Practical Answers in Licensure, Enrollment, Accreditation and Certification

Compliance is Critical for Optimal Health Care

In the midst of healthcare reform, providing optimal healthcare to patients relies upon strict regulatory compliance. Compliance precedes payment. It is vital to maintaining revenue flows. Providers must exercise due diligence to stay up-to-date on a vast array of present and proposed regulations that may impact the bottom line.

Murer Consultants has assembled a highly skilled team of experienced consultants to work on issues related to state licensure, Medicare and Medicaid enrollment, accreditation and certification matters to assist clients with the ongoing demands of compliance. By maintaining compliance, providers promote strong business development habits, enabling them to better exploit financial incentives, avoid payment delays, and maintain the highest standards for quality care.

The Murer team offers assistance with licenses, permits, accreditations and certifications as well as provider and practitioner enrollment for all governmental and non-governmental payors. Murer oversees ongoing maintenance of enrollment records from all regulatory agencies, including changes of information and revalidation/re-attestation matters. Murer works with health facilities on matters of accreditation, including surveys prior to initial accreditation, anticipated re-surveys, and extension surveys as new services are added. Murer also assists with responses to any deficient findings and offers recommendations for addressing identified issues.

Murer partners with clients throughout the entire licensure, enrollment, accreditation or certification process. The goal is to create pragmatic, cost-effective solutions for achieving full compliance. Our work increases control and accuracy of the credentialing processes, reduces payment gaps and increases cash flow. A strong understanding of insurance companies and their needs and requirements resides in-house as well.

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Timeliness – aka meeting deadlines – is critical. Providers must always be conscious of changes and updates that trigger reporting obligations.  Maintaining this aspect of compliance requires time-consuming business practices. Providers must keep important information on file with reporting agencies, including addresses (practice locations, billing, correspondence, etc.), NPI numbers, and ownership information (corporate and individual).  Providers must report site additions, CHOWs, or governance changes within dedicated timeframes.  Often, the provider is required to report changes to multiple governing bodies, such as the State and the Joint Commission.  Providers must maintain an organized database of information enabling them to track all previous and upcoming regulatory filings. Murer Consultants has an expertise in all aspects of compliance.

Utilizing the latest technology, Murer’s professional coders, billing experts and hands-on consultants have been assisting in the provision of optimal healthcare to patients for decades, performing credentialing and enrollment services for clients from coast to coast.

Murer Consultants can handle the enrollment, certification and licensure process in its entirety; or we can partner with providers on particularly troublesome aspects of any documentation project. Murer evaluates your current practices to suggest ways to implement and embrace best practices. Our consultants train your employees in the latest credentialing techniques, resulting in greater efficiencies and more successful outcomes.

What Types of Providers Must Engage in Provider Enrollment?

In order to maximize financial benefits, all healthcare providers must engage in provider enrollment. Enrollment includes institutional providers as well as practitioner groups. Provider enrollment extends to individual practitioners, such as physicians and nurse practitioners, as well.

A common scenario occurs when an individual practitioner is providing services at a fixed location, like a hospital or a clinic. In this instance, compliance demands that both the individual and the organization be enrolled in Medicare. Depending on the type of agreement between the individual and the healthcare organization, both of them may be required to complete various provider enrollment applications in order for the healthcare organization to bill properly on behalf of the individual for Medicare services rendered. Bill improperly and Medicare will not pay for those services.

How Do I Begin the Provider Enrollment Process?

Paper applications are readily accessible and can be completed on your computer. However, PECOS (Provider Enrollment, Chain and Ownership System) is the most efficient method of submitting enrollment applications. PECOS guides each provider through the application process to ensure that only relevant information is logged. Additionally, PECOS reduces the likelihood of incomplete applications that may result in costly rejections and time-consuming requests for additional information.

In any event, paper applications and PECOS submissions allow providers to choose from a wide variety of applications. The various types of applications include the following:

  • CMS-855A – Institutional Providers
  • CMS-855B – Clinics and Group Practices
  • CMS-855I – Physician and Non-Physician Practitioners
  • CMS-855R – Reassignment of Medicare Benefits
  • CMS-855S – Durable Medical Equipment Prosthetic Orthotic and Supplies (DMEPOS) Suppliers
  • CMS-855O – Eligible Ordering and Referring Physicians and Non-Physician Practitioners.

Proper credentialing, enrollment, accreditation and compliance work hand in hand.

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application-enrollmentMedicare and Medicaid: Why a Provider Might Need to Submit a CMS-855 Application?

Completing an initial provider enrollment application is often described as the “ground floor” for healthcare providers. As long as Medicare or Medicaid services are rendered, providers will be subject to provider enrollment rules and regulations. As a result, providers must consistently notify CMS of any and all service changes related to Medicare no matter how insignificant they may seem. For example, providers must promptly complete regulatory filings for changes involving a practice location address, billing agency, or board membership. The most noteworthy changes that must be reported on involve certification status, including changes related to licensure and accreditation. The most complex issues with regard to regulatory filings arise when a provider elects to undergo a change of ownership (CHOW), acquisition/merger or consolidation within the industry.

No area of healthcare management presents more compliance issues than Medicare and Medicaid. With decades of experience assisting healthcare providers through the regulatory mazes of Medicare and Medicaid, Murer Consultants has developed comprehensive strategies intended to save you time and money. In order to stay up-to-date on the vast array of present and proposed regulations and regulatory changes with potential industry-wide impact, providers must constantly and consistently exercise due diligence.

Murer can provide that due diligence. We constantly monitor regulatory changes and developments to benefit our clients. Murer is both experienced and highly skilled at guiding providers through the many regulatory intricacies of Medicare and Medicaid compliance. Compliance, after all, dictates the flow of provider revenues.

