What if I have already paid the bill I received for COVID-19 services?
You may be entitled to a refund if your provider billed HRSA as well. First, check if the bill lists HRSA reimbursement for the COVID-19 services. Also, contact the provider/healthcare facility who billed you to discuss a possible refund.2
You may be responsible for payment if the care was not eligible for HRSA reimbursement or the provider did not submit the claim to HRSA. However, at this time, any provider administering COVID-19 vaccines cannot charge you for the vaccine or administration of the vaccine.2
Does immigration status affect eligibility for free COVID-19 services?
No; all uninsured patients are eligible for free COVID-19 services regardless of immigration status.1
Will my immigration status be reported to an immigration agency if I receive free COVID-19 services?
According to HRSA, “Testing, treatment or vaccinations paid for by the federal government will not affect anyone’s immigration status or be shared with immigration agencies.”1
Do I need a Social Security Number or government ID to obtain free COVID-19 services?
No; although you may be asked for this information by the healthcare facility or pharmacy, you can still receive free COVID-19 testing, treatment, and/or vaccination if you unable to provide it.1
EligibilityAdvocates: Helping Uninsured Patients
EligibilityAdvocates assists uninsured patients with finding health coverage and/or applying for other programs to help cover their medical costs. Our services are free to patients.
What Does Medicaid Expansion Mean for Indian Health Service Facilities, American Indians, & Alaska Natives?
Posted on Thursday, July 8, 2021
Medicaid expansion can improve healthcare access for the American Indian and Alaska Native (AI/AN) community in many ways, including by providing health coverage to a larger portion of the population and by increasing third-party revenue for Indian Health Service (IHS) facilities.
Medicaid expansion can improve healthcare access for AI/AN people and increase third-party revenue for IHS facilities.
Expanding Health Coverage for AI/AN People
As of 2019, an estimated 19.1% of American Indian and Alaska Native people in the U.S. were uninsured.1
Inadequate health coverage is a significant barrier to healthcare access and often causes patients to delay or avoid medical care altogether.
In states that expand Medicaid, more people qualify for Medicaid based on income; so, more members of the AI/AN community become eligible for Medicaid coverage and may no longer be uninsured. This helps remove a major obstacle to healthcare access and enables many AI/AN people to obtain care from other providers in addition to their IHS facility.
Increasing Third-Party Revenue for IHS Facilities
After states were given the option to expand their Medicaid programs beginning in 2014, third-party collections for federally operated IHS facilities increased by 51% from 2013 to 2018.2
During that same timeframe, the percentage of patients at these facilities who reported having health insurance increased by an average of 14 percent, with facilities located in states that expanded Medicaid seeing the biggest increases.2
An increase in third-party revenue in the form of payments from patients’ Medicaid and private health insurance coverage made it possible for IHS facilities to expand their on-site services and lower the need for patients to use the Purchased/Referred Care (PRC) program, while also allowing for an extension in the complexity of services delivered off-site through PRC.2
If your IHS facility is in a state that is or will be expanding Medicaid, you can also expect a boost in third-party revenue as a result. This money can be used toward adding more providers and specialty services, purchasing medical equipment, facility maintenance, and more, all of which will greatly enhance the quality and accessibility of care for your AI/AN community.
Best Practices for Optimizing Self-Pay Conversions & Third-Party Revenue
Helping patients apply for Medicaid – Eligibility professionals have the resources and expertise to help patients correctly and more efficiently complete their Medicaid applications.
Screening patients before discharge –Patients may not realize they qualify for Medicaid, and those who are screened for eligibility and engaged before they leave your facility will be much more likely to follow through with the Medicaid application process.
Meeting with patients one-on-one and in person – Face-to-face and personalized engagement with patients results in higher self-pay conversion rates than attempts to assist patients via email and phone alone.
EligibilityAdvocates: Helping IHS Facilities Maximize the Benefits of Medicaid Expansion
Our Patient Advocates work on site to help patients enroll in Medicaid and other health plans or financial assistance programs. By finding alternative funding sources for patients’ medical costs and helping them apply, we can increase your third-party revenue and improve patients’ access to care.
Our services are free to patients and provide a guaranteed ROI for our clients thanks to our performance-based pricing model. We are only paid once we’ve successfully helped you collect reimbursement.
