting functions required to become a participating provider with a government or non-government sponsored managed care
plan. Participation with a particular payer's managed care product lines is extremely important to the financial survival of your practice. When considering a participation
status with those non-government sponsored plans, you need to identify the overall fee schedule proposed, evaluate that schedule's impact on your practice, negotiate with
the payer regarding that fee schedule, and the move to implement the participation status if in fact you select to do so. The entire pre-application/application/contracting
process can easily take 120 days or more to complete after the documents have been received by the managed care entity. BCS is an expert at working through these major
details and has specific Credentialing Team Specialists assigned to perform and carry out these important responsibilities daily. Furthermore, in today's every changing
healthcare marketplace, the need to constantly evaluate, re-evaluate, and consider new manage care participation opportunities never appears to end. Keep in mind that during
this often times very lengthy application process, your group will NOT be a recognized participating provider and more than likely will not be so in a retroactive fashion as
well. This important factor increases the complexity and urgency of evaluating all managed care opportunities entirely.
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Medicare Changes Definition of Anesthesia Time
Allowing Blocks of Time to be combined
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Yes it is true, Medicare has issued a modified definition of anesthesia time which allows the provider to add or combine blocks of treatment
time. This modification has come about as Medicare recognizes that certain types of treatment or procedures require "set up" time. These blocks of time can now be combined and billed as total
anesthesia minutes. Below is the actual modified definition of anesthesia time for your review.
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How are we certain we are maximizing CRNA reimbursement within our facility?
BCS, Incorporated Waconia, Minnesota
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This is an excellent 'opener' at a meeting with facility administration for any department head
of an anesthesia department when the topic of anesthesia revenue comes up. Professional services in the anesthesia department may well be the only department within
the facility that potentially has untapped revenue available for today's educated and 'street smart' healthcare administrator. I say 'street smart' because today's
effective healthcare administrator needs to think entirely 'out of the box' to develop methods of efficiency and revenue enhancement and identification that have not
been previously tried and tested within today's healthcare marketplace. Professional services revenue is available to anyone that employs or contracts with anesthesia
providers whether physician or CRNA. Another 'out of the box' theory is to grasp professional services revenue and own it, manage it, measure it, and control it so
that the employer or contractor of the anesthesia group is in control of the economic drivers that are present within the marketplace for anesthesia. Only then will
the 'street smart' healthcare executive maintain the ability to state that they are maximizing their CRNA reimbursement.
In order to determine if your facility can answer this question in the affirmative, you will need to essentially dismantle the anesthesia professional fees within your
facility and analyze the current methodology that is in place. The duration or total anesthesia time is only one element of this puzzle and if time is the only element
utilized within your institution then financial losses are imminent. BCS has designed our Anesthesia Practice Impact Study process to do just this identify current
revenue generators, breakdown their methodology, compare and contrast to industry standards, and layout the changes that are needed to make certain you can affirmatively
answer the question, "How are we certain we are maximizing CRNA reimbursement."
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Payment for Performance (P4P) In Today's Healthcare Marketplace
BCS, Incorporated Waconia, Minnesota
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Inside the loop at the Centers for Medicare and Medicaid (CMS) the latest buzz phrase in DC these days is 'Payment for Performance.'
Facing some extremely difficult budgetary dilemmas, the Washington crowd is considering revamping the payment mechanisms for physician services to reflect some
aspect of performance. Taken from the leaders in the private healthcare payer community, the concept of payment for performance, or reward for better than
average performance is being touted as one possible savior to the budgetary woes of CMS. The greatest concern amongst physician and non-physician providers
that are reimbursed by CMS's Part B Program and would be impacted by any "revamping" of the Part B reimbursement system, is how will performance be evaluated
and measured? Will performance in fact be based upon quality of care, comprehensiveness of care, or cost effectiveness of care? Irregardless of which of these
aspects may be selected as the measuring stick of performance, what will be the benchmark of performance that CMS may use? Subtle commentary from CMS indicates
that they would like to see providers be proactive in assisting in the design of such a system of measuring performance.
Private managed care entities have been rewarding primary care providers for similar achievements in the past, but the measuring stick in those
instances has almost always been costs, reduce the costs to provide care and a portion of the savings will be passed along to you. It appears that the current
flavor of P4P is considering a much more sophisticated measuring stick. One that takes into consideration the sometimes intangible aspect of "quality." The measurement
of quality is somewhat subjective. Yes there are ways to scientifically measure quality in healthcare, but to what extent is the level of quality simply expected
verses the measurement of quality that goes beyond the norm. For example, certainly an expectation of a surgical procedure would be successful repair of a defect
or damaged portion of the patient's anatomy, but someone else may simply measure success in the fact that the patient survived the procedure. A third may measure
quality by the element of time. Measuring the amount of time, spent testing and / or researching the patient's presenting condition that was required to arrive
at any given solution or diagnosis. All have positive outcomes to some degree, obviously the quality outcome would be the survival of the patient, the achievement
of repairing the damaged or defective area, and doing so in the shortest period of time with the least interruption of the patient's daily life. But that is in
a perfect world and that is only a potential measurement of the primary treating physician. What about all of the other medical service providers involved in a
patient's care that would be subjected to a quality measure, all of which may be impacted by the success or failure of the primary care physician.
As we move closer to determining the benchmark of quality in healthcare we find ourselves looking at outcomes and determining what a quality outcome
really is, and then using that as a measuring stick up against the majority of healthcare services provided. The danger in this is that we may mis-identify quality,
after all there are no guarantees in the field of medicine, there is always some risk. Furthermore, the field of healthcare is very interdependent on the exhaustive
networks of many healthcare providers across any given delivery system. An exhaustive network that is only as efficient, or as able to provide or produce a quality
outcome as the least member of the network. There are always extraordinary clinicians that will devote their lives to achieving the best possible outcomes for their
patients but may in fact find that the outcome or quality may be as unique as the individual they are treating. Without the risks, risks defined as the potential of
a less than quality outcome, associated with some treatments and research in healthcare we may have never achieve some of healthcare's greatest accomplishments.
Therefore, we need to tread lightly on this extraordinary issue so that we do not trample or stifle the effervesces and desire of achievement held so close to the heart
of our nation's healthcare providers in the light of identifying quality.
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