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CMS Demo Projects to Curb Improper Medicare / Medicaid Payments
[1950]
$45.00


[PGM1950] CMS Demonstration Projects to Curb Improper Medicare / Medicaid Payments

Summary: Learn what CMS is doing and how it can affect your agency.

HCSSA Topic(s) Addressed:

  • 97.259[d][4]agency responsibilities
  • 97.260[a][7]financial management

Faculty: Irwin, Carmen [CMS]

Program Description: This program provides details on three CMS demonstration projects that will affect Texas Home Care providers. [1] The Recovery Audit Prepayment Review demonstration will allow claims to be reviewed before they are paid to ensure the provider complied with all Medicare payment rules. [2] The Prior Authorization for Certain Medical Equipment demonstration will require prior authorization for certain medical equipment for all people with Medicare in Texas. [3] The Provider Enrollment Revalidation Project will be in Phase II of the process. This program provides focus on the current and future aspects of this revalidation project and useful tips for providers attempting to revalidate.

Program Objectives: Upon completion of this program, the viewer will be able to:

  • Identify prepayment review activities of Medicare Administrative Contractors (MAC) and Zone Program Integrity Contractors (ZPIC) for specific Part A claim types
  • Discuss the Provider Enrollment Revalidation Project

About the Presenter: Carmen Irwin has worked with Medicare for the past 16 years. She started her career working in the anti-fraud department at Palmetto GBA. After a few years working fraud in Miami-Dade & Broward counties, Carmen moved on to beneficiary outreach and education. In the fall of 2002 Carmen accepted a position with CMS in the Dallas Regional Office.
Carmen works with several Medicare ZPICs and is the point of contact for fraud education in the Dallas RO. In addition, she works with the local SMP projects throughout Region Six. Carmen is bilingual in Spanish and English and works with the local beneficiary advocate groups promoting Medicare and anti-fraud initiatives. Carmen also is the DMEPOS policy expert for the Dallas Regional Office.

Education-Training Credits:

  • 1.50 Hr(s) HCSSA Administrator/Alternate

[PGM1950] CMS Demonstration Projects to Curb Improper Medicare / Medicaid Payments

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This product was added to our catalog on Tuesday 07 February, 2012.
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