Description:

This training provides an overview of the latest Medicare (CMS) updates affecting credentialing, enrollment, and billing operations. It focuses on high-risk areas identified by CMS, including improper billing practices, inaccurate data reporting, and non-compliance with enrollment requirements.
Participants will gain practical guidance on how to apply these updates in day-to-day operations, ensure data accuracy, meet reporting deadlines, and avoid compliance violations that could lead to audits or penalties.

Learning Objectives:-

• Identify key Medicare updates and CMS compliance requirements affecting enrollment, billing, and credentialing processes.
• Apply correct procedures for reporting, documentation, and billing practices to maintain compliance and avoid penalties.
• Recognize high-risk activities and implement preventive measures to reduce exposure to audits, revocation, and legal consequences.

Areas Covered:-

• CMS Enforcement Focus
  • Increased audits, surveys, and data verification
  • Fraud, waste, and abuse prevention initiatives
• Enrollment & Credentialing Updates
  • Reporting timelines (CHOW, leadership changes)
  • Revalidation requirements and PECOS updates
  • Address verification and USPS requirements
  • DBA documentation alignment across systems
• Billing & Operational Compliance
  • Proper use of locum tenens modifiers
  • Accurate Place of Service (POS) reporting
  • Telehealth provider address requirements
• Regulatory & Administrative Changes
  • On-site survey requirements and effective dates
  • DME moratorium and potential expansions
  • Integration of 855 forms (855R into 855I/855B)
• High-Risk Compliance Areas
  • Signature misuse and credentialing violations
  • Failure to disclose criminal convictions
  • Improper role designation (A/O, D/O)
  • Affiliation risks and revocation impacts
• Operational Best Practices
  • Monitoring preclusion and opt-out lists
  • Managing EFT verification processes
  • Ensuring accurate contact information handling.

Background:-

Recent updates from CMS reflect a stronger enforcement environment focused on preventing fraud, waste, and abuse. Increased audits, stricter documentation requirements, and tighter controls on enrollment and billing processes highlight the need for organizations to stay fully compliant.

These changes impact multiple areas, including provider enrollment, billing accuracy, reporting timelines, and operational procedures. Failure to comply may result in penalties, revocations, or legal consequences, making it critical for teams to stay informed and aligned with current CMS expectations.

Why Should You Attend?

It will help:

• Avoid costly mistakes by understanding the latest Medicare rules and high-risk areas
• Stay audit-ready as CMS intensifies reviews, surveys, and data validation
• Protect your organization and career by preventing violations that could lead to fines or legal action
• Improve accuracy and efficiency in enrollment, billing, and reporting processes
• Gain confidence in handling updates and applying them correctly in your daily work.

Who Will Benefit?

This training is ideal for:

• Credentialing and Enrollment Specialists
• Medical Billers and Revenue Cycle Teams
• Compliance Officers and Auditors
• Practice Managers and Healthcare Administrators
• Provider Relations and Operations Teams
• Leadership overseeing Medicare-participating organizations.