To create a more efficient and convenient Medicare and Medicaid enrollment process for physicians, the Centers for Medicare and Medicaid Services (CMS) have proposed a new pilot program. The program will include an updated enrollment application with improved provider screening for state Medicaid agencies that will use the same methods that are now in place for Medicare.
The new program and approval process will allow physicians to be simultaneously approved for both Medicaid and Medicare and decrease administrative costs to enable health care professionals to spend more time focused on patient care.
New Medicare Application
Providers and their administrative staff have criticized the previous Medicare enrollment process because of inconsistent standards used to identify qualifying physicians. In the past, clinicians have been approved, but were lacking the education or other qualifications necessary for enrollment. This resulted in billions of dollars of improper payments to unqualified physicians.
The new application will create a single document with in-depth information about enrollment criteria. This will serve to standardize requirements for those in charge of application approvals, ultimately reducing the number of physicians who are erroneously accepted.
Although the new application form has been criticized for not completely relieving the administrative burden to physicians and their staff, CMS plans to lighten the Medicare and Medicaid load for physicians and health care staff with a swifter, more economical enrollment process.
Pilot Program Benefits
Later this year, CMS is expected to launch a pilot program to test efforts that streamline Medicaid and Medicare enrollment. For physicians, the benefits of the new program include:
- Application to one agency for enrollment in both Medicare and Medicaid
- Background and credential checks will be done in house, reducing practice and hospital administrative costs
- Reduce processing time, allowing newly hired medical staff to begin work sooner
The Bigger Picture
In 2017, improper Medicaid payments totaled $90 billion. This figure is billions of dollars higher than the previous year. Improper Medicaid payments are defined as:
- Fraudulent claims
- Payments distributed to the wrong recipient
- Incorrect payment amounts
- Improper use of funds
- Payments to unqualified clinicians
CMS has released several initiatives to combat improper payments. The current ideology holds that improving the Medicaid and Medicare system will be an effective tool to create a more convenient, cost effective enrollment process for physicians, and will improve the integrity and quality of care for patients as well.
Philadelphia Physician Lawyers at Sidney L. Gold & Associates, P.C. Protect Health Care Providers from Medicare and Medicaid Legal Issues
The highly experienced Philadelphia physician lawyers at Sidney L. Gold & Associates, P.C. understand what health care providers are up against. If you are a physician, nurse, or another heath care professional facing a medical malpractice claim, fraudulent insurance charges, or another legal issue, call us today at 215-569-1999 or contact us online. We are in Philadelphia, and we proudly serve clients from the surrounding areas, including Bucks County, Chester County, Delaware County, and Montgomery County.