EligibilityAdvocates delivers more self-pay conversions through one-on-one interaction with patients, a pre-discharge screening rate of 90 percent, expanded on-site hours and home visits, advanced technology and screening software, and our expertly trained, compassionate staff who are changing patients’ lives every day.
Contact us to learn more about how we can increase Medicaid enrollment at your IHS facility and help you maximize the benefits of Medicaid expansion.
2GAO (United States Government Accountability Office). “GAO-19-612 Highlights, Indian Health Service: Facilities Reported Expanding Services Following Increases in Health Insurance Coverage and Collections.” (2019). Retrieved from https://www.gao.gov/assets/gao-19-612-highlights.pdf
Out-of-state Medicaid reimbursement poses significant challenges to healthcare facilities. Many choose to write off these difficult claims. Those that attempt to work them experience success rates so low, they don’t seem worth the effort.
Fortunately, you don’t have to lose out on this valuable revenue.
It is very hard for an internal billing team to keep track of all the rules governing Medicaid because they are continually modified and vary from state to state. Each state, U.S. territory, and Washington, D.C. has a separate Medicaid program with its own requirements and processes. If you do manage to find an employee with this niche expertise, an additional challenge arises in retaining the employee or retraining someone else if you face turnover.
Before you can submit a claim to Medicaid, you must enroll your facility and providers in the specific state’s program you are billing. This is a very involved task as it typically requires gathering sensitive personal information (e.g. social security numbers, home addresses, copies of driver’s licenses, signatures) from each of the hospital’s board members and/or physicians. Even ordering, prescribing, and referring (OPR) providers for Medicaid patients must complete OPR provider enrollment.
Enrollment must be completed in a timely manner so that you don’t miss your window for reimbursement. The enrollment process and which documentation each program requires for enrollment differs by state, further adding to the difficulties. In fact, may healthcare organizations consider this the most painful step on the road to out-of-state Medicaid reimbursement.
Solution: EligibilityAdvocates completes, submits, and maintains your facility AND provider enrollment applications at no additional cost to you. Save yourself the money, time, and headache it takes to accomplish this job and simply let us do it for you.
Challenge: Billing & Follow-Up
The billing process for Medicaid also differs by state. Each program has its own claim forms, billing requirements, list of covered services, and reimbursement rates. Even a simple error like using the Medicaid billing template for your own state to submit a claim to another state’s program can result in a denied claim.
Your billing team will need to devote time to follow up on delayed or denied claims, sometimes unaware of why the claim was initially rejected.
Solution: The EligibilityAdvocates out-of-state Medicaid team has experience in all 50 states’ billing procedures. We will bill and follow up on each out-of-state Medicaid claim for you, ensuring no claim is neglected, as well as take care of the appeals process for any denied claims when necessary. Not only are our team members specialists in claims resolution for Medicaid and out-of-state Medicaid, but our Medicaid expertise and pre-arrival workflow solution also prevent errors and issues that cause denials, underpayments, and reimbursement delays in the first place – providing you with higher remittance and quicker reimbursement.
For each Medicaid program you wish to bill, your facility must maintain its qualifications according to the program’s requirements and your providers must complete periodic revalidation with the program(s). Failure to do so will result in deactivation with the Medicaid program and denied claims. If a provider is un-enrolled, re-enrollment will entail more time and work and there may be a gap in eligibility for reimbursement.
Solution: EligibilityAdvocates provides maintenance and monitoring of all your Medicaid credentials to prevent expirations and deactivation and to make sure you are proactively maintaining compliance with each program.
Challenge: Drain on Resources
Each of these challenges requires time, expertise, and resources that your staff may not have or that they cannot afford to take away from their other billing responsibilities. Focusing their attention on out-of-state Medicaid reimbursement is not the best use of their time and your money if they do not collect a sufficient volume of revenue.
Solution: EligibilityAdvocates is a performance-based extension of your revenue cycle team. Our services are strictly contingent, meaning we don’t get paid until we’ve delivered on our promise to get you paid. The revenue we bring in will always exceed the cost of our services and your employees can focus on other objectives while we manage your complicated out-of-state Medicaid work.
Solve Your Out-of-State Medicaid Reimbursement Challenges with EligibilityAdvocates
The New Year is here and it’s time for families to start traveling. With travel, come patients from out-of-state. With out-of-state patients, come out-of-state Medicaid claims.
