This transcript has been auto generated
00;00;00;00 - 00;00;37;16
Meg Pekarske
Hello and welcome to Hospice Insights: The Law and Beyond where we connect you to what matters in the ever-changing world of hospice and palliative care. If Only I Knew… Avoiding the Most Common Mistakes with the 855. Okay, Andrew, thank you for doing this podcast with me. I will say our 855 podcasts don't ever perform as well as some other exciting topics like audits and AI and all that stuff.
00;00;37;19 - 00;01;04;21
Meg Pekarske
But as lawyers who have to deal with problems, we are doing this as a public service despite the fact that no one listens because I hate getting called on a Friday at five. Oh my God, like, you know, I can't. I'm not getting paid by Medicare because I've been, you know, deactivated and then someone wants to pull a rabbit out of the hat and, like, fix this.
00;01;04;21 - 00;01;33;18
Meg Pekarske
And it's like, okay, this is going to take a while. So yeah. Anyway, this is not because we love talking about it. I think it's because we don't like people to foolishly get into trouble when they don't really need to, because this is all human error administratively. You're just not paying attention. And the government means business on the stuff they do.
00;01;33;19 - 00;01;55;10
Meg Pekarske
So if you have not caught that, because you've ignored our other like 2 or 3 podcast, I mean, 55, maybe we're going to try to make this real punchy because you've come up with, like, a top head list or something. So we're going to try to make this as fun as possible. But yes.
00;01;55;12 - 00;02;00;06
Andrew Brenton
So yes. And if you're listening now, you are among the elite. So you know.
00;02;00;07 - 00;02;06;20
Meg Pekarske
Elite, that's what we're going to do. We're going to, give people, you know.
00;02;06;27 - 00;02;07;25
Andrew Brenton
The inside scoop.
00;02;08;02 - 00;02;47;13
Meg Pekarske
Yeah, the inside scoop. And, because the government means business. So. Yeah. And none of this stuff is hard. Everyone's capable of doing that. And if people need help with these things, we are a phone call away. We help people with 855 all the time. And so, so before we get to your list, though, I'm going to say one important thing on like how to avoid this is I will say it for the millionth time, do not have finance people do your 855 because I think it should be in compliance.
00;02;47;13 - 00;03;18;28
Meg Pekarske
Or someone who's more tuned in to listening to like our podcast than like, no, you know, the government, focus on 855 and accuracy and because I think most folks we listen to all of these tasks that we're talking about lie with finance because they think it's payment related. But I really think it houses in compliance because it's just like you don't give finance when we have to.
00;03;18;28 - 00;03;50;01
Meg Pekarske
We got a new administrator. You need to update your license that the new administrator to the state finances usually doing that someone else's. Right. So and I think it's and we've covered that in other other podcasts. But I think the top top ten, whatever list we have here think about who in your organization is doing this, because none of the things that we're going to say to do are only finance would know this.
00;03;50;03 - 00;04;00;13
Meg Pekarske
It's actually maybe they're less likely to know these things. So I will get off my high horse and you take it away. Andrew. Yeah. Yep.
00;04;00;13 - 00;04;35;14
Andrew Brenton
One tip. One though. And I guess. But, you know, kind of framing these as, mistakes to avoid, you know, the most common mistakes we see. And in working with a lot of, hospice and other providers on these, if I provide enrollment issues. So the first mistake, that we commonly see that you should avoid is waiting until revalidation to update your a 55 year Medicare enrollment record.
00;04;35;17 - 00;04;40;17
Andrew Brenton
You know, I, we see this frankly a lot. Right. And, I mean, we value.
00;04;40;19 - 00;04;43;18
Meg Pekarske
Andrew revalidation said every three years.
00;04;43;23 - 00;04;45;06
Andrew Brenton
I believe it's every five years.
00;04;45;07 - 00;04;48;15
Meg Pekarske
Okay. So yeah. Can't wait five years.
