Billing: Maintain clean record

Q. Should I be performing regular audits of my provider enrollment record? 

A. Short answer, yes! Providers should review, or audit, their Provider Enrollment Record at least annually. In doing so, you could avoid potential issues with incorrect or outdated information that, when discovered by your payer’s provider enrollment department, could result in a revoked or deactivated enrollment. Loss of enrollment status could not only result in penalties and fines, but also impede the ability to service your patients and prevent continued growth and claims processing. It could also result in reimbursement and payment delays. 

Regardless of your payer mix, it is imperative that you maintain a clean and concise Medicare enrollment record. Most payers rely on accurate Medicare enrollment screenings to approve enrollment. This includes your state Medicaid enrollment and commercial and private payers. Recently, CMS has increased enforcement actions on Medicaid enrollment to ensure an excluded or revoked provider is removed from any payer plans that receive federal or state funds. Conversely, many payer contracts include the requirement of an active Medicare enrollment record to stay in-network and maintain contracts.   

Areas of attention should include licensure, insurance, location and correspondence information, and product/equipment additions or subtractions. This responsibility should be assigned to your compliance officer or compliance department and should include a backup staff member for coverage. 

Kit Shellhouse is director of business development for the van Halem Group. Reach her at Kit@vanHalemGroup.com.