All states have their own rules and regulations regarding Medicaid. But on March 25, 2011 the Centers for Medicare & Medicaid Services (CMS) implemented additionalscreening requirements for states to follow for Medicaid provider enrollment. If these requirements are not met, the provider risks termination from the Medicaid program and/or a delay in reimbursements.
How Do CMS Provider Screening Requirements Affect Out-of-State Medicaid Claims?
Requirement: States are required to screen all providers “upon initial enrollment and monthly thereafter for as long as the provider is enrolled in the Medicaid program” (p. 5897).
2.) Unscheduled & Unannounced Site Visits
Requirement: The Secretary may carry out unscheduled and unannounced site visits. “States must conduct pre-enrollment and post-enrollment site visits for those categories of providers the State designates as being in the “moderate” or “high” level of screening.” Providers must permit the on-site visits (p. 5898-5899).
3.) Provider Enrollment & Provider Termination
Requirement: All providers must undergo screening at least once every 5 years. States are required to deny or terminate the enrollment of providers if:
The provider “does not submit timely and accurate disclosure information or fails to cooperate with all required screening.”
The provider is “terminated on or after January 1, 2011 by Medicare or any other Medicaid program or CHIP.”
The “provider fails to submit sets of fingerprints within 30 days of a State agency or CMS request.”
States can also deny enrollment to a provider “if the provider has falsified any information on an application or if CMS or the State cannot verify the identity of the applicant” (p. 5900).
4.) Criminal Background Checks & Fingerprinting
Requirement: Each provider the State designates as within the “high” level of screening is subject to fingerprinting (p. 5901).
5.) Deactivation & Reactivation of Provider Enrollment
Requirement: Medicaid providers who have “not submitted any claims or made a referral that resulted in a Medicaid claim for a period of 12 consecutive months” must have their Medicaid provider enrollment deactivated (p. 5903).
6.) Enrollment & NPI of Ordering or Referring Providers
Requirement: The State “must require all ordering or referring physicians or other professionals to be enrolled under a Medicaid State plan or waiver of the plan as a participating provider.” Their NPI must be on applications to enroll and on all claims for payment (p. 5903).
The CMS regulations established more consistency in the screening process so that states can better ensure providers are qualified to serve the Medicaid population. However, since the CMS provider screening requirements were enacted, many providers have been discouraged to seek out-of-state Medicaid reimbursement because of the amount of work involved in the application process. Plus, on top of these standardized enrollment requirements, states vary in their rules and regulations for filing claims.
When you outsource out-of-state Medicaid work to EligibilityAdvocates, you can collect payment for these complex claims without devoting your time and resources to monitoring (ever-changing) federal and state regulations. We will do so for you and take care of every aspect of Medicaid enrollment for both the provider and facility, claims submission, and claims follow-up.
Contact us today to learn more about how we can help your practitioners and facility meet CMS provider screening requirements and obtain reimbursement for your out-of-state Medicaid claims – all at a performance-based rate.
1) Why are OPR providers required to complete Medicaid enrollment?
Additional integrity requirements are placed on state Medicaid programs. This requirement complies with federal regulation 42 CFR 455.410 concerning the screening and enrollment of providers.
2) How do I know if I should enroll as an OPR provider?
This type of enrollment may be suitable for you if:
You occasionally see Medicaid recipients who need additional services/supplies that can be covered by Medicaid.
You do not plan to submit claims to Medicaid for reimbursement.
You are not enrolled as another Medicaid provider type.
3) What are the OPR requirements?
The 3 basic OPR requirements are:
The provider who wrote the order/prescription/referral must be enrolled in Medicaid (either as a participating Medicaid provider or as an OPR provider) and that provider’s NPI must be included on the claim.
The provider’s NPI must be for an individual physician or non-physician practitioner (not an organizational NPI).
The provider must be of a specialty type that is eligible to order, prescribe, or refer.
4)Do I have to be enrolled as a participating provider or can I be enrolled only as an OPR provider?
If you will only be ordering, prescribing, and referring services for Medicaid recipients and won’t be billing Medicaid for these services, you may enroll as only an OPR provider. But if you wish to bill Medicaid, you must enroll as a fully participating Medicaid provider.
OPR providers do not bill Medicaid and are not required to treat Medicaid patients.
5) If I am already enrolled as an active provider with a state’s Medicaid program, do I also need to enroll as an OPR provider in that state?
No; anyone who is an active Medicaid participating provider does not need to enroll again as an OPR provider.
