Welcome to this Medicare Learning Network video on the Medicare Cost
Report e-Filing System. This presentation was recorded at the Medicare
Learning Network webcast on Tuesday, May 1, 2018.
This is Diane Maupai from the Provider Communications Group at CMS in
Baltimore, and I'll be your moderator today. Welcome to this Medicare
Learning Network webcast on the Medicare Cost Reporting e-Filing
System..
Our speakers today are Linda Uzzle, Director of the Division of Provider
Audit Operations, CMS, and Patrick Herrity, Business Consultant, CGI
Federal. I'll now turn the call over to Linda.
Linda Uzzle: Thanks, Diane. Hi. My name is Linda Uzzle, and I'm the
Director of Provider Audit Operations Division of Provider Audit
Operations. And this is an exciting time for us that we are introducing
a new system where providers for the first time can electronically
submit their cost report 100 percent.
And when we look at a little bit of the past, we receive about 50,000
cost reports annually. We have 12 MACs who have various websites that
have how to submit your cost report, where to mail your cost report,
where to handdeliver your cost report, and where to send the check.
And we know that this is it's confusing and overly burdensome,
especially when we have a consultant that could be filing a thousand
cost reports. They're continually having to go to websites to see if
anything changed. So, about 3 years ago, we decided that it was time for
us to change and create a system to where a provider could go to one
spot and electronically file their cost report. But we had one issue.
And that was the wet signature. And so, until we could overcome that
burden, a cost report would never be able to be filed 100 percent
electronically. And as most of you know, in the previous yearI guess it
was in August when the final rule came outthe wet signature is no
longer required for cost reports beginning on or after 12/31/17. So,
this is the first time that we can go live with this.
So like I said, we've been working on it for 3 years, and we think we
have a great product. We believe it's very easy. And we really believe
providers are going to enjoy that this efficient, quick service in
uploading your cost report.
And so I'm going to turn it over to Patrick, who design who worked on
the design team for this for MCReF.
Patrick Herrity: Thank you so much, Linda. My name is Patrick Herrity.
I'm a senior consultant with CGI Federal. Welcome to the Medicare Cost
Report e-Filing system webinar.
Please proceed to the next slide. Essentially, this slide is just a list
of acronyms for your reference for later. Wewon't go over the each of
these acronyms, but you can use these for your reference when accessing
theslide deck at a later time.
Please go to the next slide. All right, so as Linda was saying, we're
really excited to introduce a new CMS system, the Medicare Cost Report
e-Filing system, also known as MCReF. We'll also be communicating a
rollout plan to provide additional resources and information to the
providers and all other Medicare stakeholders regarding the system.
Please proceed to the next slide. On tap for today's agenda, we've
already done introductions. We'll provide a little bit of business
background and overview so that we know what part of Medicare we're
talking about that MCReF deals with. We'll provide a high-level
overview, a walkthrough and detailed overview of MCReF, the system
itself. As I said on the prior slide, we'll discuss a rollout plan to
provide additional information. And we'll finish today's meeting with a
question-and-answer session.
Next slide, please. Slide number 5, please. Next, we want to provide a
high-level business overview. We know there is a large number of
participants on the line with a variety of different backgrounds and
expertise. So, we want to make sure we're all on the same page, and what
we're talking about is where MCReF is involved with. And that's the
Medicare Cost Report.
So as Linda was saying earlier, the Medicare Cost Report is used to
determine Part A providers' annual Medicare reimbursable cost. Provider
providers use a large number of sources to create their cost report,
including CMS's existing system, the Provider Statistical and
Reimbursement system. As Linda was saying, there are approximately
50,000 cost reports submitted each year, which account for over $200
billion worth of Medicare reimbursement.
Providers themselves have a regulation-driven deadline for submitting an
acceptable cost report to their Medicare Administrative Contractor. And
then, MACs have a policy-guided requirement for receiving, accepting,
reviewing, auditing, and finalizing cost reports.
Please go to slide 6. To talk more about the current cost report
submission process from a provider's perspective and the receipt from
the MAC's perspective, for the provider to make a submission, they have
tocreate a cost report package, which can include some or all of the
following files: an electronic media computer-readable version of the
cost report, which is a custom text file; a human-readable version of
the cost report, which is typically in PDF format; interns and residents
data, also known as IRIS; and then any other required supporting
materials that they have to submit, such as a working trial balance, a
bad debt listing, etc. Lastly, they'll print the Worksheet S and provide
a signature in ink by an officer of the provider.
