This transcript has been auto generated
00;00;05;01 - 00;00;24;14
Meg Pekarske
Hello and welcome to Hospice Insights: The Law and Beyond where we connect you to what matters in the ever changing world of hospice and palliative care. A Rise in Medicare Deactivation: Tips for Avoiding This Financial Pain. Financial pain is absolutely the truth, Adam.
00;00;25;00 - 00;00;26;20
Adam Royal
Among other types of patterns.
00;00;27;01 - 00;00;56;27
Meg Pekarske
Yeah, this is unfortunately something you and I have been spending a lot of time working on recently. I think we're I've now lost count. We are counting how many deactivations we've been involved in in the last six months. I think we stopped counting after ten or eight or something. I don't know. But yeah. Too many. Too many. And I think that this is a right the government has always had as a right to deactivate.
00;00;57;15 - 00;01;21;04
Meg Pekarske
And this is deactivating your Medicare provider number, which is something different than terminating you from the Medicare program. And so it's less severe than getting terminated did. However, when you get terminated, you have a ton of due process, right? You got to appeal that decision. You get to do all this at a deactivation. I mean, there is a rebuttal process that isn't very helpful.
00;01;21;04 - 00;01;45;03
Meg Pekarske
Right. But yeah, most of it is just you have to hurry up and file new. 855 And so I guess pick your poison. That's not you don't want either one of these things, but the activations are the reason why they're financial pain. As the money dries up. Right. Exactly. And so and it's not even cash flow delay necessarily.
00;01;45;03 - 00;02;03;23
Meg Pekarske
You won't necessarily get paid for things that potentially during the time in which you're deactivated. But I guess anything new about the law we want to talk about, I mean, we can list that it's in 42 CFR for 24.540.
00;02;03;27 - 00;02;05;22
Adam Royal
And everyone goes straight there for.
00;02;05;23 - 00;02;23;02
Meg Pekarske
Listening. But like, you know, anything to highlight with the law other than maybe it's just like with all this enrollment stuff and fraud concerns, there's just now enforcement of laws that were on the books or. What do you think, Adam?
00;02;23;08 - 00;02;55;24
Adam Royal
Yeah, I think that's the gist is the law remains the same. It's been on the books. The reasons for being deactivated haven't changed. I guess the small caveat that recently the ability to be deactivated for non billing was shortened from 12 months to six months and that that occurred at the beginning of the year when all of the kind of hospice fraud related revisions came out.
00;02;56;25 - 00;03;05;16
Adam Royal
So the non billing option for deactivation already existed, but it was shortened recently to six months. Otherwise it's it's remained the same.
00;03;06;00 - 00;03;41;23
Meg Pekarske
And yeah. So and those reasons are you're not reporting a change. You don't respond to the government when they do the development requires you're not in compliance. A practice location is not operational and then if the law is in change, why is everyone getting deactivated? And I think it's like but now they're actually enforcing these laws because I think the problems are errors that people are making are maybe not new ones.
00;03;41;23 - 00;03;46;22
Meg Pekarske
It's just that the government is sort of monitoring this like a hawk.
00;03;47;19 - 00;04;23;28
Adam Royal
Exactly. Yeah. They're they're looking into how and whether your report in your ownership of the hospices. But are you doing it in a timely manner and. Ah, yeah, proactively looking into, into that sort of thing. And then we've also seen just a whole round of re validations pop up recently, which has also prompted some de activations. But yeah, I think it's, it's greater attention from the government that's, it's just causing them to exercise this right of deactivation that they haven't before.
00;04;23;28 - 00;04;57;17
Meg Pekarske
And Revalidation, I think, is important because probably half of what we've been dealing with as people sort of screwing up a reveille station and screwing up has often at least the first screw up people have had is they didn't respond. So one of the reasons for deactivation is failure to respond to CMS contractor. So when you file your revalidation, you should expect to get an email response from the government confirming they got it.
00;04;57;22 - 00;05;30;04
Meg Pekarske
So if you're not getting that right away and we'll circle back to this in the tips, then maybe you didn't send it to the right email address or didn't actually go through. But, you know, it is you should be hearing back from people. It shouldn't be. I know many things with government sometimes seem like radio silence when you submit an update to your 855 like you're updating board members or something, you should there should be communication back and forth.