6) Is there a separate Medicaid enrollment application for OPR providers?
Yes; each state has a separate Medicaid enrollment application specifically for OPR provider enrollment.
7) If I am enrolled in one state’s Medicaid program, do I still need to enroll in other states’ programs?
If you order, prescribe, refer, or render services for a Medicaid patient, you must be enrolled in the state program to which the patient belongs. For example, if you are a provider located in California and enrolled in California’s Medicaid program and you write a prescription for an Arizona Medicaid recipient, you must be enrolled in the Arizona Medicaid program as well.
8) What will happen if I fail to complete Medicaid enrollment as an OPR provider?
The healthcare providers and facilities who deliver services according to your orders/prescriptions/referrals will not be reimbursed by Medicaid for those services if you are not enrolled and your NPI is not included on the Medicaid claims they submit.
9) If a claim is denied because the OPR provider is not enrolled in the Medicaid program, can the OPR provider retroactively enroll?
In most cases the billing provider can resubmit the claim after the OPR provider enrolls. There are state-specific claim timely filing limitations.
10) Do claims submitted to Managed Care Organizations (MCOs) have to follow the OPR requirements?
This depends on each MCO or HMO and its specific requirements.
If you’re struggling with out-of-state Medicaid enrollment and/or billing in-house, it may be time to consider an alternative solution. Outsource out-of-state Medicaid enrollment and billing to a performance-based company that specializes in these claims.
Here are the top reasons to outsource out-of-state Medicaid enrollment and billing:
1. Lack of internal resources.
Like many healthcare organizations, you may choose to write off out-of-state Medicaid accounts rather than allotting time and resources to working these complex claims. However, you are missing out on a substantial form of reimbursement that could improve your revenue cycle while reducing aged receivables.
2. Lack of expertise in complicated out-of-state Medicaid claims requirements.
If you have tried to manage these difficult claims internally, you’ve probably found that they require more time and expertise than your staff can reasonably deliver. EligibilityAdvocates specializes in out-of-state Medicaid and we handle all the work necessary for reimbursement. This includes enrolling providers and facilities in states’ Medicaid programs, billing and submitting claims, following up on any delayed claims, and appealing denials. We devote our time and extensive resources to all aspects of the out-of-state Medicaid process so your teams can focus on other objectives.
3. No standardization – there are over 50 Medicaid programs.
Each state, U.S. territory, and Washington, D.C. has its own Medicaid program with different and continually changing rules. Additionally, there are new and temporary Medicaid flexibilities to navigate due to COVID-19 and these vary by state as well. When you choose a partner who is proficient in every Medicaid program, you don’t have to keep track of all these moving parts – we do it for you.
4. Occurrence is increasing, Medicaid Expansion, and Americans love to travel.
Even in light of COVID-19, a recent survey of over 30,000 Americans found that 46% are ready to travel once lockdowns are lifted. Expansion and the increase of Medicaid patients accessing care outside their enrollment states will continue to grow for hospitals in the future.
5. Return on investment – move to performance-based contingent fee pricing.
It’s difficult to realize a positive ROI when a facility manages, enrolls, and/or bills out-of-state accounts. Switch to a performance-based resource. There are no up-front costs OR facility enrollment fees when you outsource out-of-state Medicaid work to EligibilityAdvocates. You only pay for our services once we’ve delivered results and the hospital has received payment.
7. Look to EligibilityAdvocates to expand your revenue cycle team with no increase in internal labor costs.
EligibilityAdvocates is a performance-based partner that serves as an extension to your revenue cycle team. By partnering with us, you can ensure your out-of-state Medicaid accounts are settled without the need to hire additional staff to work them. You won’t have to train new employees, add them to your payroll or benefits programs, or pay for any extra office space and equipment (desks, computers, phones, etc.). These are fixed expenses, regardless of how much money your staff actually collects. Conversely, when you hire EligibilityAdvocates you’ll only pay us as much as our performance warrants.
Updated Friday, August 28, 2020: The deadline to apply for Phase 2 General Distribution Funding has been extended to September 13, 2020.
Providers still have time to apply for aid through the CARES Act Provider Relief Fund. Below you’ll find important information about this program that can help providers recover revenue lost to the COVID-19 crisis and help uninsured patients avoid unexpected medical bills related to coronavirus testing and treatment.
