Medicare and Medicaid Managed Care Enrollments 2024

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Medicare and Medicaid Managed Care Enrollments in
2024

• Presented By
• Toni Elhoms, CCS, CPC, CPMA, CRC, CEMA,
  AHIMA-Approved ICD-10-CM / PCS Trainer

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Toni Elhoms, CCS, CRC, CPC, CPMA, CEMA, AHIMA
Approved ICD-10-CM/PCS Trainer

• CEO Alpha Coding Experts
• Podcast Host Alpha Coding Podcast
• National Speaker - Coding, Compliance, and
  Reimbursement SME
• Former President of Orlando, FL AAPC Chapter
• Expert Witness
• Published Author
• Consultant/Educator/Trainer

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Agenda
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Medicare

• Federal Healthcare Program
• Signed into law in 1965 under the Social
  Security Administration
• Primarily for US Citizens ages 65
• Initial enrollment typically starts three months
  before turning 65
• Also includes younger individuals and certain
  disabilities, including end-stage renal disease
  (ESRD) or amyotrophic lateral sclerosis (ALS)
• 58 Million People enrolled in Medicare
• Reimbursement based on bundled care rates,
  fee-for-service, risk adjustment, alternative
  models, etc.

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Medicare

• Medicare has 4 distinct types of coverage with
  varying rules, code sets, regulations, payment
  methodologies, etc.
• Part A Facility Inpatient Care
• Part B Traditional Outpatient Care
• 53 of Medicare Beneficiaries
• Part C Medicare Advantage
• 47 of Medicare Beneficiaries
• Part D Prescriptions
• Participation-based enrollment for Part A and B
• Highly regulated federal healthcare program

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Medicaid

• Federal Healthcare Program but administered at
  the State Level
• Primarily for low-income and indigent
  populations
• Participation-Based Enrollment
• Reimbursement is a blend of fee-for-service and
  managed care organizations
• Highly regulated federal healthcare program

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Workflow for Enrollment
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Methods for Medicare Enrollment
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CMS-855 Enrollment Types
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2024 Medicare Enrollment Update

• CMS will allow MFTs and MHCs to enroll in
  Medicare and bill as mental health professionals
  greatly expanding access to BH Providers
• 400,000 LMFT and MHCs professionals are now able
  to get paid and render services to Medicare
  Beneficiaries
• Goes into effect on January 1, 2024
• Requires 2 years of clinical supervised
  experience to enroll in Medicare
• Make sure the NPI Number is linked to the correct
  Taxonomy code

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Most Common Errors
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Most Common Errors
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Best Practice Tips
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Best Practice Tips
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Compliance Considerations

• Are you using a billing company?
• Section 8
• Are your NPPs billing incident to your
  physicians?
• All NPPs need to be enrolled
• Do you have specialists or multi-specialty?
• Specialty designations
• Taxonomy linkage between NPPES and CMS
• Providers who opted out of Medicare or enrolled
  solely to order, certify, and prescribe do not
  have to revalidate

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Medicare and Medicaid Managed Care Enrollments in
2024