00;05;30;04 - 00;05;30;26
Meg Pekarske
And so.
00;05;31;12 - 00;05;31;19
Adam Royal
Right.
00;05;32;02 - 00;05;41;20
Meg Pekarske
I think that that's where again, what is the reason why people are getting deactivated? Most of the time? It's the failure to respond to the contractor. Right.
00;05;42;01 - 00;06;12;10
Adam Royal
Right. Exactly. And so when you submit something through Paco's, you'll get within a matter of seconds an auto generated email to the contact email address confirming that that the submission went through. And you should be able to see the status of that submission on your Paco's application or on your your Paco's page, too. So those are two places that you can confirm that a revalidation or any other change of information has actually been submitted.
00;06;12;10 - 00;06;38;04
Meg Pekarske
And if you're not getting that email confirmation right away and this again, we'll run down the tips at the end, but they're going to come up as we talk through the problems is you didn't get that email, but you confirm you sent it, then you probably aren't listed like the email that's designed to get these notifications is like, oh goodness, who's set up for that, right?
00;06;38;04 - 00;06;43;04
Meg Pekarske
Like is this going to someone who hasn't been at the organization for three years or something?
00;06;43;20 - 00;07;29;11
Adam Royal
Mm hmm. Yeah, exactly. And so that's a problem we've seen, too, is old email addresses are listed as contact addresses on on the application. And so communications are going to something that isn't monitored or to somebody that isn't with the hospice anymore or to an address it doesn't exist anymore. And same thing with physical letters too. So if you're putting a physical address, sometimes those will get sent to an old, outdated address and sometimes it's the fault of the provider, and other times it is the fault of the the max or it seems to be they'll they'll send things to addresses that may be out of date but are listed somewhere on your enrollment information
00;07;29;16 - 00;07;32;27
Adam Royal
and kind of without explanation. We'll send it to that address.
00;07;33;15 - 00;08;20;10
Meg Pekarske
This is not an area to be passive, I guess is what we're is the gist of this podcast. As you know, the task is then to file the revalidation. The task is to get an approved revalidation, or the task is not to file, you know, updates to your board members. It needs to be getting those approved. And so another area that's in the law, but we have seen, I think, less enforcement on or at least more grace being given is timely reporting changes, which is typically if you're making a change like board members, managing employees, practice locations, there is a timeframe to do that.
00;08;20;10 - 00;08;59;13
Meg Pekarske
It can be 30 days, 90 days depending on the change, but you're supposed to do that and you don't you shouldn't be waiting for your revalidation to make those changes because essentially you need to keep this information updated. And so if you're not reporting things, that could be also reason to be activate. Yeah I guess why we've known that there has been grace is I think got a lot of things that we've worked on most people's 855 is not totally and completely updated and and again I don't think we should expect grace from the government forever on this.
00;08;59;13 - 00;09;30;03
Meg Pekarske
So I think a takeaway from this podcast should be keeping your 855 staff updated should be a very important job within your organization, not something that's given to someone who doesn't understand the importance because you got to really stay updated on these changes. And we've covered this in other podcast ad, but like the types of things that need to get reported on the 855 are more expansive.
00;09;30;03 - 00;09;58;23
Meg Pekarske
That may be historically people have reported like who's considered a managing employee. Right now you have medical director and others, but you know, practice locations and all the staff. So I just can't stress enough the importance of 855 keeping that updated and knowing the timeframes for doing that. I mean, it's been implied through our conversation so far about what deactivation is, but what's the short of deactivation?
00;09;58;24 - 00;10;04;24
Meg Pekarske
We we said that it's different than being terminated, but what is it and how do you get back in?
00;10;05;10 - 00;10;53;04
Adam Royal
Yeah, essentially deactivation is not termination or revocation of your provider agreement. So you continue to be enrolled in a medicare program. But during your deactivation, your billing rights are revoked. So you can't submit claims or you can't get paid for claims. And so you you don't have to become reactivated. You don't have to re enroll in the Medicare program, but you do have to file a reactivation request which is made through the 55 or Paco's and certify that all of the information supplied the amount is accurate.
