CMS to test new screening for provider enrollment

The CMS wants to make it easier for physicians to enroll in Medicare and Medicaid through a pilot program that streamlines the screening process.

The agency plans to launch a pilot program sometime this year to offer provider screening for state Medicaid agencies on an opt-in basis using the same methods now in place for Medicare, according to CMS Administrator Seema Verma.

"From a provider perspective, this is easier because they can go to one agency and if they're approved they're approved for both Medicaid and for Medicare," Verma said.

The move could potentially save hospitals and medical practices millions of dollars annually in administrative costs to enroll providers in the programs.

Physician practices in the U.S. spend nearly $83,000 annually per physician on administrative costs, according to Health Affairs estimates.

Currently, doctors can wait as long as six months to go through the coverage credentialing process for Medicaid programs, according to Dr. Michael Munger, president of the American Academy of Family Physicians.

Physicians and other healthcare practitioners who wish to bill either Medicare or Medicaid must undergo a credentialing process to verify their education, training and experience.

"If you as a physician try to do it yourself, you'd have to take time from patient care, so you have to hire staff," Munger said. "It's a very costly problem."

A lag in credentialing can slow new doctors from joining the workforce as employers tend to insist they are enrolled in Medicare and Medicaid before they start to see patients, Munger said.

The move may also help to address the rate of improper payments in the Medicaid program, Verma said.

Improper payments for Medicaid in fiscal 2016 hit $36 billion up from $29 billion in the previous fiscal year, according to federal data.

Improper payments include fraudulent claims, payments distributed to the wrong or ineligible recipient or for the wrong amount, payments with insufficient documentation and issues where the recipient uses the funds improperly.

The Government Accountability Office found in 2016 that states and Medicaid managed-care plans face significant challenges in screening providers for eligibility to participate in the Medicaid program due to inconsistent access to federal databases.

"So, we're doing the same background checks, and it's just much easier for providers and states in terms of burden," Verma said. "I think you can get more integrity from the system that way."