They'll bundle that whole package together, and they'll mail it or
handdeliver it to their MAC. And the majority of cost reports are sent
in that way with a few being transmitted via portal websites available
by some MACs. Once the cost report is received by the MAC, the MAC has
30 days from receipt to perform their acceptability review to make a
determination on that cost report.
Please go to slide 7. So to improve on the current process, CMS set out
the following goal: to standardize, automate, and streamline the cost
report processes for provider submission and MAC receipt, acceptance,
and the subsequent handling there afterwards.
Please proceed to slide 8. Critical to achieve this goal, CMS
established the MCReF system, which is a new application which allows
Part A providers to electronically transmit their cost report package,
essentially electronic filing. The system will be available as of today
at 4pm Eastern Time. Usage is entirely optional. It's not required. You
can still mail or hand deliver your cost report to your MAC as you may
do today. The system will be accessible to EIDM PS&R security officials
and backup security officials and also Medicare or MCReF authorized
cost report filers. And we'll get to that in a moment. Once you've
submitted your cost report via MCReF, it will immediately be accessible
to your MAC to download all of the materials that you've filed.
Please proceed to slide 9. There are several advantages to MCReF. So
here's a few that we'll go over. Once you see the page that we're about
to go over in a moment, it's very easy to use.
It provides one process for all Part A providers via one official
submission portal. Again, it'll be available to all Part A providers.
It'll be particularly beneficial to large chain organizations which have
providers that are serviced by multiple or all MACs and also any
providers that may change MACs due to a change in ownership or for some
other reason. Ultimately, having this one process via one submission
portal, we think it'll reduce confusion, delays, and time you spend on
administrative processes.
The other thing that MCReF provides is immediate response on regarding
the receivability of your cost report submission. So sometimes you'll
mail in your submission and it'll take several days for it to get to
your MAC. And then they'll make a determination or they'll determine if
it's received or not. MCReF the moment you click the Submit button, it
will tell you whether your cost report was received or not.
Please go to slide 10. The next slide will get into more details. And
then from there, we'll actually go through some screenshots of the how
the system works, how you'll log in and access the site, and then
particulars about the details of each field.
Please go to slide 11. So as I was saying earlier, the new system,
MCReF, will be available this afternoon at 4pm Eastern Time, and it'll
be accessible via the URL listed on the slide, https://mcref.cms.gov.
It's not available right now but will be available at 4pm Eastern Time.
As I stated prior, the access is controlled by CMS's Enterprise Identity
Management system and right now is restricted to EIDM PS&R security
officials, backup security officials, and MCReF authorized cost report
filers. Anyone that has the existing PS&R SO or BSO role will, by
default, have access to MCReF. So, you won't have to do anything to
change your role. You'll just be able to access the URL, and you'll be
able to log in. Any organization that doesn't have access to PS&R will
have to enroll a PS&R SO within EIDM to access MCReF.
One thing that's particularly important if you do want to use MCReF is
it'll be very important to keep your EIDMSO and BSO accounts in good
standing. This includes updating your password per CMS's policies
and procedures as they relate to password updates and the timely
replacement of your security official due to turnover or changes in
staff. Any issues with your EIDM account, your credentials, or being
able to log in will not be a valid reason for filing your cost report
late, because you can always basically drop your cost report in the mail
as you do today if, for some reason, you're having EIDM issues.
One thing we have mentioned here on this slide but has since changed is
CMS is working with EIDM to create a dedicated MCReF role that the EIDM
Security Official of your organization or Backup Security Official could
delegate out to a particular person that they want for cost report
filing. That is actually available as of yesterday for people to
request. And the SO or BSO will be able to approve that role. And it's
called the MCReF authorized cost report filer role.
Please proceed to slide 12. So now we'll go through a few slides that
actually involve accessing and logging into the system and using the
system. The first one is when you go to mcref.cms.govand again, it's
not available right now but it will as of 4pm you'll basically get the
EIDM Terms and Conditions page. Here, you'll click I Accept at the
bottom of the screen.
Please proceed to slide 13. From there, you'll see the EIDM User ID
screen. Here, you'll enter your SO, BSO, or your MCReF exclusive role
user ID and click Next.