00;10;53;09 - 00;11;07;25
Adam Royal
So if you if you get deactivated and are reactivated, the effective date of your P10 will be what it was before. That won't change. It's just this interruption in billing essentially during the deactivation period.
00;11;07;25 - 00;11;37;18
Meg Pekarske
There can be a gap there between. So it's not just like, oh, I can backfill. I mean, in many of the situations they have allowed us to backfill because the reactivation date is the day you file it or the date of deactivation. But you know, there is some wiggle room there. And so, again, needless to say, this is urgent since 90, close to 95% of the revenue in hospice is coming from Medicare.
00;11;38;04 - 00;12;02;24
Meg Pekarske
This can be, you know, a real zinger, even if you get to back Bill, I mean, making payroll for people, I mean, depending on what your cash reserves look like, I mean, this is a real problem because that's not just like you file this, you get notified, you're deactivated and you file tomorrow. It doesn't mean the faster you get to file claims immediately.
00;12;02;24 - 00;12;03;06
Meg Pekarske
Right?
00;12;03;17 - 00;12;35;07
Adam Royal
Exactly. There's really two cash flow related problems with it. One is the regulations and guidance state that your ability to bill retroactively extends back to the day you submitted your application and not to the date of deactivation. So if you're deactivated on the first of the month, you submit an application on the 15th of the month, those 15 days under the regulations and guidance, you're not entitled to payment for for those days.
00;12;35;23 - 00;12;58;11
Adam Royal
The second problem is, even once you submit the application, the Mac still has to process it and it's a full revalidation application. All of your provider enrollment information. And so that can take some time. And during that time, even though you will eventually be able to bill retroactively to the date you submitted the application while they're processing it, you still can't, Bill.
00;12;58;11 - 00;13;07;23
Adam Royal
And so they could be processing it for a month or two months. And and during that timeframe, the Hospice's cash flow is, is pretty much stopped.
00;13;08;05 - 00;13;39;14
Meg Pekarske
We had a client where this happened to and they the Pfizer got turned back on within days to week, which was pretty, pretty unheard of fast. Other things we've worked on. It's taken 30 to 60 days, right, for things to get processed. And it's not like it doesn't ultimately like get approved, but, you know, tick tock. And I mean, as much as you might want to call, it's really hard to get this moved along.
00;13;39;14 - 00;14;02;03
Meg Pekarske
I mean, there is no one person you can call. Well, just put you in front of the line as much as, you know, lawyers like to think they can work magic. I mean, yeah, we have different connections, but I think for these 855 things, it's, it's hard to I feel like they're going to say there is a process and I have to follow it.
00;14;02;03 - 00;14;07;09
Meg Pekarske
And I mean, you can be bugging the analyst all the time, but that the last like.
00;14;07;12 - 00;14;22;20
Adam Royal
Yeah, yeah, it can it can take a while, especially if there have been a lot of intervening changes that you have to bring up to date. And also with the new fingerprint requirements, if you're submitting fingerprints for an owner, that whole process can slow things down a lot.
00;14;23;06 - 00;14;37;18
Meg Pekarske
Yeah, so. So word to the wise you don't want to be in here. I guess any one other sort of wrinkle you need to hospice is this whole filing of the A.B. while you're deactivated. How does that work out? Because we've had to work through that.
00;14;38;06 - 00;15;13;08
Adam Royal
Yeah, that can that can get to be a a complicated issue. Generally. We've seen hospices be able to submit in a ways during the deactivation period because hospices are subject to their two tight time requirements as to when they have to submit those anyways. So generally we've recommended continuing to to submit those anyways. The max don't process them, but the anyways aren't kicked back or rejected to the hospice.
00;15;13;08 - 00;15;35;07
Adam Royal
And so the guidance in the manuals is that generally that in a way is submitted when it when it's kind of put into the system and not rejected or kicked back by them back. So, so yeah, we've seen hospices be able to continue meeting their entry requirements during the deactivation period.
00;15;35;19 - 00;15;59;02
Meg Pekarske
For anyone listening to this, if you ever got in the position of deactivation, I think the first call should be to a lawyer because you're going to want to, you know, get file reactivation right away. But like, you don't want to do that wrong too. And then like now you got like another a reactivation where stuff isn't right.
