Transcript
Joshua Aubey (00:00) good afternoon. Sorry about that. We had the thing telling us that the recording was in process. So, hey Glenn. Hello. How are you? I’m good.
Collette Waddell (00:11) How are you doing?
Joshua Aubey (00:12) Good, good. See Kimberly’s going to be on in just a minute. We just got off of our one on one call. Okay, we were just talking about several of the department initiatives and so on. But while we’re waiting, I actually am first going to acknowledge Peter’s email that he sent. He sent us an email. So maybe we could discuss this later when Kimberly joins. And it gives me a perfect opportunity to bring it up.
Joshua Aubey (00:38) Peter sent us an email. I think it was yesterday. Okay, Peter bosworth. Yes, it was Monday so we can discuss this. It says on April seventh, we released a change that now requires the provider id field to have a saved value on any existing medicare or medicaid enrollment record. He says this update is intended to ensure that our operations team has the necessary information to effectively manage medicare and medicaid related dependencies. So we could go through that. And in the meantime, I did have something else. Let me get this out here. Okay. On the train to work today, I was reading through an article in my compliance newsletter about, you know, how we do explosion checks, monitoring. Yes, we use the oig list of excluded list of excluded entities and individuals. There’s. The Sam website. I think you also monitor preclusions for us, like the health plan preclusions. I was reading an interesting article today about how the trump administration is now using revocation as a penalty for providers, which is interesting, which that targets their enrollment. So, the trump administration is saying like this is a bad apple and so we want to prevent them from continuing to do wrong in the future. So we’re just going to revoke their medicare enrollment. Yeah, I mean that’s an interesting way. It’s kind of like using the carrot or the stick, right? So if you are a bad apple, we’re going to cut off your enrollment, which should place you on the preclusions list at the same time. But I’m not sure. The article said that there’s now going to be made available to the public, a searchable revocation list. And again, that revocation list has to do with medicare enrollment. According to the article, it says, let’s see here. Health care organizations have another tool to screen physicians and other clinicians for the medicare version of the scarlet letter. CMS for the first time is providing the public with a searchable database of providers whose medicare billing privileges have been revoked. It’s the latest source of data that factors into an organization’s billing and services, along with medicare’s opt out list and the HHS office of inspectors list which we mentioned, it let’s see here, let me read on, see if there’s anything, whether providers and CMS is a good race, ability to participate is because of revocation. Yeah, whether a provider is in CMS’s, good graces, also affects their ability to participate with medicare advantage because the revocation can trigger preclusion. And with commercial payers that use medicare enrollment in credentialing. So, I think this is interesting, I believe and maybe we could do some more research on this. I believe this is another source of exclusion. It’s.
Collette Waddell (03:52) a clearing, yeah. Yeah, I’m actually as you were just reading that, I’m trying to look up what you’re talking about here with this CMS revocation?
Joshua Aubey (04:05) Yeah, it’s called or at least the article calls it the revocation list. Yeah. And the article kind of links it to enrollment. So really what CMS is saying is that we don’t want to enroll a bad apple. That person may not make it. I don’t know. I don’t know if they would make it to the oig and Sam lists though if they’re preventing them from enrolling in the first place. So, I guess the risk here just thinking out loud is if we’re only searching the exclusions databases and if the provider has not been excluded, but instead they’re prevented from enrolling in medicare in the first place. I think the credentialing team should catch that when we’re credentialing because that’s one of the things that we confirm is we try to enroll them in medicare. And I think at that point, once we’d filed the a 55, if… the provider has been denied enrollment, then I think the credentialing team would know about it even at that time.
Collette Waddell (05:10) But I.
Joshua Aubey (05:11) think, right. But I think, yeah, going forward if CMS doesn’t exclude them, but if they revoke their enrollment, I think that’s really the risk to us is that, how would we know?
Collette Waddell (05:24) Yeah, I’m going to, I’ll take this back because I’m trying to, I’m looking at and it’s kind of talking about the revocation versus preclusion. So the revoked providers typically placed on the preclusion list are.
Joshua Aubey (05:42) Okay. That’s what the article is saying too. Yeah.
Collette Waddell (05:46) It says reasons for revocation, common causes include felony convictions within the last 10 years, misusing billing privileges, non operational status, and false reporting,
Collette Waddell (06:03) So, let me see what I can find internally and if this, sorry, I just noticed that Brandon isn’t sitting in the waiting room. Sorry, I was just about to mention that. Oh, thank you. Hi, Kimberly. Hi, Collette. I was very intrigued by what? Yeah.
Joshua Aubey (06:23) Yeah.