Moreover, provider enrollment is a key component in obtaining provider-based status and 340B eligibility. Provider-based status enables healthcare facilities not located within the four walls of a main hospital to realize financial and administrative benefits in that they will be treated like any other department of the hospital. To be in compliance, the provider-based entity must first be enrolled as a practice location of the main hospital in order to properly bill under the hospital’s Medicare provider number. Subsequently, it is in the best interest of the main hospital and the provider-based entity to submit a voluntary provider-based attestation in order to confirm that they are operating in accordance with the provider-based regulations prescribed by 42 C.F.R. 413.65. Assuming provider-based status is approved after a CMS review, the provider-based entity will then be able to seek 340B eligibility, if applicable.

Generally speaking, the same scenario applies at the State level in regards to Medicaid as to Medicare at the Federal level. The administrative burden on the provider is the same. Each state applies their own unique rules and regulations with regard to provider enrollment. Staying on top of all the applicable rules and regulations inevitably proves a drag on provider performance. Murer Consultants turns this management burden into an asset.

Murer Consultants has vast experience with all forms of regulatory filings, from the most straightforward to the exceedingly complex. The provider knows they are in full compliance through the good agency of Murer Consultants.

Who Processes Provider Enrollment Applications?

Ultimately, the Centers for Medicare & Medicaid Services (CMS) is the governing body with regards to Medicare and Medicaid provider enrollment. However, Medicare Administrative Contractors (MACs) play a crucial role in the provider enrollment process. Pursuant to Section 911 of the Medicare Prescription Drug Improvement, and Modernization Act (MMA) of 2003, CMS established MACs as multi-state, regional contractors responsible for administering both Medicare Part A and Medicare Part B claims. MACs were created in order to improve Medicare’s administrative services for beneficiaries and health care providers through the use of new contracting tools, including competition and performance incentives. Since being integrated in the provider enrollment process in 2006, MACs have been successfully enrolling healthcare providers in the Medicare program, as well as serving as a driving force in creating various cost-effective Medicare claims processing business operations.

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Credentialing and Enrollment Services

The process of becoming credentialed with governmental and commercial payers is a distraction from your principal mission: providing high quality patient care. Murer Consultants offers solutions that utilize the latest technology. That technology is powered by highly skilled coders, billing experts and healthcare professionals with decades of relevant experience.

With a keen knowledge of provider needs, our contracting and insurance credentialing services are developed to address every step in every process. Our work increases control and accuracy of credentialing processes, reduces payment gaps and increases cash flow. Additionally, Murer has a strong understanding of insurance companies and their needs and requirements.

Murer Consultants offers full credentialing services for all types of healthcare professionals. Murer handles provider enrollment needs for all facility types, including but not limited to Ambulatory Surgical Centers, Clinic/Group Practices, Clinical Laboratories, Hospitals, Federally Qualified Health Centers, Home Health & Hospice Agencies, Independent Diagnostic Testing Facilities, Rural Health Clinics, and Skilled Nursing Facilities.

For decades, Murer Consultants has been offering health providers practical solutions for their credentialing, enrollment and reimbursement needs. From major hospital systems to solo practitioners, we can help you navigate the many regulations and voluminous forms so that you can better focus on your business – serving patients.

Maximize Reimbursements from Insurance Companies: Murer Consultants Assists with Negotiating or Renegotiating Insurance Contracts

Renegotiating insurance contracts is a complicated and important process that can directly impact your bottom line. Murer Consultants is skilled at negotiating and renegotiating insurance contracts. We understand the many complexities and nuances of the process. Murer has developed unique strategies for various insurance products and providers. We have a strong track record of obtaining reimbursement increases for our clients – far above the 2 to 5 percent that insurance providers normally offer.

Murer Consultants understands how to find and exhibit the added value your organization provides to its patients – a critical fact that insurance providers evaluate when establishing reimbursement thresholds. Murer also comprehends fee schedules, Medicare rates and has a sophisticated understanding of reimbursement trends.

Murer Consultants offers full credentialing services for all types of healthcare professionals. Murer handles provider enrollment needs for all facility types, including but not limited to Ambulatory Surgical Centers, Clinic/Group Practices, Clinical Laboratories, Hospitals, Federally Qualified Health Centers, Home Health & Hospice Agencies, Independent Diagnostic Testing Facilities, Rural Health Clinics, and Skilled Nursing Facilities.

Murer Consultants commonly obtains reimbursement increases from insurance companies far above the 2 to 5 percent that they normally offer.

CAQH Enrollment Services

The Council for Affordable Quality Healthcare, Inc., is known among health providers by the acronym CAQH. Much like its name suggests, the organization works to improve healthcare access and quality of care for patients while streamlining paperwork for providers.

CAQH offers a credentialing database, the “Universal Credentialing Data Source.” This online database collects and organizes all provider information needed for credentialing and makes that data available to different insurance carriers.

Murer Consultants works with providers to complete the CAQH credentialing process, which can be tedious and, at times, confusing. Our team has completed thousands of these applications and understands their nuances and potential pitfalls.

The process of becoming credentialed or enrolled with governmental and commercial payers distracts from serving patients. Murer Consultants can better handle your enrollment services and make that distraction disappear.

Murer offers:

Health Facility Enrollment Services

Health Provider Credentialing Services

Clinical Laboratory Enrollment Services

Medicare and Medicaid Enrollment

CAQH Enrollment

Insurance Enrollment

Insurance Contract Negotiations

Please contact a member of our leadership team to discuss how Murer Consultants might be able to partner with you.