In honor of Halloween, Newport Credentialing Solutions’ Vice President of Operations, Allyson Schiff, braves the spooky scene of New York Medicaid revalidation.
Seven years ago CMS Medicare began doing revalidations on all its enrolled providers. For many of these Medicare-enrolled providers, this was a “hellish” situation. Letters alerting providers to impending revalidations either weren’t received or were lost to old addresses. This resulted in missed deadlines, providers being deactivated from Medicare, and freezes placed on physicians’ accounts. Millions of dollars were lost before a more streamlined approach was found and used by CMS to improve the process. Unfortunately, this scenario is now a reoccurring nightmare for some Medicaid-enrolled providers.
A Lingering Pain
Within the past couple of years Medicaid has implemented revalidation requirements mirroring that of Medicare’s. While Medicare has remedied the issue of lost paperwork by creating a national online site that shows if and when a provider is due for revalidation, Medicaid is managed on a state-by-state basis. This means some states, like New York, still rely on paper mailers to one address to alert providers to impeding revalidations; this is downright scary. Some of these addresses may be the original correspondence address established by a provider when they first enrolled with Medicaid and may no longer be applicable to that provider.
In the quest to regain control over lost or missing revalidation letters, a common response is to consolidate letters so that they are funneled through one central location. While well intended, this creates a whole new level of pain that no healthcare organization or provider will want to endure.
New York Medicaid will only allow one correspondence address on file per provider. Therefore, if a provider is offering services at multiple locations, correspondence letters for the other practices are sent to this one address. Even more frightful, every future piece of correspondence related to this provider including EOBs, change of address information, etc. is also sent to this single address.
Every provider is responsible for revalidating all information on file with Medicaid, including all groups that they have been linked to over the years. In the event group information is not provided on the revalidation application, the provider’s active linkage to said group will be end-dated.
Facing the Fear
There is hope that eventually all states will offer an online, searchable portal to make managing Medicaid revalidations significantly easier. Until this happens, steps must be put into place so healthcare organizations can avoid costly disenrollment scenarios.
The first step to understanding where a provider falls within the revalidation timeframe is to speak with someone at Medicaid. The Medicaid representative should be able to tell you if there is a revalidation initiative going on and, if yes, the timeframe for sweeping providers. Leveraging the enrollment information on file should provide enough information to determine, based on when a provider was enrolled, if they fall within the date range of the current revalidation cycle.
If the list of providers is manageable (around 20 providers), the next step is to call Medicaid on an individual provider basis. Regardless of whether a letter was received, the Medicaid representative should be able to share if the provider is in good standing and if there are any revalidations due. If a letter is received, start processing revalidations immediately. Lastly, set up a process to call Medicaid on a quarterly, bi-annual or annual basis going forward to stay current on revalidation cycles.
Provider credentialing and enrollment software will greatly simplify and speed this otherwise torturous process. With a date range in hand, the system will generate a report that identifies providers within the revalidation range. Start by simply setting up alerts that flag impending deadlines, then easily add safeguards to ensure that lapses do not occur.
Mediciad revalidations can be difficult to manage. However, best practices and the right cloud-based credentialing and provider enrollment software can help end revalidation nightmares.
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