MPSM Newsletter - December 2022

5 Reasons We’re Smiling About Enhanced Dental Coverage Under Medicare!

1. Medicare beneficiaries will have additional coverage for certain medically necessary dental treatments.

In November, CMS announced that it will expand Medicare coverage to include additional medically necessary dental procedures when they are tied to certain procedures and outcomes. Specifically, those that are aimed at eliminating infection prior to an organ transplant and certain cardiac procedures will begin in 2023, while coverage of dental services linked to head and neck cancers will start in 2024. These dental procedures may be performed in a dental setting and billed on American Dental Association claim forms, or 837D claims, which Medicare currently does not accept or process.

2. Dental claim ingestion and processing will serve as a guide for handling other claims in the future.

According to MPSM Project Strategist Sarah Langford, “We are hopeful that MPSM’s agile approach to modernization will allow us to build off of what we learn and develop for dental claims processing as we continue to modernize the fee-for-service payment systems.” The approach for ingesting and processing the 837D claims will be our first use case and will lead to scalable, reusable services that, in the future, can be used for processing other claims as well. We are well positioned to handle this, but even so, there is a lot to do to get ready!

3. Implementation will not increase the footprint of legacy systems.

MPSM Program Management and support teams have been working to identify the functionality necessary to receive, process, and pay for dental claims. The objective is to implement the changes in dental coverage in a way that aligns with MPSM’s strategic vision and agency priorities and that does not increase the footprint of legacy systems. The goal is to leverage the cloud to ingest and process 837D claims.

4. Risks, issues, gaps, and dependencies are being proactively addressed.

MPSM leaders are engaging and partnering with stakeholders across the agency to ensure that key risks, issues, gaps, and dependencies are understood and proactively addressed.

Though the scope is still being defined, they are reviewing how resources might be allocated and which teams will be able to shift focus toward dental processing efforts. Two teams are currently being formed, with one focusing on parsing, storing, and validating 837D claims and the other exploring CWF functionality to analyze beneficiary and provider eligibility and utilization on dental claims.

5. Dental implementation gives MPSM a wonderful opportunity to see how our strategy and roadmap perform.

This is an exciting new development and the MPSM program will play a crucial role! It is the perfect opportunity to realize the modernization strategy and roadmap and make progress towards our fee-for-service modernization goals.

DSSM Agile Pilot

Wouldn’t it be great if there was a process that would allow Shared System Maintainer (SSM) teams to bypass the constraints of planned quarterly release dates more readily for Change Requests (CRs) to promote changes for FFS legacy systems?

This is the idea behind a new agile pilot spearheaded by the Division of Shared Systems Management (DSSM). They are developing a collaborative review process where teams review CRs (which are already baselined and estimated) and group them into a specific body of work (Epics) broken down into user stories or tasks.

This has several benefits:

1. This collaboration of SSMs, Change Request Authors, Business Owners, Medicare Integrated Service Testing (MIST), and MACs, leverages the vast experience of the teams and other stakeholders to build a solution faster than we do today.
2. With this agile pilot, everyone works together in 2-3 meetings to build the Epic. This approach eliminates months of emailing back-and-forth, thus reducing the turnaround time between when a change is requested to when a solution can be delivered to the users, without sacrificing quality.
3. Having all stakeholders come together to plan their next release allows them to quickly identify and discuss dependencies and other needs on the spot.

This agile pilot is intended to encourage flexibility, collaboration, and transparency. To that end, the Medicare Change Control Board (MCCB) will still be involved to determine if a change is approved, changes will be documented in eCHIMP and TDLs (Technical Direction Letters) will still be issued following the implementation of a change.

“We are excited for this new pilot.” says Bonnie Hockaday, Deputy Director of DSSM. “We are always looking for ways to add collaboration and flexibility within the change management process. Delivering faster and more accurately for the agency is one of our top priorities.”

At the conclusion of this agile pilot, lessons learned will be incorporated towards having the capability to continuously deliver iterative changes and promote them to production more vigorously, allowing more flexibility to implement changes as needed instead of waiting until a traditional quarterly release is implemented.

Click here to learn more information on this agile pilot.

"We Are MPSM" featuring Diane Kovach

"We Are MPSM" provides an opportunity to take a glimpse into leaders and product managers’ vision of MPSM, hear their views on the importance of modernization, and learn some fun facts about them along the way. The series continues with Diane Kovach, a member of the MPSM Product Steering Committee (PSC) and Director of the Provider Billing Group within CM. 

Who is Diane Kovach? 

Diane joined CMS in July 1990 as a Presidential Management Intern and worked for several years in Medicare fee-for-service claims processing, entitlement, enrollment, and coordination of benefits. She worked in what used to be known as the Office of Information Services on one of the Y2K Contractor Oversight Teams and as a manager in several divisions responsible for Medicare shared systems maintenance. Diane became Deputy Director of CM’s Provider Billing Group (PBG) in 2004 and has been the PBG Director since 2014.   

What is the importance of modernization for CMS?  

“The Medicare program is far different than it was when the current systems were first developed and, while we have successfully implemented increasingly complex initiatives, sometimes it is harder than it should be. We’ve recognized for a long time that we need to modernize our systems to allow for quicker changes, but it all really came to a head for me with the creation of the Innovation Center. Because of the limitations we faced, we’ve had to implement things outside of the systems or on timelines that aren’t always optimal.  It’s been a struggle to make headway over the years, but now we have some real momentum and pockets of modernized coding that give us a glimpse of how a fully modernized system can function. It’s an exciting time!”