Please go to slide 14. Then you'll reach EIDM's Password page. So then
you would basically enter in your password corresponding to your EIDM
user ID that you entered on the prior screen, and you'd click Log In.
Please proceed to slide 15. And then, you'll be into MCReF, and you'll
be logged in to the system. Like I said, this is the entire system. It's
one simple, easy-to-use screen. I'll go over each of the fields in a
moment in great detail. But for now, I just want to go over the business
process, or the workflow, that you'll encounter if you want to use
MCReF.
So first, as highlighted here in the presentation, you'll select your
provider CCN from the Provider dropdown. Or and then, after you've
selected your provider, you'll select their fiscal year end that you'd
like to e-file for.
Please proceed to slide 16. From there, you'll select the Medicare
utilization level of the cost report that you're filing, and you'll
confirm your First Cost Report Submission status. So the system is aware
if you've had a submission logged as of the time that you logged in. And
so there, you'll confirm if that's correct, and then you'll proceed.
Please proceed to slide 17. And then, you'll upload all of your cost
report materials. Some materials are required based on the type of
provider you are or the Medicare utilization you have selected. And
that's indicated based on a little asterisk red asterisk to the left
of the field. So you'll see in the example that we're showing on the
screen the ECR, print image, and signed certification page are required.
In this actual example, the provider has actually uploaded the ECR,
print image, signed certification page, and other, which has all of
their other supporting documentation.
To upload anything for a particular row, all you have to do is click the
Browse button to the right, corresponding to that row, you navigate to
the location either on your network drive or your work computer for that
file, you select it, and then you'll see the path once you click to
open or select that file, you'll see the path in the File Upload column
for that row. The system expects that you only upload one file per row.
If you have multiple files that you submit as part of your supporting
documentation, that would all go into a ZIP file or another archive file
type in the Other row in the Other slot.
One thing that to note that's on the screen is you should never
encrypt or password protect any of the files, either the main file that
you submit or files within ZIP files. The system is a secure portal for
transmission of your cost report materials, including safe submission,
or safe transmit, of your PII and PHI. So, no need to password protect
or encrypt your files.
Once you've uploaded all of your materials that you would submit
typically through the mail via the system, you need to read the
acknowledgment statement at the bottom of the screen acknowledging that
this is your official submission to CMS and your MAC. By checking that
box, you are acknowledging that, and the Submit button will become
activated. So if you notice, right now, the box is not checked. The
Submit button is disabled. Once you select it, the Submit button will be
enabled. At that time, when you click Submit, the system will perform
specific validations just to make sure that it is a sound submission.
And so would you please go to slide 18? This screenshot is an example of
what an error would look like. So in this case, the provider has
selected the checkbox of the acknowledgment statement, has clicked the
Submit button, but something is actually wrong with the submission that
they've made. In this case, the Error Messages section pops up at the
on the screen. One moment. All right, sorry about that. So in this case,
the Error Messages section pops up on the screen and essentially gives
you an error code that you can discuss or basically you can have for
your reference so you can talk to your MAC about the issue or for some
reason you talk to CMS.
But in this case, the issue here is that the Provider FYB or FYE
specified in the cost report does not match the value selected on the
screen. And in particular, we point out to you that the fiscal year end
that's selected in the or that's in the cost report does not match the
one that's selected on the screen. So in this case, the system looks in
the ECR file, determined that the fiscal year ended 12/26/2017 in the
file, but the submission that's made on the screen is for 12/31/2017.
And so, essentially, the provider would have to resolve this issue to
successfully submit their cost report to MCReF. Once they've resolved
the issue and uploaded the correct file to the ECR slot, once they
submit again, if no other errors are triggered or warnings, they will be
presented with a Success Message.
Please go to slide 19. And in slide 19, we show the Success Message at
the top of the screen. It informs you that for the provider and fiscal
year end that you filed for, your cost report's been electronically
postmarked with CMS as of the date and time in Eastern Time that you
made the submission. The system will also give you a unique e-filing ID
for your reference if you need to talk or discuss this cost report or
for your records in general.
Please proceed to the next slide, 20. Okay, as I mentioned before, the
prior six or so slides essentially just went over the workflow and how
you'll submit a cost report. Now we'll actually dive into the details of
what was actually in each of those dropdowns.