00;15;59;02 - 00;16;29;28
Meg Pekarske
Because I would remind people again, this 855 staff is really important because you're certifying that all this information is correct. And so if things are not correct right, then your certification isn't fully accurate, right? So so I think that sometimes people rush into filing reactivation before calling a lawyer and sometimes that can make things messier than if you just I mean, these things are 911 for us.
00;16;29;28 - 00;17;07;00
Meg Pekarske
So like we get on these things very quickly, but it's like, don't handle the stuff on your own because they're just you're messing with, you know, your primary paper source and you don't want to back it up further because we have seen people do that. So, I mean, not that this is rocket science, but I just we've seen so many problems with this and it's not always intuitive how you go about things, but that's that's quickly run through the tips for avoiding day activations.
00;17;07;18 - 00;17;36;12
Meg Pekarske
And a lot of these go more towards like revalidation and like if you file something but don't get a confirmation, that kind of stuff. I guess one tip for avoiding is just to is keep this information up to date. Right. Don't wait. I think people were waiting or not maybe always taking a seriously and and I think you can have things that are ten years out of date.
00;17;36;12 - 00;18;04;03
Meg Pekarske
Right so right to take this seriously. So I guess tips to avoid is generally I think most organizations probably are going to be needing to file something with 855 staff at least once a year. Right. Because you're going to have changes maybe in board member or some one on the management team changes like. And then you should also think, do I need to update my license or Medicaid as well?
00;18;04;03 - 00;18;27;12
Meg Pekarske
So like that whole job thing. But another thing that that's been sort of a connector between a lot of the problems we've dealt with is that email thing. So you came up with a good idea of how do you avoid like, oh, this is to the email address of our old compliance officer. What do you what do you do to avoid that?
00;18;27;28 - 00;18;58;28
Adam Royal
Yeah, I think it would be a good idea to have a consolidated ID or departmental email address like compliance at swisscom that multiple people have access to and that that won't be subject to staff turnover. So instead of being sent to an individual email address and that individual may leave, it's a departmental address that's going to be constant throughout turnover so that that could help prevent that kind of a situation.
00;18;59;08 - 00;19;34;29
Meg Pekarske
Or if someone's on medical leave or something like that. So yeah, group like a general email address that multiple people have access to and get notifications of, right? So like maybe it's only used for this person, but you do get notifications when an email goes to that. So then again, the point is to avoid not responding to requests because you might file something, but they're going to email back the person not who filed it, but like the contact that is listed and Paco's.
00;19;35;14 - 00;19;35;25
Adam Royal
Yeah.
00;19;36;20 - 00;20;12;20
Meg Pekarske
Another thing and this is sort of good practice in general I think is keep copies of everything you file like the, like whether or not you want to take a picture of it, print it out and save it as a PDA for and then save it electronically. But actual filings like of what I submitted so that you can track like because ideally yes they should have this on Paco's but if you filed some things on paper versus electronically, the paper isn't always reflected in your electronic right.
00;20;13;00 - 00;20;29;25
Adam Royal
Right. Yeah. Yeah. So copies of if it's paper submissions, copies of the submission and also the mailing receipt, proof of delivery, anything like that, the document that you sent it and that it was delivered and dates.
00;20;29;25 - 00;20;59;11
Meg Pekarske
Yeah. And again, you should be able to get this on the electronic system, but like I would just to just keep copies of your actual filings like electronically, like even if you submitted electronically, there's a way like you can say that because we've had some people where weird things have happened where they said we wanted like we didn't want this unit anymore, like ten years ago.
00;20;59;11 - 00;21;22;22
Meg Pekarske
And it's not in our profile and we have like no record of ever filing anything that ever said that. And so, but it's always good to be able to go back to your record and be like there was no such filing, right? So I think having documentation of all of the correspondence and all of the submissions I think would be really helpful.
00;21;22;22 - 00;21;31;19
Meg Pekarske
So you can go tit for tat because I think sometimes we've been dealing with situations where we don't really have the proof because it's like, Wow, I don't know.