00;04;48;17 - 00;05;24;14
Andrew Brenton
No, no. Now if, if when revalidation comes and you find that you haven't updated things I mean, yes, definitely update things. But, under the law you actually do have there are deadlines for reporting changes to your enrollment record that are much shorter than five years. So if you are, you know, updating, personnel. Right, a section six, because you have a new administrator or you have a new board member or board member left or whatever, those are kind of changes of control.
00;05;24;17 - 00;06;09;25
Andrew Brenton
Or if there's an ownership change, then there's a 30 day deadline to report that, kind of your more mundane, you know, business identifying information type changes like a new email address or something. Those are 90 day, deadlines. So after the change, you have 90 days to report it. But there are even some changes that, Medicare wants you to get pre-approval, before doing so, like, if you're a hospice and you're relocating or, you know, change in your business address, like the practice location of the hospice, technically, you want to get, you know, that or you submitted before, it happens as opposed to, you know, waiting a long
00;06;09;25 - 00;06;11;23
Andrew Brenton
time after the fact or. But.
00;06;11;25 - 00;06;43;10
Meg Pekarske
Yeah, super important. And I do think, and it's probably even more for nonprofits because they have board members, then people cycle on and off. If you're a privately held company, I mean, I guess you could have different ownership, changes because percentages that considers a change to. So if someone gets more equity, like they're moving you at 13% now you have 15%.
00;06;43;13 - 00;07;08;05
Meg Pekarske
You still need to report that change, even though it's not a different percent. So I mean, private companies can have, you know, some reporting. But I think for nonprofits who some, some nonprofits don't have pretty big boards, right. Like and those people can cycle off and all of that stuff and that this is something everyone needs to pay attention to.
00;07;08;05 - 00;07;33;13
Meg Pekarske
But I think especially nonprofits, you need to have a checklist because you're probably updating your website to remove that board member. Right. And it's like your checklist should also be, oh, I need to report that change. And I guess too is we're talking about board members. You have to the board member needs to give their Social Security number.
00;07;33;13 - 00;07;42;04
Meg Pekarske
I feel like this happens a lot. Yeah. Where we have board members who don't want to give Social Security numbers, and there isn't really a way around it. Right.
00;07;42;08 - 00;07;43;02
Andrew Brenton
So that.
00;07;43;04 - 00;07;44;08
Meg Pekarske
Yes, like.
00;07;44;11 - 00;08;19;12
Andrew Brenton
CMS wants to see the date of birth and the Social Security number of anyone that you're reporting has a controlling interest in the provider. So, yeah, board members, administrator, medical director. So, yeah, some you're I sometimes want we need to like, you know, wait for them to call us to verbally tell us that information. But it is something that, you know, you're not going to be able to even submit the 55 through Pecos if you don't provide that required, information.
00;08;19;15 - 00;08;30;08
Meg Pekarske
Yeah. So. So. All right, so we got that that you have to make. They can't wait to five years. Yeah. Tell the government who's in charge. Okay.
00;08;30;10 - 00;08;59;13
Andrew Brenton
Yes. So, yes. The second, common mistake we wanted to bring up is the mistake of not reporting your hospice administrator and medical director. This is a more hospice specific, tip. Most of these are, you know, kind of agnostic as to the provider type, but specifically for hospice is your administrator and your medical director need to be on your A55?
00;08;59;15 - 00;09;38;12
Andrew Brenton
That is because they are considered to have a managing control, you know, of the day to day operations of the hospice. So it's always been a requirement that they be on the five. But we've seen enforcement on that issue recently. In the past year or two, I would say the we've had clients who have received letters from CMS saying you need to update your A55 to add administrator and medical director and the current version of the A55 application, which was updated in September of 2024.
00;09;38;14 - 00;10;00;16
Andrew Brenton
It actually now specifically has a checkbox for hospices. It's five for entering a person and it says, you know what, this is for us. This is this person or, you know, the administrator or the medical director. So very, very clear. This is something on CMS radar. If your A55 does not currently have these folks listed, you would be advised to list them.
00;10;00;18 - 00;10;17;14
Meg Pekarske
And again, the ramification for not doing this, the government has very broad authority to deactivate you. Right? Yes. So which means facet is turned off.
00;10;17;16 - 00;10;18;15
Andrew Brenton
Yes.
