Volume 25.01
The Form CMS-855A was revised in September 2024. Effective October 1, 2024, all skilled nursing facility (“SNF”) providers must use the revised form for all enrollment applications and updates. Other Part A providers are required to use the new form for submissions on or after December 1, 2024.
Skilled Nursing Revalidations
Any skilled nursing facility that received a Notice of Revalidation letter from its MAC in October, November, or December of 2024 can disregard the revalidation due date as provided in the Notice. The revalidation date is now May 1, 2025, and the revised Form CMS 855-A is to be submitted. The SNF does not have to wait until May 1, 2025, to submit the revalidation application. The MACs will not be issuing updated letters indicating the May 1, 2025, due date.
Find news article details here.
Medicare Enrollment application can be found here.
Guidance for SNF attachment can be found here
OIG POSTS EXCLUSION DATABASE UPDATE
The Office of Inspector General (“OIG”) has the authority to exclude individuals and entities from Federally funded health care programs for a variety of reasons, including a conviction for Medicare or Medicaid fraud. Those that are excluded can receive no payment from Federal health care programs for any items or services they furnish, order, or prescribe. This includes those that provide health benefits funded directly or indirectly by the United States (other than the Federal Employees Health Benefits Plan).
The OIG maintains a list of all currently excluded individuals and entities, called the “List of Excluded Individuals/Entities” (“LEIE”). Any provider that hires or contracts with individuals or entities of the LEIE may be subject to civil monetary penalties (“CMP”). To avoid CMP liability, health care entities should routinely check the list to ensure that new hires, current employees, vendors, and independent contractors are not on the LEIE.
LEIE downloadable databases can be located here.
QUARTERLY CREDIT BALANCE REPORTS NO LONGER REQUIRED
As of December 1, 2024, providers are not required to submit the Medicare Credit Balance Report (CMS-838) on a quarterly basis. However, to ensure that monies owed to Medicare are repaid in a timely manner, all providers participating in the Medicare Program are still required to report self-identified overpayments and submit credit balance reports when they occur.
A credit balance is an improper or excess payment made to a provider as the result of patient billing or claims processing errors. Examples of Medicare credit balances include instances where a provider is:
- Paid twice for the same service either by Medicare or by Medicare and another insurer.
- Paid for services planned but not performed or for noncovered services.
- Overpaid because of errors made in calculating beneficiary deductible and/or coinsurance amounts.
- A hospital that bills and is paid for outpatient services included in a beneficiary’s inpatient claim.
Credit balances do not include instances where the provider received a demand letter or in cases where proper payments made by Medicare are more than a provider’s charges, such as diagnosis-related group (DRG) payments made to hospitals under the Medicare prospective payment system.