00;21;31;24 - 00;21;37;07
Adam Royal
Yeah, yeah. It's almost like proving a negative. Yeah, yeah. Kind of hard to do it retrospectively.
00;21;37;07 - 00;22;05;14
Meg Pekarske
Exactly. And then because Adam, you said you do get this immediate confirmation, you look for that. But then you indicated when we were prepping for this, there's a tracker on every Mac has a tracker so you can watch the progression of your app, whether it's a revalidation or it's reporting a change of information. Right. You can track that.
00;22;05;25 - 00;22;38;04
Adam Royal
Yep, you can. They've got that through their websites and you can search by paten or pie or tracking number from the application just to to see the status. So if you have confirmation of submission and 15, 20 days have passed and you haven't heard anything from an analyst, it would be prudent to look into that tracker to see make sure, you know, it's been assigned to an analyst or somebody who's processing it.
00;22;38;13 - 00;23;00;15
Meg Pekarske
Yep. And obviously, people are running into problems. They can always, you know, call a lawyer to help them sort that that out. Yep. And I guess the final point, which I probably said like ten times on this podcast, like this is not an area where no no news is good news. Right. That is absolutely not the takeaway from this.
00;23;01;00 - 00;23;25;10
Meg Pekarske
You know, no news is not good news. No news is bad news because it means they send something, you're not getting it or it's taking a long time to process because they have, you know, whatever it is. But this is not like sit on your hands and wait for a receipt. You know, they never got back to me because I think sometimes with the government, people might think, well, I didn't hear anything back.
00;23;25;10 - 00;23;31;25
Meg Pekarske
I'm sure it's fine. Right? It's like that's actually absolutely the opposite approach you should take.
00;23;32;12 - 00;23;41;02
Adam Royal
Yeah, you'll get an affirmative response and in some manner, if they're in receipt of it and processing it.
00;23;41;07 - 00;23;44;10
Meg Pekarske
And a final approval of the change. Right.
00;23;44;14 - 00;23;44;22
Adam Royal
Yeah.
00;23;45;02 - 00;23;54;11
Meg Pekarske
Whatever it is, if it's a change of information or it's a revalidation, you will get like the final thing that says this has been approved.
00;23;54;27 - 00;24;08;08
Adam Royal
Yeah, exactly. Yeah. So the the monitoring and follow up, like you said at the beginning of the episode is is just as crucial as actually getting it submitted. The goal is approval, not just submission.
00;24;08;20 - 00;24;29;20
Meg Pekarske
Well, I hope with this podcast we've changed the world and we never have to deal with it. Now I'm sure deactivation after we have because you know, it's far and wide and everyone listens. This is their favorite. It's favorited on their Apple podcasts and yeah, again, if you enjoy our podcast, please rate them so people can find us.
00;24;29;20 - 00;25;11;18
Meg Pekarske
But and then we can change the world. Exactly. So but these are just such stressful situations for clients to work through. And I if we can do anything to help people avoid those problems, I hope this has because it is like the least favorite conversation I feel like anyone wants to talk about is 855 stop. But you know, even as a CEO, this has actually got to be your business a bit like not that you're filing it, but like you have a process in place and, you know, it's a it becomes a priority item because the way things were before is not how the government's handling this now and into the future.
00;25;11;18 - 00;25;28;18
Meg Pekarske
And I think it's just going to get much more into the weeds. I mean, is everything right and every everybody in T crossing while hopefully our experience in this area has stopped here and we'll never work on another one.
00;25;28;24 - 00;25;29;22
Adam Royal
But fingers crossed.
00;25;30;08 - 00;25;40;08
Meg Pekarske
So hopefully there'll be no further update to this podcast for the next ten years. So anyway, but thanks. Thanks for your time Adam. This is really helpful.
00;25;40;16 - 00;25;47;06
Adam Royal
Yeah, thank you. Happy to be here.
00;25;47;06 - 00;26;08;17
Meg Pekarske
Well, that’s it for today's episode of Hospice Insights: The Law and Beyond. Thank you for joining the conversation. To subscribe to our podcast, visit our website at huschblackwell.com or sign up wherever you get your podcasts. Until next time, may the wind be at your back.