Collette Waddell (06:24) Yeah, by this, yeah, let me, and, I guess if there, if there’s anything that you find on your end in terms of some sort of like… monitoring source… but I’ll also take this back and inquire if this has surfaced and if there’s any type of monitoring… yeah.
Joshua Aubey (06:51) Well, that, that’s what the article says again, I think for medicare advantage, I think you’re right? I think, if a provider, if their enrollment is revoked after they started working technically for ma, I think they should be on the preclusions. But I think the article, the intended audience is more than just medicare advantage. So, the audience also includes hospitals, right? So that’s why the article says the list of revocations should help hospitals and other organizations identify providers whose medicare billing numbers were taken away before or after hiring revocation, hurts their ability to get hospital privileges because hospitals expect clinicians to be in good standing with medicare and some hospital bylaws expressly require that, after the date of revocation, which may be retroactive. That’s another thing CMS can retroactive, the revocation, it says CMS won’t pay the revoked practitioner. So, I think I remember reading in the article somewhere where it says there was a case where, for the, for a period of time, a provider was engaged in fraudulent activity against medicare. So, what medicare did is they revoked their enrollment, and then they also retroed it back during the period when they were performing the fraudulent things. Oh.
Collette Waddell (08:08) Yeah… that’s interesting. What do you mind me asking what you were? Where you were reading that article? I mean, I’m sure. There’s a I’m sure. There’s many articles out there related to those. Yes. Yeah.
Joshua Aubey (08:25) Yeah. The thing that caught my, so we subscribe in the compliance department to a newsletter that’s published by the hcca which is the healthcare compliance association, and that newsletter is weekly, it’s called report on medicare compliance. And it’s I can go down. I actually have the paper copy here. It’s in volume 35 number 13, which is dated April sixth of report on medicare compliance.
Collette Waddell (08:53) Yeah, I was just curious. Thank you. Yeah.
Joshua Aubey (08:57) Sure.
Collette Waddell (08:58) Yeah. I’ll see what I can find internally, but if there’s any specific asks from your team that I can make sure get, you know, to the right place here, please do, let me know.
Joshua Aubey (09:13) Yeah. I think the specific ask is again, since we’re 100 percent medicare advantage, we don’t have as many things to be concerned about as the hospitals. I guess the question is that if we could confirm that the preclusions list will catch any revoked… any enrollment revocations?
Collette Waddell (09:32) Revocations. Yeah. So we might just need to do some digging on CMS. Yeah, yes, I’ll ask and see if we, if anybody has been able to research… this or validate, that list… would entail yeah.
Joshua Aubey (09:57) Okay. Yeah, cause I think if it does, then I think we’re good. Yeah, we don’t have any concerns. Yeah.
Collette Waddell (10:03) Okay. Yeah, we’ll do some homework on that that’s interesting though. Thank you.
Joshua Aubey (10:07) Yeah. As I said, I just read it on the train today, so I haven’t had, I haven’t had a chance to even Google it so.
Collette Waddell (10:13) Yeah, dive deeper into it. Yeah.
Joshua Aubey (10:16) Yeah.
Collette Waddell (10:17) Any other regarding… Peter’s you know, kind of fyi, email about just kind of the product enhancement piece. Any questions or concerns that I can, whether I’m able to answer them now or take them back? Yeah.
Joshua Aubey (10:36) I’ll defer to Kimberly and Brandon, but essentially, Peter’s email from yesterday said that self serve users will encounter this requirement when editing an existing enrollment or adding a new enrollment for medicare and medicaid payers. It says a banner notification was made available on the platform at the time of release to communicate this change. Any questions, Kimberly and Brandon, did you receive Peter’s email from yesterday?
Joshua Aubey (11:06) Yes.
Kimberly Jones (11:08) So, a couple of the team members have already encountered the enhancements and we’re working through them. So they did not have any questions. Everyone seemed to be fine.
Collette Waddell (11:22) Good. Glad to hear that. We just wanted to make sure you know, there’s just a handful of customers that really utilize that, you know, as a self serve model. And so we just wanted to make sure that you understood, you know, what that platform enhancement was and was all about. Yeah.
Kimberly Jones (11:42) Yes, yes, great. And.
Collette Waddell (11:46) Then Kimberly, I know at, so I was out all of last week and the day for the previous week, but I wanted to make sure that you received and were able to access that monitoring report that I had sent on the second of this month earlier this month.
Kimberly Jones (12:06) Yes, I did receive that, yes, and I was able to access it. Yes. And.