Information for Providers
The federal government has allocated $175 billion to the Provider Relief Fund (PRF) to be distributed to qualified health care service and support providers for:
The Coronavirus Aid, Relief, and Economic Security (CARES) Act appropriated $100 billion, and the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA) appropriated $75 billion, to this program. The program is administered by UnitedHealth Group through a contract with the Health Resources & Services Administration (HRSA).
Payments from the Provider Relief Fund do not need to be repaid by providers who comply with the program’s terms and conditions.
Information for Uninsured Patients
According to HHS.gov: “Providers who participate in and are reimbursed from the HRSA COVID-19 Uninsured Program are not allowed to “balance bill” individuals who do not have health care coverage (uninsured).”
If you are an uninsured patient and you receive a bill for COVID-19 testing and/or treatment services which shows that a portion of the bill was paid for by the Health Resources & Services Administration (HRSA), you should contact your healthcare provider as you may not be responsible for the balance.
However, if your provider did not participate in the HRSA COVID-19 Uninsured Program or the care you received was not eligible for reimbursement from the program’s funds, you may be responsible for payment.
Applying for Reimbursement Through the CARES Act Provider Relief Fund
UPDATE: PROVIDERS – The deadline to apply for Phase 2 General Distribution Funding has been extended to September 13, 2020 to apply for Phase 2 General Distribution funding from the CARES Act Provider Relief Fund.
The deadline to apply for Phase 2 General Distribution funding has been extended to September 13, 2020. Providers should check the HHS.gov website for the latest updates on deadlines and requirements.
Key conditions for reimbursement from the Provider Relief Fund include:
Qualifying health costs and services such as COVID-19 testing, office visits, telehealth, non-emergency transportation, and more, with dates of service/admittance on or after February 4, 2020, are eligible for reimbursement.
Claims cannot be repealed or reprocessed after submission.
To submit claims electronically, providers need a clearinghouse or similar relationship.
Providers must attest that the information submitted is correct (billing companies/revenue cycle vendors can attest to the accuracy of the information for the provider).
An on-site patient eligibility service can significantly improve patient experiences, increase self-pay conversions, and reduce account cycle time. For the best results, patient eligibility services should be performance-based and you should choose a vendor who can provide both on-site patient advocates andcutting-edge technology.
Here are just a few reasons to outsource patient eligibility services:
Outsource patient eligibility to maximize patient advocacy and reimbursement.
Establish a Culture of Patient Advocacy
Show your patients and everyone who belongs to your organization that your facility values and is committed to patient advocacy. The presence of a patient eligibility and enrollment service, on site and at no cost to patients, will do just that.
However, the help that an internal eligibility team can provide is often inhibited by their limited hours. Most facilities’ eligibility employees work a typical 9:00 AM to 5:00 PM schedule, whereas EligibilityAdvocates’ outsourced services are available on site, including in the Emergency Department, at a minimum of 12 hours a day and 6 days a week (and up to 24 hours/day, 7 days/week – based on peak analysis). This significantly extends patients’ access to support.
The more support you offer your patients, the bigger impact you can make on your entire community’s economic outlook. Our patient eligibility services help patients and healthcare facilities financially; plus, we create job opportunities because we hire patient advocates from your local community to fill all our on-site positions.
Maximize Patient Advocacy & Reimbursement with a Team of Experts
When you outsource patient eligibility and enrollment, you can ensure your patients are served by patient advocates who specialize in this service and all the rules and regulations that impact it.
State and federal laws, as well as individual health plan and financial assistance program requirements, change regularly. And waivers are often enacted when national emergencies like the COVID-19 crisis occur.
EligibilityAdvocates monitors all policies and guidelines that determine whether a patient will qualify for assistance, what the patient must do to apply, and how your reimbursement will be affected. You and your patients don’t have to keep track of all these moving parts or risk missing a detail that results in a denied application or claim.
In addition to patient advocates’ extensive knowledge and compassion, an outsourced patient eligibility service can bring innovative technology to the table as well.
At EligibilityAdvocates, we equip our patient advocates with technology that enables mobile patient screening, such as at bedside or in the field. This includes convertible laptops/tablets, HL7 for real-time notes, electronic forms automation software, data encryption in transit and at rest, intermediate saves of information, and photo capture for documentation of driver’s licenses, insurance cards, etc.
We also supply our clients with customized dashboards and reports that deliver near-real-time transparency and alerts. Plus, our pre-arrival workflow solution streamlines financial clearance and automates many tasks for Patient Access.
