While Systems Design West puts significant effort toward assisting with their payer enrollments, the maintenance and accuracy of the provider file is ultimately the responsibility of the provider. SDW can only assist with this important responsibility when we know that a reportable change has happened. Here are some situations that involve updates to your provider enrollments and other areas of the billing process that we need to know about as soon as they are planned:
- You change your fees: Our billing software only knows the fees that have been entered, so you need to supply any updated fees in advance of their effective date. This is true even if your Resolution/Ordinance includes an “automatic” percentage increase/escalator. You should confirm in writing with ShelleyB@sdwems.com prior to the effective date to be sure.
- You receive a payment at your location: We generally route mail to our PO Box in Silverdale, but some payers may choose to mail to your physical address, or patients may arrive at your office with cash in hand. You can accept and deposit the money, but the patient’s account won’t be credited until you tell us that you did so. Forward all paperwork that comes from insurance payers, and in the case of a cash payment, get as much info as you can about the patient’s name, account number, etc.
- You get a new EMS license: All State Medicaid programs require that the current EMS license be on file with them or they will terminate your enrollment. Some do the courtesy of asking for it in advance, others don’t. Make a habit of forwarding a scanned copy of your new license to our Enrollments Team (Enrollments@sdwems.com) as soon as you get it.
- You change your bank account: Many payers submit their payments by EFT and need to be told to re-route to a new account as soon as possible once the new account is established. This also applies to credit card and check capture vendor operations. Do not close the old account prematurely! Wait until you’ve stopped seeing payments arriving there for at least a month.
- You change your legal name/Tax ID: Doing this makes you a completely new entity and means that you will need to re-enroll with all payers as a new provider. Assume that this will take 4-6 months to be complete and give yourself plenty of lead time before planning to do business under the new name. If you are contemplating this type of major change, please contact ShelleyB@sdwems.com for advice on how to accomplish this with minimal disruption to your cash flow.
- You change your ePCR software: If you currently use ePCR software and plan to change to a different vendor, you need to let our Imports team know Imports@sdwems.com. There are specific requirements that need to be set up and tested in advance of live tickets being exported successfully. If you currently send us your PCRs via fax, mail or FTP and want to explore ePCR software, please contact our Imports team to discuss options.
- Your Authorized or Delegated Officials leave your agency: Medicare requires providers to have at least one Authorized Official (AO), who is someone with the authority to bind your agency to a contract. Delegated Officials (DO) are optional but can be delegated by the AO to sign off on routine enrollment file updates. Both must provide a certain amount of personal information to CMS to allow a background check that ensures they are who they say they are before their signatures are accepted. Each agency should have their current AO and DO names on record so when those people leave, you will know that someone else needs to be added in their place. If SDW did your enrollment, we will have that information, but we won’t know to help you initiate an update if we don’t know that your City Manager or Fire Chief retired.
- You add a new Location: Locations where you “do business” are part of the Medicare application. For ambulance providers, this means all locations where your ambulances are parked when not in use. Each of these locations is subject to a “site visit” from Medicare contractors to ensure that the location is suitable for the services offered as a check against billing fraud. When new ones are added, they must be reported to Medicare and an enrollment fee paid to cover the site visit to the new location. Medicare has been waiving the fee for the duration of the national health emergency, but it will be back in due time. Locations taken out of service should also be removed from your Medicare enrollment files.
- You change your mailing address: Medicare rarely sends snail mail, but when they do, certain documents will go to your “Correspondence Address” of record, which must be the provider’s address, not that of the billing agency. If Medicare gets return mail because of an out-of-date address, there will be trouble, and you could miss important deadlines about claims, audits, or revalidations.
- You take an ambulance into or out of service: Like locations, ambulances are listed on your Medicare file and need to be updated as they go in or out of service. We often try to pick these up as we are doing updates for other reasons, but they can be done as a stand-alone update.
- You change your logo or wish to use a DBA name: SDW includes a color copy of your logo on all invoices and statements that go to your patients, so that they will know that this mail is coming from you and not a random address in Silverdale, WA. Please provide a good quality color jpg of your new logo to our Enrollments Team (from item 2) so that we can update our system accordingly.
- You change your billing policies/process: Your contract with SDW specifies that you will provide your billing policies in writing. If they change, we need to be notified with an updated policy document. If you’re adding or changing collections agencies, we need to know that too.
- You sign a contract with a payer: If you agree to accept a lower payment or that payer needs to be billed at fees other than your usual, your billing agency needs to know. We prefer that you consult with us before you sign anything that affects your billing operations.
- You anticipate a substantial change in transport volume: We know that 911 responders can’t always know how busy they’re going to be, but if you know that you’re going to go from being a 30-a-month agency to a 300-a-month agency (or you’re going to temporarily cease billing for several months) your billing agency would appreciate a heads up to be able to staff appropriately.