So first, we talked about selecting the Provider number. In this case,
the Provider number contains all of the CMS Certification Numbers that
are registered in EIDM which the provider also has entered into
CMS's System for Tracking Audit and Reimbursement. This system is also
known as STAR, and it's a MAC maintained system. But essentially, it has
to be in STAR and also registered in EIDM for your organization.
The Fiscal Year End dropdown is the next thing that we selected to
e-file our cost report. And the Fiscal Year End dropdown contains all
the fiscal year ends for the selected provider which have occurred in
the past 6 years that are on or after 12/31/2017 as recorded by your MAC
in STAR.
Next, we selected the Medicare Utilization. And that essentially is just
selecting your Medicare utilization level of the cost report that you're
e-filing. The options available in that dropdown are Full, Low, and No.
What I mentioned on one of the prior slides is next you confirm the
First Cost Report Submission indicator. And essentially, this tells you
if the cost report has already been recorded in STAR as received by your
MAC for the provider and fiscal year end that you have selected on the
screen. So it'll be Yes if this is your first cost report submission and
we have an indicator that there aren't any records in STAR. It'll be No
if there has been something received in STAR.
Next is the Cost Report Materials table. That's where you upload all of
your files. Essentially, this is where you would upload all of the cost
report materials needed to submit a complete cost report package. Just
like you would mail everything in, everything needs to go in its
dedicated slot or in the Other slot for supporting documentation.
One thing to note at the bottom of the screen or the bottom of the
slide 20 is that, for Provider and Fiscal Year End, if you don't see a
value in the dropdown that you're expecting, you should confirm a few
things first. First, you should verify with the SO of your organization
that the that if you're looking for a specific provider, that it is
registered its CCN is registered in EIDM for that organization. The
next thing you need to confirm is that you are a user set up in that
organization with an e-filing role. And again, that's a security
official, a backup security official, or the new MCReF authorized cost
report filer role. Once you've confirmed all of those things, if you
still have issues seeing a value in one of those dropdowns, you should
contact your MAC.
Please go to slide 21. Next, we'll discuss all of the cost report
materials. Those were the rows where you were uploading or where the
provider will upload all of the particular files that they need to
submit as part of their cost report package.
First is the ECR, which is the Electronic Cost Report file. Based on
your provider type, it's our understanding that this file is also known
as the EC file for hospitals, the SN file for SNFs, and so on. The ECR
file is required for all providers filing a full Medicare utilization
cost report except Home Offices and Limited Purpose Insurance Companies.
The format expected is a single generate a single file generated using
a current version of CMScertified ECR vendor software that is not a
PDF, a ZIP file, or another archive file type. It should be that custom
text file that you generate in your cost report vendor software. You
cannot upload a file over 1 MB.
Next is the Print Images the Print Image, which is the human-readable
copy of the cost report. And for Home Offices, this is where you would
upload the 287-05 cost statement. The Print Image is required for all
providers filing a full or low Medicare utilization cost report except
for LPICs. It's also required if you provide an ECR file because those
should come hand in hand. The format expected by the system is any
human-readable format that is not a ZIP file or other archive file type.
And the file limit for the Print Image is 10 MB.
Next is the Signed Certification Page slot. This is the electronically
signed Worksheet S certification page. We'll discuss more about
e-signature in a moment. But that's the expectation for this slot. For
the Home Offices, this is the 287-05 Schedule A. So this particular row
is required for all providers except LPICs. The format expected is any
human-readable format that is not a ZIP file or other archive file type.
And the size limit for this is 10 MB.
Please move to slide 22. To continue along the cost report materials,
next is IRIS. This is the Intern and Resident Information System files
required for teaching hospitals claiming GME or IME fulltime
equivalents ontheir cost report. Currently, this is not required by the
system but may but CMS may decide to do so in the future. The format
expected is an unencrypted ZIP file containing a single set of master
and assignment DBF files. That's the M and A files. The file limit is 1
MB.
Next is the Other. This is the particular row where I talked about all
of your other supporting documentation thatdoesn't already have a
dedicated row would either be zipped up or included in that particular
row. And that includes things like the working trial balance and the bad
debt listing as I mentioned previously. This particular row is required
for all LPIC provider cost reports. And the format expected is this
row, essentially, can support any file type, including the support of
multiple files within a single unencrypted ZIP or other archive file
type. So as I was describing, any other materials you want to submit
that you normally submit in the mail to your MAC but that don't already
have a dedicated slot, this is where that would go in a ZIP file. The
file limit forthis slot is 300 MB.