00;10;18;18 - 00;10;57;03
Meg Pekarske
So you you have to essentially start all over. I mean, you're not going to a new provider number, but you have to complete, the whole thing. 55 and now I can take, you know, I mean, the quickest thing I think we've seen is like two week processing time, but it's also taken several months for people to. So all of these things we're talking about, if you don't do it right, they can deactivate you and then you can have serious cash flow issues because not that many people can float.
00;10;57;05 - 00;11;22;08
Meg Pekarske
You know, if 90 plus percent of your revenues from Medicare were, you know, rent for months on end because you've been deactivated. And so that's why I don't know why more people don't take this seriously. But, you know, it's not like we love talking about this, but because the ramifications mean everyone's all interest in audits and payment suspension that can happen to that.
00;11;22;08 - 00;11;39;14
Meg Pekarske
And this is essentially a payment suspension that's going to happen to you if you don't do this stuff. Right. And so functionally it is it is like that. So all right. So, so tip three, tip three.
00;11;39;17 - 00;12;06;26
Andrew Brenton
We were kind of hinting at this earlier, but that would be to make sure that you're a 55, list that your full governing body. So if you have a board of directors, every single director needs to be listed on your A55. All of those people are considered to have, you know, a control, interest in the provider.
00;12;06;29 - 00;12;38;09
Andrew Brenton
And, you know, if you're depending on the size of your board, right, you might have a lot of turnover. People leave even beyond sort of like, you know, like the scheduled terms ending. So all of that does need to be reported within 30 days of the change happening. So if you don't have your full governing body on the 85, you should add it and then be mindful, you know, to update, your a55, if there are any changes throughout the year.
00;12;38;12 - 00;12;53;14
Meg Pekarske
Yeah. And so I guess this, this tip, comes from people maybe just putting in their executive board on there or selective board members as opposed to the full board. Is that where.
00;12;53;14 - 00;13;18;27
Andrew Brenton
This is coming from? I mean, yeah, I've seen that. I've seen no board members whatsoever on the A55. So, yeah, you know, I mean, if, if you're, if you have like a 20 member, or, you know, if your board of directors has 20 people on it, I mean, that's a lot of, you know, changes of the property that are happening.
00;13;18;27 - 00;13;33;27
Andrew Brenton
So it's a lot to manage. So, you know, I can see why maybe that has slipped through the cracks at times. But it is important, you know, not just to the list or to the board chair or the, you know, executive committee, but the full board.
00;13;34;00 - 00;13;55;11
Meg Pekarske
Yeah. So so that's important. What's our our fourth tip with these because we you have them written out, Andrew, we'll include a link in our podcast notes just to like yes this little tip sheet because yep, there are so important. And like I'm a very visual person. So yeah. Yeah.
00;13;55;13 - 00;14;27;28
Andrew Brenton
Well so yeah, the fourth mistake to avoid is not keeping your correspondence address or the contact person is listed on area 55 up to date. So these are basically the email addresses. Right. A phone number that you've listed on there. 855 as the people that the Mac should contact. Right. If, if you do make a change or, you know, even if you haven't made a change, if the Mac wants to talk to you about your 855, those are the people you know.
00;14;27;28 - 00;14;55;09
Andrew Brenton
The Mac's going to reach out to if if you're not monitoring these addresses, right. If you have some, you know, contact person who's left the organization. So the Mac is sending emails and calling a phone number. That right. No one's answering. No one's monitoring. That's bad. We have seen providers be deactivated for that exact scenario where the Mac is trying to get Ahold of you.
00;14;55;12 - 00;14;56;23
Andrew Brenton
You know, whether you whatever.
00;14;56;23 - 00;14;57;07
Meg Pekarske
Reason.
00;14;57;07 - 00;15;14;22
Andrew Brenton
Or whatever reason. Yeah. If you don't respond to them, they will eventually deactivate you. So critical to make sure that, you know, the address is that you are monitoring actively are reflected, in the 855 and that we're kind of keeping that up to date.