Collette Waddell (12:12) Then I know that at the end of March, there was some emails regarding a provider who had raised concerns about, that… limited power of attorney. It’s like that release form language on there. And I know Peter had replied back with a response and I just wanted to any further updates or follow ups that I can do on my end or should that be good?
Kimberly Jones (12:46) No, I think she will be fine. I guess Peter… did explain that at no time will medallion… be accessing her information, her caqh profile, but that’s not clear in that statement. And I told, I conveyed to her that actually she maintains control of her caqh profile and actually, there will be no difference in how we’ve been operating all along.
Kimberly Jones (13:22) She maintains it. She updates it. She keeps her, you know, everything is kept up to date from her by, from her end. And so, yeah, everything should be fine. She was okay with the… she’s. Okay. Yeah. But I had to ask.
Collette Waddell (13:44) Yeah, no, no, I’m glad I just want to make sure I didn’t see, you know, any additional follow ups there? I just wanted to close the loop on that and make.
Kimberly Jones (13:53) sure. Okay. Yeah, great. Awesome. And.
Collette Waddell (13:57) Then there was also another email. I wanted to make sure we chatted through. I was responding and then knew that we had this call. It was regarding the question you had asked about the credential committee and having more than one team member or member on that committee. Did you still want to kind of work through that or?
Kimberly Jones (14:24) Yes. And this is a perfect time since josh is also on the call as well. So the question as ei transitions to his new position, josh, I was looking to see if dr booth could be in that role. I’m not sure if you had that conversation with her yet, or should I speak with her about it, but it is definitely something that she needs to respond to in a timely manner if she were to absorb that role, take on that role, to approve the credentialing the clinicians in the medallion… platform once they’ve been approved by committee? Yeah.
Joshua Aubey (15:08) I think that’s a great idea. I think transitioning that over to dr booth is the way to go. And based on previous conversations I’ve had with her, I think the only thing that she would need to know is maybe if we schedule even a third, a 45 minute, 45 minute call with her to share someone’s screen and walk her through medallion to show her how to do it?
Collette Waddell (15:33) And is that Kimberly something that you would do internally or would you need support… from, on my end? And I only mention that because it would you ideally want to do it when there’s a file in that queue for her to look at, you know? So there’s actually information live that she can work through. That’s a good point. Yeah. So if you’re not logging in and the screen is blank… and I can look to see if we have any like screenshots or, you know, kind of from like a test environment to see if there’s anything like that I could send over that might help and it might not be live but it might be when you log in. This is what your screen is going to look like. And then you’re going to click this and then you’re going to, you know, you’re going to come back and you’re going to kind of record your recommendation, you know, on that file. So, yeah.
Kimberly Jones (16:30) So then, yeah, one question I had is, could you have two providers to be able to approve at the same time? And could there only be… needed one signature to actually approve all the files and not need the votes or approval of both people that were in that approval status for the committee?
Collette Waddell (16:54) So currently, the… way that the platform is designed for that committee feature is if there is more than one individual that’s kind of assigned to that configuration for that committee, then all of those individuals are, would have to sign off on each of the files. So it doesn’t allow like one to skip or, you know, not to record their review. I’ve had some and there, that is a product. I had actually a couple months back submitted some product feedback, an enhancement request because there are oftentimes you know, some organizations have multiple individuals reviewing files but somebody might be out on leave or, you know, on vacation. And, and so it’s a limitation right now that we’re aware of. And, and there it’s on the it’s kind of on the list of product enhancements… but it’s not currently available. So, so I’ve seen customers do one of two things is I can create a second committee like it’s just in that dropdown, you know, when you’re assigning a file, so you could assign a file. If you know that it’s only going to be reviewed by this one individual, you would assign it just to them or to the other. So I could create more than one quote unquote committee. And, you know, each provider could be assigned to one of them or… some customers use opt to not have their committee members actually vote on them. And then as, the admin is kind of listed as the in platform approver because they actually, you know, are capturing the reviews outside of the platform and that’s just been kind of a workaround that some choose to do. But if I add like two physicians, for example, to the existing committee structure that’s in there, it would require both to vote on every file current. Okay?
Kimberly Jones (19:18) So, I’ve not had the opportunity to see it from that perspective of, the… approver. So I would like to see the screenshots that you have available first. Yeah.
Collette Waddell (19:34) Let me find, let me see if we have any screen I was hoping to. I had, I’m going to try to see if we have any kind of screenshots that I can track down from like a test environment that might be helpful. Yeah, I can.
