Cancer Services Program Direct Provider Payment webinar for CSP - - PowerPoint PPT Presentation

Direct Provider Payment webinar for CSP August 2018 1

Direct Provider Payment in the Cancer Services Program

Direct Provider Payment webinar for CSP August 2018 2

Agenda/Topics To Be Covered

• Introduction to Direct Provider Payment (DPP)
• DPP Process for:
• State-funded clinical services
• Federally-funded (HRI) clinical services
• Provider payment inquiries
• Responsibilities of:
• NYS Department of Health (“Department”)
• contractors
• providers

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Direct Provider Payment

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Beginning 10/1/18, services provided to eligible clients by CSP participating providers will be reimbursed directly by the State and HRI

Depending on service(s) provided, CSP-participating providers may receive two separate payments (State and HRI) each month

• The Department and HRI will use the Monthly Billing Report (MBR) for October 2018,

and all future MBRs, to reimburse providers directly.

• Services that occurred before, but are not reported until after, October 1, 2018 will

be reimbursed via the Direct Pay Process (DPP).

• Regardless of funding source (State or Federal), the DPP will reimburse the global

(professional and technical) payment directly to the one site code reported.

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The mechanism, and therefore the process, for providers to be reimbursed for State- and HRI-funded services via the DPP is different.

HRI: reimburses providers via check State: reimbursement via the State Financial System (SFS) - NYS government’s accounting and financial management system

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Important DPP Definitions

• SFS Vendor ID #: 10-digit identifier issued by

NYS to vendors (provider practice/facility) registered in the Vendor File (associated with Federal Employee ID #)

• SFS Payee Name: vendor name shown on

its charter or other legal documents

• Vendor Address: default address in SFS

Vendor Portal, corresponds with SFS Vendor ID #

• SFS Contact: designated by vendor as

primary contact; has ability to add/update information such as contacts, addresses, and bank account for direct deposit; can view status of invoices and pending payments via vendor self-service portal

• Program Pay To Contact: point person at

provider site (may be different from SFS Contact) including email, address and telephone.

• responsible for all CSP billing issues
• receives monthly CSP Patient Service

Summaries

• receives HRI checks
• works with SFS contact (if different) to

ensure proper identification of CSP payments and assists with client account reconciliation

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Process to Reimburse State- funded Services

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1: CSP contractors collect all information (via annual credentialing process) needed to set up DPP with each participating provider

1. Department reviews current credentialing workbooks to identify current provider site codes with existing SFS Vendor ID# 2. Department staff pre-fills credentialing workbooks with SFS Vendor ID and SFS Vendor Address if available 3. Department staff sends contractor a) list of providers who have no SFS Vendor ID and other discrepancies b) link to Substitute Form W9 (including instructions) to request SFS Vendor ID# 4. provider completes Substitute W9 5. provider returns completed Substitute W9 to contractor 6. contractor submits completed Substitute W9 form to CSPcredentialing@health.ny.gov 7. CSP Credentialing facilitates submission of Substitute W9 to SFS to obtain Vendor ID*

*NOTE: only DOH programs can submit Vendor ID requests

All site codes for each provider site need an SFS Vendor ID # to receive reimbursement for State-funded services

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2: CSP contractors obtain new provider agreements required for contract period 10/1/18 – 9/30/23

• Department staff provides contractor with required Provider Agreement
• contractor obtains signatures from each CSP-participating provider and

contracting agency ▪ contractor submits Agreements to CSPcredentialing@health.ny.gov

• Department staff documents receipt of Agreement and obtains Department

authorized signature

• Division Fiscal staff returns copy of completed & signed Agreement to contractor
• contractor provides copy of Agreement to appropriate CSP-participating

providers

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3: Provider authorization of payments

Department:

• uses Monthly Billing Report (MBR) to

prepare monthly Patient Services Summary (PSS)

• PSS provides client-level detail for all

State-funded services: ▪ rendered by that provider; and ▪ entered or modified on Data System for that month

• emails password-protected PSS (via

CSPfiscal@health.ny.gov) to designated Pay To contact each month

Pay To Contact:

• reviews PSS to confirm listed services were

provided & are accurate

• replies to email with confirmation of services,

e.g.:

• “We confirm that we have provided the

services on the attached listing and request reimbursement for reported services” NOTE: providers cannot receive reimbursement for State-funded services without this confirmation.