00;15;14;25 - 00;15;46;27
Meg Pekarske
Well, and Adam and I covered in an earlier podcast, like instead of having it be an individual mailbox like bagged up a car skid hutch blackwell.com enrollment at Hash blackwell.com or whatever. Like it. And many people are checking that. So you know, if someone's on PTO, someone gets fired. You know all the staff. Absolutely you. And so I think that's an easy fix.
00;15;46;27 - 00;15;50;10
Meg Pekarske
That is should become never events.
00;15;50;12 - 00;15;56;21
Andrew Brenton
Yes. Yep. And the the the the fifth tip here.
00;15;56;23 - 00;16;00;08
Meg Pekarske
This is a drum roll. Your final tip.
00;16;00;11 - 00;16;33;16
Andrew Brenton
This will be anticlimactic because it's sort of part and parcel of the last tip, which is to make sure that you respond promptly to Mac development requests, because not doing so will lead you to being deactivated. So a development request is, you know, essentially if you submitted a 55 update, the Mac, if they, you know, want to quote, develop that because there's information missing or they need clarification or they want to see supporting documentation, they will let you know that's all the development request.
00;16;33;23 - 00;17;00;14
Andrew Brenton
You know, they'll say, you know, please update this section or, you know, please submit an org chart to reflect the changes in reporting. If you don't respond to that promptly, you could be deactivated. There are I believe it's the 30 day, timeline that you're given. Although I've seen in the development request itself, the Mac will tell you like you need to respond by this date.
00;17;00;16 - 00;17;22;04
Andrew Brenton
Yeah. So that, you know, they might give you leeway. It's sort of at their discretion, but the risk of not taking that seriously is, again, they'll conclude that you're just being unresponsive. You've sort of, you know, been neglecting your, your, you know, your obligation to update your a55 and, and all that. So not bad.
00;17;22;06 - 00;17;51;02
Meg Pekarske
Yeah. And I guess who thinks about that in operationally is, you know, when you submit your 855 update calendar, put a tickler on your calendar that if I don't hear something in a week or something, I should follow up and make sure they got it, because it is really unusual to submit stuff unless the bits like the simplest update.
00;17;51;04 - 00;18;29;19
Meg Pekarske
But if you're updating a lot of stuff, it's very hard to get a clean submission. So like 99% of the time you're going to get a file development request. Yes. And so you don't want something to get caught in spam or this or that. And so if you're hearing nothing, this is not a situation. No news. Good news don't make that assumption is it could be there's something that is missing, you know, it's it's like if you haven't gotten a demand letter and an audit from the government, it's not like good news, like, oh, yeah, they're not going to come collect this.
00;18;29;19 - 00;19;07;15
Meg Pekarske
No, you probably missed it. Like, yes, I got them to the wrong address or whatever. You need to start asking questions. And this are the same thing. Like expect to get a development request. And obviously you can track online. But most people are submitting stuff online like where this is. But like don't forget that you submitted it. And but probably there's going to be follow up, needed and that we need to take that seriously and know that the things that they ask for sometimes don't make any sense or we think are not required.
00;19;07;17 - 00;19;30;25
Meg Pekarske
And because I go through what we were dealing with is it's sort of like, oh, I was thinking like, why are we always getting development requests? And I think we've done this so much now. And it's like, I feel it's like impossible to send something and, and not have them ask some type of question that even if it's clarified or whatever.
00;19;30;27 - 00;20;05;03
Meg Pekarske
And so so this is all elementary school staff I think, and this is sort of surprise, surprise. We're probably going to have another 855 podcast or two into the future, because they've made significant changes to 855 reporting requirements for nursing homes and staff. That are very cumbersome. I expect those to come down the pike for, for, hospice at some point here, given our level of, concern.
00;20;05;03 - 00;20;51;19
Meg Pekarske
They have with, you know, impropriety and fraud and other stuff, because that's what all this enrollment stuff is. A lot of it is about making sure that bad actors aren't jumping around and, you know, doing shell companies to try to, you know, profit. And they really shouldn't, you know, they're they want to create more transparency. And so if we can't get these basic stuff right, and you're not building an infrastructure to manage this stuff because they think this should be taking up more time in your organization that it ever has before, because you most people, right, were not being as fastidious about all of this stuff.