All our solutions are HIPAA-compliant and will adhere to your organization’s specific procedures and compliance standards.
Reduce Uncompensated Care and Improve Your Revenue Cycle
Partnering with a patient eligibility and enrollment service provider will reduce your write-offs and A/R days. When patients obtain health coverage and/or financial assistance, you get reimbursed at higher rates. And, the face-to-face meetings between patients and patient advocates result in higher conversion rates, increased point-of-service payments, and the establishment of patient payment plans.
When you choose EligibilityAdvocates, we will pursue every possible source of funding for each patient account – so your organization will always be the “payer of last resort.”
You’ll also improve your revenue cycle with the benefits of our pre-arrival workflow solution, which prevents integrity issues and errors that would otherwise cause payment delays, denials, underpayments, and rework.
Experience a Greater Return on Investment
Your ROI will be much higher when you outsource patient eligibility services in comparison to managing this work internally.
Costs accrued by in-house staff include payroll and benefits, hiring and (ongoing) training expenses, office space, and equipment (phones, computers, printers, desks, etc.). You’ll need to allocate money, time, and resources to these employees whether their performance earns it or not.
In contrast, EligibilityAdvocates offers contingent fee pricing, so you’ll only pay us a percentage of the reimbursement we collect, and you won’t have to worry about any of the typical labor costs an internal team would necessitate.
Keep Your Focus on Patient Care: Outsource Patient Eligibility Services
EligibilityAdvocates can handle all aspects of patient eligibility and enrollment for you so that your teams can devote their time and resources to providing quality patient care.
Contact us to learn more about how we can lower or eliminate your patients’ out-of-pocket costs and improve your revenue cycle.
Strengthen the financial situation of all stakeholders in your organization – outsource patient eligibility services to EligibilityAdvocates today.
The coronavirus (COVID-19) is affecting all individuals and organizations in significant ways – physically, emotionally, and financially, to name a few. In addition to creating a national health emergency, more people are out of work and without insurance as a result of this crisis.
THANK YOU, from all of us at EligibilityAdvocates!
Thankfully, our patient advocates can continue serving patients during this difficult time. They have been classified as essential staff members and are working on-site to help patients obtain benefits and secure alternative payment methods (including COBRA).
We at EligibilityAdvocates would like to thank all those working in health care who are risking their own safety in order to protect and care for these patients and keep our communities healthy. You are truly health care heroes.
We also want to express appreciation for each one of our patient advocates who is making a critical difference in patients’ lives on the front lines as well.
You are health care heroes too, as you work to minimize the financial impact of this virus on individuals and families.
As you may be aware, the Centers for Medicaid and Medicare Services (CMS) issued emergency blanket waivers in response to COVID-19, which have a retroactive effective date of March 1, 2020 until the end of the emergency declaration.
We’d like to draw your attention to these changes in particular, as stated by CMS:
3-Day Prior Hospitalization Waiver for SNF placement – “CMS is waiving the requirement for a 3-day prior hospitalization for coverage of a SNF stay, which provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who experience dislocations, or are otherwise affected by COVID-19. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (this waiver will apply only for those beneficiaries who have been delayed or prevented by the emergency itself from commencing or completing the process of ending their current benefit period and renewing their SNF benefits that would have occurred under normal circumstances).”
CAH Length of Stay Waiver – “CMS is waiving the requirements that CAHs limit the number of beds to 25, and that the length of stay be limited to 96 hours under the Medicare conditions of participation for number of beds and length of stay at 42 CFR §485.620.”
States and territories may submit a request for a waiver of statutes and regulations related to Medicaid and CHIP programs using the 1135 waiver checklist; CMS provides these examples of flexibilities they may seek:
“Waive prior authorization requirements in fee-for-service programs.
Permits providers located out of state/territory to provide care to another state’s Medicaid enrollee impacted by the emergency.
Temporarily suspend certain provider enrollment and revalidation requirements to increase access to care.
Temporarily waive requirements that physicians and other health care professionals be licensed in the state in which they are providing services, so long as they have an equivalent licensing in another state; and,
Temporarily suspend requirements for certain pre-admission and annual screenings for nursing home residents”
As always, we are here to help you navigate these new regulatory flexibilities and to assist your patients with the financial challenges they may be facing. We are all in this together as we work to protect the physical and financial health of your patients and their families.