Upon receipt of confirmation, Department staff creates SFS invoice to initiate payment

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Provider authorization of payments (continued)

What if provider does not respond to Patient Services Summary (PSS) communication?

• Department staff makes three (3) bi-weekly attempts to obtain payment authorization
• n 3rd attempt, CSP Coordinator and Regional Manager will be copied to assist with

follow-up

• CSP Coordinator contacts provider to ensure they received email & confirm whether Pay To

contact has changed

• changes in Pay To contact require Credentialing Workbook update

▪ contractor must submit name and email address of new Pay To contact to CSPcredentialing@health.ny.gov

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4: Receipt of payment via SFS

• Provider receives payment per SFS-designated method
• Checks are mailed to address designated in SFS
• electronic payments deposited to bank account designated in SFS
• SFS contact will be able to view payments in the SFS via the

Vendor portal.

• Beginning October 2018 will appear as Site Code – MBR Month –
• CSPDPP. Example 730014 OCT18 CSPDPP
• Pay To contact works with SFS contact and other provider billing staff

as applicable to reconcile payment to PSS for that month

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Direct Provider Payment webinar for CSP August 2018 14

Provider Inquiries on Payment of State- funded Services

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Department FMU staff will respond to questions posed by the Pay To contact about payment details, including:

• payment amount
• date of payment
• payment method (ACH or check)
• invoice number associated with

payment

Department FMU staff generally cannot respond to questions from anyone other than SFS contact except for inquires about:

• confirmation the Department has/has

not successfully communicated with the Pay To contact

• the specific “Subject Line” included on

the PSS emails sent (to help locate the email communication)

• how to contact SFS help desk

Department FMU staff will not provide the password for PSS communication or client-level information (name, DOB, ID, service date, procedure, or rate) over the phone. All questions related to clients who do/do not appear on PSS, data reporting, and direct client care will be directed to the CSP Coordinator.

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Process to Reimburse Federally- funded (HRI) services

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• HRI will reimburse providers directly for all federally-funded services

rendered by CSP-participating providers and entered or modified on the data system each month.

• HRI does not require PSS sign-off from Pay To contact to process

reimbursement of Federally-funded services.

• HRI sends check to Pay To contact for site code (collected during

credentialing process).

• Checks include PSS, which provides client-level detail for all

federally-funded services reported on the data system that month.

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Provider Inquiries on Payment of Federally- funded (HRI) Services

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All HRI checks are stamped with: "Please deposit within 30 Days, for Questions: cspfiscal@health.ny.gov” Department staff will respond to questions related to:

• check and invoice numbers
• payment amount
• date of payment

All other questions (e.g. data reporting (clients who do/do not appear

• n PSS), direct client care) will be referred to the CSP Coordinator

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Contractor Responsibilities related to Direct Provider Payment

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CSP Contractor Responsibilities:

• btain required NEW provider agreements for the 10/1/18 – 9/30/23 period
• share changes or information about Direct Payment Process with all

participating providers (may use these slides)

• work with CSP-participating providers to
• obtain SFS Vendor ID #s as applicable and
• verify any changes needed to Credentialing workbook contact information
• facilitate discussions where contractor previously divided the global payment

between two providers (technical and professional).

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Ongoing CSP Coordinator Role

• follow-up with provider Pay To contacts who did not respond to authorization of payment as

requested by the Department

• complete credentialing change forms when the Pay To contact changes at a participating

provider

• work with Department to respond to participating provider inquiries seeking to reconcile

payment for services rendered

• follow up with providers to ensure payments are received and cashed, as requested by the

Department

• closely monitor State and HRI clinical services funding allocations to ensure full and

appropriate expenditures

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