Next is the Cover Letter. Essentially, this is a document for describing
the nature of your submission or if there's anything particular that you
want to address up front to your MAC about the submission you're making.
This is required for all revised cost report submissions. And we'll talk
about original vs. revised or your first cost report submission vs. a
revised cost report submission in a moment. The expectation of the
format for this particular row is any human-readable format that is not
a ZIP file or other archive file type. And the file size limit for this
is also 10 MB.
Please go to slide 23. All right, so we covered all the details on the
screen. Next, we'll kind of go into a little bit more details about the
workflow again.
So we have shown examples of an error and a success scenario in the
screenshots that we showed a few slides ago. This slide essentially
covers that the system will perform specific receivability validations
to confirm that your cost report submission is fundamentally sound.
So, there'll be certain checks that happen. And if the cost report
submission fails any of those checks, the error will be communicated to
you on the screen as we saw in the previous screenshots. If an error is
displayed, that cost report will not have been received by your MAC. So,
you'll have to resolve that issue to then resubmit successfully to get a
received cost report to your MAC. These are not considered rejections
and will not follow CMS's formal cost report rejection process.
If a submission as we saw on the success scenario on previous slides,
if your submission passes all the receivability validations, you'll get
a message that your cost report was received and will give you an or
the system will give you an electronic postmark date in Eastern Time and
a unique e-filing ID for your reference.
Please go to slide 24. All right, so as for those checks that the system
is doing, we're actually going to go through each of those. Some of them
we described when we talked about the cost report materials and what's
allowed from a file size perspective and what format the system expects.
In this case, all required cost report material files must be included
that are required. And they must be in a valid format and within the
size limits that we talked about on prior slides. The attached files
must also conform to system technical restrictions such as they must
any file that you upload cannot contain a virus or malware, must have a
valid file name, and cannot be blank.
Next, I talked a little bit about your first cost report submission vs.
your revised. For any provider and fiscal yearend as you go to submit
your cost report, any fiscal year end will can always have its first
cost report submission. Anything subsequent to that after you've done a
successful first cost report submission is considered a revised
submission in the system. And a revised submission can be submitted
prior to acceptance or can be submitted as an amended cost report
submission after asfiled acceptance.
The one thing to note is that this particular thing is talking about you
can only submit one revised cost report per day. If, for some reason,
you go to submit your revised cost report submission and you realized
you've missed a file, you can if you need to submit another cost
report on that day, you can formally send an email or basically a letter
to your MAC to ask them to reject that cost report submission so that
you can actually do another revision on that same day.
The next one essentially deals with you cannot file a cost report as
basically, the fiscal year end has to be within the last 6 years and
must be on or after 12/31/2017. And this actually isn't a particular
error. This is actually dictated by the options that are available in
the Fiscal Year End dropdown. So, if you need to file anything that is
older than 6 years or that is prior to 12/31/2017, you'll have to do so
via the mail. MCReF only has that one limitation as to what you can
submit.
The one example we talked about where we showed an error is that the
provider, fiscal year begin, and fiscal year end in the ECR file must
match must exist in STAR, the system that the MACs maintain, and must
match the ECR file and what's submitted on screen.
Next, the provider cannot be locked in STAR. An example of being locked
is if the provider is administratively closed. The provider for that
fiscal year end cannot be a subunit. Any subunit should be submitted
under their parent's cost report. And for that fiscal year end, there
cannot already be a finalized NPR present for the year.
Lastly, the last receivability check is that, for a full Medicare
utilization cost report, the system will check that the subunits and
consolidated FQHC/RHC units in the ECR file match exactly what is
documented in STAR by your MAC.
Please go to slide 25. All right, the next slide covers some additional
details or miscellaneous details about MCReF. There are also warnings.
We spent some time talking about the Success Message and the error
messages. But there are also a few warning messages. When you encounter
a warning, you'll click Submit. Apopup screen will display, and will
the system will describe what the warning is, and you'll be able to
acknowledge the warning, and they'll allow it and then proceed with your
submission or you'll be able to canceland actually consider whether you
need to resolve that warning to ensure that once your cost report
isreceived, your MAC will also accept it.