Kimberly Jones (19:46) Work on that. And then I don’t know, I don’t know that it would take 40, josh, how much it’s I don’t know that it would take 45 minutes to, what did you have in mind for? You know, I mean, what… I think once they, yeah, when they log in, well, Colette, you need to explain it because I’m I don’t know what they see. So maybe it will take more time. I’m sorry, josh didn’t mean to interrupt.
Collette Waddell (20:21) No, no, that’s fine. No. Yeah. So when you are, let me just do a quick screen share and I’m not going to be able to, there’s nothing in that committee queue, but let me just kind of that way I can just speak to what we’re looking at.
Kimberly Jones (20:44) Yeah, we just had committee yesterday. Yeah. Is this?
Collette Waddell (20:48) Big enough? Can you see this or do I need to zoom in? Yeah, I’m.
Kimberly Jones (20:51) fine. So.
Collette Waddell (20:52) So, when a committee member, like if I were to log in as a committee member and I click on this, you know, you’re going to see the files here. Now, right now, it’s blank. There’s nothing here. It’s going to look very much like this. Here. The view is going to look very similar to this except on this right hand side, you know, right now these are the ones that are sitting in the ready under the actions. They’re not going to see send to because it’s already going to be sitting in that committee bucket, but they’re going to see like I think it says like approve or reject or like approve or deny. There’s like two buttons. So it’s like a vote like a vote button.
Kimberly Jones (21:36) Okay. So.
Collette Waddell (21:37) Their view is going to look exactly like this minus this little grid here that’s just going to be instead of send to it’s. Just going to have the vote option for the files. So they’ll you know, I think in terms of training or, you know, if you will, it would be, you know, upon them logging in, of course, it’ll be under this committee tab, but we’re just using the ready for just for visual. It is, you know, clicking this or however, you know, your organization uses it, this is how maybe I would teach it or explain it is, you know, clicking this hyperlink and that kind of presents the packet and the overview here. And then, you know, the different options here or they can click on this, you know, download button to actually open… up the PDF in full. If they just want to kind of look top to bottom, you know, start to finish. And then they… would X out of that bubble once they’re done looking at the file, and then they would just record their, you know, here where it would say like approve or reject it’s. Either approve or reject or deny it’s. Two, you know, you get it. It’s two words, yes.
Kimberly Jones (22:49) Yes. Okay.
Collette Waddell (22:51) So that’s really all it is. So it looks very similar to your view in this ready. It’s just this right hand column right here. That’s really the only difference… as, you know, viewing it as a committee member, when they’re you know, when they’re logged in under this tab here.
Kimberly Jones (23:09) Do they receive another notification? Any other notification that the files are in committee? They?
Collette Waddell (23:17) Do receive a notification that the file is in committee or has been, you know, sent to committee for their review. They do get an email notice for that. I want to say if I… don’t know the cadence of how… they would receive a weekly? If it’s been sitting in there a week, they would get like a Monday notification, but I can double check to see there may be as it relates to committee files, there might be like where it sends maybe like a day or two later. I’m not sure if it’s increased more than just like a weekly, you know, notice because usually those are more timely. So I can do some homework to see if I can figure out if there’s additional cadence beyond the initial notification and like the weekly reminder that go out.
Kimberly Jones (24:10) Okay. What I’ve been doing now is as soon as our committee has met, I send a notification to our chair and ask that they go in and to approve those committee, that committee vote. Yeah. Okay. And who is?
Collette Waddell (24:33) Who’s your committee member right now? It’s dr E.
Kimberly Jones (24:36) Yeah, Hussam. Okay.
Collette Waddell (24:38) Yeah, it was. Yeah.
Collette Waddell (24:44) Just wanted to see and their email preferences should not.
Collette Waddell (25:00) Dr Hussam’s email preferences currently has this disabled. So you can see here notification.
Kimberly Jones (25:09) Files?
Collette Waddell (25:10) Are marked ready to require committee vote, approve, projected or expired? However?
Collette Waddell (25:23) I’m going to do some digging to see… if the platform will still send a notice, an initial notice once a file is moved to that committee queue, because I almost feel like it should… they shouldn’t have the option to turn that off. Okay? I’ll check on that. So if you, again, once I think doing a training is… would be helpful once there is a file in there, you know, to kind of work through that together.
Collette Waddell (26:04) I’m not sure in terms of timeline, if, you know, when… you think you might have another file there where we could, you know, schedule 30 minutes and I don’t think that it would take 30 minutes, but… I don’t think it would take 45 minutes. So, I think 30 minute call would be fine. But I’m happy to help there. I just think it would probably be more beneficial for there to actually be like a file to look at together, you know, in that.