00;20;51;19 - 00;21;17;14
Meg Pekarske
But yeah, the government signaled and you know, several years ago now take this seriously will give you a grace period like will be nice and not immediately deactivate you. But I think that may soon be coming to an end. And there's not going to be a lot of sympathy. So. Yeah. So anyway. But so we'll post the, the five common mistakes.
00;21;17;14 - 00;21;42;27
Meg Pekarske
And then obviously within this we've also talked about how do you operationalize some of these to avoid these mistakes. Like what does it mean that you do. You know it's the email website. If it's the, you know, tickler on your calendar, do you expect follow up to monitor that? It's actually been fully processed. I mean, there's a bunch of stuff to operationalize this and then who's completing it to begin with?
00;21;42;27 - 00;22;05;21
Meg Pekarske
And probably it should be people who are keeping track of your license staff. Right. Because this does licensing while it impacts payment, it really isn't payment related. This is really about licensure and certification. Which I think really go together. And so that's probably whoever's doing that makes sense.
00;22;05;23 - 00;22;34;07
Andrew Brenton
So yeah, and, and you know, amplify that point if you are updating your 855, more than likely you will need to also update your license and your Medicaid enrollment. So these but all align, right. The information on these different, you know, enrollments and licenses I mean they should match. So that yeah, all the more reason to kind of have the same compliance person and a covering all of those different territories.
00;22;34;09 - 00;23;13;03
Meg Pekarske
Yeah. And when they don't we've seen then the activations as a result of that. And then you're having to explain why you reported someone here and not here. And then of course, it's always infer that there's intent behind that. Well, it's like probably an oversight. And and so I just think it's this is a laundry list of compliance has to be a bigger part of your budget than it was ten years ago, because between all these audits and and all the stuff, this enrollment staff, and it's going to get worse and this is the, you know, tip of the iceberg here.
00;23;13;03 - 00;23;38;28
Meg Pekarske
I expect they're going to continue to want more more transparency. You know, this is just more of a job now, especially as we see salivation about hospices are getting bigger. And you have multiple provider numbers under a single and broad that can be almost a full time job trying to keep all of the staff updated as people come and go and change jobs and stuff.
00;23;38;28 - 00;23;52;12
Andrew Brenton
So yeah, so here to help the if you if you need it. But yeah, it's becoming more complicated and like you said and we expect that that trend to continue here.
00;23;52;12 - 00;24;14;08
Meg Pekarske
So and I'd rather help on helping people file staff correctly than dealing on the back end on the Friday afternoon and I get no payment. How am I going to make payroll conversation? Is that close or not? But I was already mentally like outside having a cocktail I'm having to deal with, you know.
00;24;14;10 - 00;24;15;21
Andrew Brenton
Yeah. Not good.
00;24;15;23 - 00;24;49;27
Meg Pekarske
Not good. So anyway, Andrew to the rescue. So yes. So here I am. But so anyway well thanks for the time. And this was this is great. Hopefully will get good listenership and we will include that the top five list. And in the show notes to awesome. And for those listening if you ever have topics you want us to cover, as I always say, please reach out or you know, if you like our podcast, please like it, follow us.
00;24;49;29 - 00;25;14;11
Meg Pekarske
That would be great because the more people like and follow us, the more other people can and find us. So that would be we're in a real niche market, but I'm sure there's hospices out there that are not listening to us, Andrew, but should be right out of the free podcasts. And there's no ads. There's no ads for weird stuff.
00;25;14;13 - 00;25;38;28
Meg Pekarske
But come up like when you're, you're watching YouTube or something, you get weird ads, like, I don't think there's any ads on our podcasts. Not that not that we put on our a who knows. But so anyway, well, thanks for your time. And until next time, thank you. Well, that's it for today's episode of Hospice Insights: The Law and Beyond.
00;25;39;00 - 00;25;54;27
Meg Pekarske
Thank you for joining the conversation. To subscribe to our podcast, visit our website at huschblackwell.com or sign up wherever you get your podcasts. Until next time, may the wind be at your back.