So examples of the warning is if you if you're filing your cost report
after your due date, you'll get a warning saying that you're filing your
cost report after your due date. You'll also get one if you attempt to
upload an ECR file that was not generated using the most updated
software available from your cost report vendor.
Next, to submit your cost report timely, you'll need to make sure you do
so by 11:59 pm Eastern Time on the date of your due date. So again,
everything's in Eastern Time. So, to be timely, you'll need to submit by
11:59pm Eastern Time on your due date.
As I mentioned when we looked at the Cost Report Materials table, you
should never encrypt or password protect any of your files. The system
itself is a secure portal, in particular for transmitting your PII and
PHI. So, do not encrypt or password protect your files.
Duplicate submissions will be rejected by your MAC regardless of how
that duplicate submission is submitted. So, if you submit a duplicate
submission, the first one received, it will be the one that your MAC
actually uses as your cost report submission. The second one will be
rejected the moment the MAC notices that it's a duplicate.
Along those lines, the first cost report received by your MAC, whether
it's via MCReF or mail hand delivery, will be treated as your first cost
report submission for the year.
So we have an example here on the slide that sort of outlines exactly
why this is important. In this scenario, a provider files their cost
report in the mail prior to their due date. But then, they decide to use
MCReF to file a cost report submission after their due date with the
first submission having not been received by their MAC thatcame in
that they sent in through the mail. In this case, because you're filing
late, as I mentioned earlier, you'll get a warning from the system
saying "Are you sure you want to submit this, because you're filing
late?" In that case, if you know you have something in the mail, you
have to consider whether you actually want to make that submission,
because the thing that's received first by your MAC will be the your
first cost report submission for that year and, at that point, you will
be deemed late. So that is the importance of that.
Please go to slide 26. Okay, so next, we'll talk about the usage of
MCReF. Up until 7/1 of this yearso 7/1 of 2018all current methods of
cost report submission are available with MCReF being an additional
option as of today at 4pm Eastern Time.
Effective on 7/2, July 2nd of this year, there will only be two
CMS-approved methods of cost report submission going forward. That's
electronic submission via MCReF this is the one we are talking about
today or physical submission via mail or hand delivery, as many do
today.
One thing we talked about earlier is that MCReF handles the majority of
all can handle the majority of all submissions, but there may be cases
where you won't be able to submit your cost report. Even though it is
acceptable, you may it may not be receivable in MCReF. And an example
that we have here is if you always submit over 300 MB of supporting
documentation, the system will only allow you to upload a ZIP file
that's 300 MB or less. So, if you always have to submit a gig or more,
you'll still have to mail that in because the system does not currently
support anything over 300 MB. But in general, that should be acceptable
as long asit passes all the other checks but just the system would not
be able to receive that.
And then the last bullet here essentially deals with if for some reason
the system is down for maintenance or, for whatever reason, you are not
able to use the system to file based on login reasons or whatever the
reason may be, you will not be given an extension for system issues
preventing you from e-filing. Essentially, you can always fall back on
mailing your cost report. And so, there really is no excuse for being
late due to the system itself.
Please go to slide 27. So that covers the majority of the details of the
system. But next we wanted to cover electronic signature with which
Linda discussed a little bit earlier in the intro.
So in general, last August, CMS issued the 2018 IPPS final rule, which
authorized providers to file an with an electronic signature of their
Worksheet S effective for fiscal year end on or after 12/31/2017. This
final rule did not change who is allowed to sign on the signature line
of the Worksheet S but just dictates that electronic signature is
allowed based on when it when that was effective. And so, CMS has been
working to release all of the transmittals for all of the current cost
report versions to support e-signature.
If you want to use MCReF but you file on a version which doesn't yet
support e-signature, then you must do both of the following. You need to
upload a scanned copy of the Worksheet S certification page to the
Signed Certification Page slot when you make your submission in MCReF.
And then, you need to mail and hand deliver a hard copy with a signature
signed in ink to your MAC. And that must be received by your MACwithin
10 days of that MCReF submission.