Kimberly Jones (26:39) Yes, yeah.
Joshua Aubey (26:40) Agree. Yeah, I think maybe, you know, as far as giving the background and everything, I know dr booth is very analytical and she likes to think things through and logic through it. So, maybe, you know, we could introduce it as, and maybe she’s done this before, you know, so she may catch on like, yeah, I’ve done this before I get it, you know. So then we’re out of there within five minutes or so. Yeah, you know?
Kimberly Jones (27:05) Yeah, I think.
Collette Waddell (27:06) It’s going to be a kind of there’s kind of two part to a training if you will, one will be the actual technical like going to the platform. This is what you click. This is what you’re looking at. And then this is what you click when you’re done looking at it. And then I think the second component is how she is reading and interpreting the information that’s in those files. And that is something that I would lean on you all internally because, you know, because there might be specific things that you’re wanting her to focus on or when she’s looking at things. So, you know, I can certainly, yeah, I could support, you know, the technical getting in there. This is like how you navigate the system, but, you know, if she has specific questions, you know, in terms of what your organization, you know, is really if you have anything like that, you know, kind of focus on this, make sure to pay attention to this, so.
Kimberly Jones (28:03) That.
Collette Waddell (28:03) Would be something.
Joshua Aubey (28:04) Yeah, I think that makes sense. I think it’s a really good observation. Yeah.
Kimberly Jones (28:09) I agree.
Collette Waddell (28:11) Kimberly, I know we’re at time but we did you have, I mean, I just kind of started and I didn’t even give you a chance to add anything to.
Kimberly Jones (28:25) I appreciate that. I do have a question about board certification outside of initial credentialing and then re credentialing in three years. Is there a cost to well being for the board certification, verification of PSV?
Collette Waddell (28:49) I guess.
Kimberly Jones (28:52) Per verification?
Collette Waddell (28:54) I guess it would depend on… if you are like triggering like if it’s through like abms, then, is that what you’re curious… about? Like if you’re if your team goes in and triggers that verification, but through like the automation because they’re I guess for physicians, it would be through American board of medical specialties, abms. So you would incur a cost or fee. Now, I can confirm with Peter because I know that is definitely more of his scope. So I can take that back with him. I actually have, a sync with him tomorrow. So I can just put that on as a talking point to review with him and make sure we get a response back to you about that, okay?
Kimberly Jones (29:46) So maybe if I help, it would help if I explain the situation. So, what happened? We had a practitioner, a physician who the M they had, we weren’t we did not know that they had not completed their moc, they hadn’t paid the fee or submitted the cme that were required. So we were just waiting for it to automatically go to, you know, it was… due April first and it didn’t show that had been renewed. So we did reach out to the physician and found out. But… we were just wondering if we did this annual re, verification, would that be at a cost to us? And then does it if they actually complete the moc annually? Is… that automatically picked up a medallion with the board certification? Yes?
Collette Waddell (31:12) I want to jump… into some of your files just to get some data. Do you have any availability to meet? Maybe just a, another 30 minute call? We maybe not even use the 30 minutes either later this week or early next week and we can actually like dive deeper into this and maybe have Peter join that call too to.
Kimberly Jones (31:36) Make sure I would love to certainly.
Collette Waddell (31:38) Yeah, I don’t want to rush, but like I want to make sure we’re actually like looking thoughtfully and carefully through that. So, happy to, if you want to maybe send over a couple of blocks of times that might work for you.
Kimberly Jones (31:53) Sure, sure into.
Collette Waddell (31:55) Early next week. And then I will just let him know that I’m throwing some time on the calendar, for us to sync again just, to kind of just have a focused conversation about this specifically. I want to make sure there’s no confusion, you know, going back and forth in emails and stuff like that. So, I think another quick call makes sense if you’re okay?
Kimberly Jones (32:15) I would love that. Thank you so much. Thank you.
Collette Waddell (32:21) Josh, any, josh or Brandon, anything else? Nothing else for me? Thank you. Okay. Yeah. Kimberly, just send over some times that work for you and I will, I’ll look at Peter’s calendar and get something scheduled in the next couple of days for us. Okay?
Kimberly Jones (32:36) Thank you. We’ll do just.
Collette Waddell (32:38) And then if there’s anything else that we maybe not, did not get a chance to get through, we can just tack it on to that conversation. Okay, good.
Kimberly Jones (32:45) I love that. Okay?
Collette Waddell (32:49) That was good. Thanks everyone. Yeah, thank you. Have a good afternoon, you.
Kimberly Jones (32:53) Too. Thanks bye.