And so please go to slide 28. We'll actually talk about which versions
currently allow for e-signature and which do not. The majority of the
versions currently support e-signature. So you can see for hospitals,
SNFs, ESRDs, FQHCs, HHAs, OPOs and histolabs, and hospices, all of
their versions currently support e-signature. So, all you need to do in
that case is electronically sign and check the box on the WorksheetS,
and then you upload that file to the Signed Certification Page row when
you do your MCReF submission.
For RHCs, CMHCs, and Home Offices, you'll need to follow the process
that I described in the prior screen where you provide a scanned copy
and a signed certification page when you make your submission in MCReF.
But then, you also need to mail in a hard copy with that wet signature
or with that signature from anofficer of your organization.
Please go to slide 29. The next flew few slides essentially cover
valid and invalid uses of e-signature. This is not an exhaustive list of
what's possible for valid e-signature or invalid e-signature. For
specifics, you should definitely reference the 2018 IPPS final rule for
guidance on electronic signature. But we wanted to go over a few
examples of what is valid and what is invalid.
So the next this slide goes over a valid use of e-signature. In this
case, what CMS has done is, on the Worksheet S page, they've added a
checkbox which essentially says that your electronic you're agreeing
that your electronic signature is your legally binding equivalent of
your original signature. So, to use electronic signature, you have to
check that box. And then in this case, the provider has chosen to type
their first and last name for the officer or the officer has elected to
type their first and last name into the signature line. This is an
acceptable form of electronic signature.
Please go to slide 31. This is also an acceptable form of electronic
signature. In this case, the officer of the provider that signs the
Worksheet S has printed the Worksheet S. They have hand checked the box
saying that their electronic signature is their legally binding
equivalent of their original signature, and they've hand signed the
signature line. They then scan that document to make it an electronic
file. And then they could use that to upload to the Signed Certification
Page row when they did their MCReF submission. So this is also an
acceptable use of e-signature.
The next two will go over invalid. In this case, I talked about the
importance of this new checkbox that CMS added. The checkbox has to be
checked for it to be considered a valid use of e-signature. Sorry. So,
in this case, since the checkbox is not checked, this is considered an
invalid use of electronic signature and would be rejected by your MAC.
Please go to slide 33. This is also an invalid use of e-signature. In
this case, the officer of the provider has checked the box appropriately
electing for e-signature. But in this case, they haven't provided a
first and last name. They've just provided X123, which is not a valid
first and last name or signature. So, this would be an invalid use of
e-signature.
Please go to slide 34. Next we'll talk about specific acceptance testing
that happened for the MCReF system.
Please go to slide 35. In this case, CMS had reached out to six provider
organizations, which represented approximately 150 Part A providers, to
have them volunteer to test this system and to get their feedback. At
the end of the testing, CMS asked them asked the participants, on a
scale of 1 to 10, how likely they were to use the MCReF system. The
average rating received was a 9.7 out of 10.
And you see some of the quotes here of the feedback that was received.
"Very easy to use and understand." "The system was quick to show errors
and intended results." The one provider who did testing had an excellent
experience and was really excited for the system to go live.
Please go to slide 36. At the beginning, we talked about that rollout
plan to provide additional information to the provider community and
other Medicare stakeholders.
We'll talk about that here on slide 37. Essentially, CMS issued Change
Request 10611. This was issued Monday, 4/30. And so there's information.
A lot of the information that's provided in the slide deck today is
inthe CR and even more. There's also a quick guide that's in there or
not a quick guide but it's a it's an attachment that serves as a quick
guide which will take you through the screens that we went through in
the presentation today.
On an ongoing effort is to provide additional outreach and education.
So today we have the webinar to discuss the system and introduce it to
everyone. There'll be a CMS website posting coming soon, which will have
a lot of additional information, FAQs, the user manual, some other
documentation that'll be valuable to you.
CMS will be up also updating a lot of their documentation such as the
Medicare Financial Management Manual, the 100-06, the Provider
Reimbursement Manual 15-1 and 15-2. And then as I said before, a lot of
the cost report version's transmittal forms are being updated to support
e-signature and other things.
Lastly, this all of this is expected to completely complete the
rollout by early June.
Thank you to Linda and to Patrick and Geoff for answering all those
questions. And thank you for joining us for today's Medicare Learning
Network webcast. Have a great day.
Thank you for viewing this presentation. The information presented was
correct as of the date it was recorded. This presentation is not a legal
document. Official Medicare program legal guidance is contained in the
relevant statutes, regulations, and rulings.
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