MPSM Newsletter - January 2023
Program Wide News: MPSM Welcomes Two New Teams!
In December 2022, two new product teams were added to the MPSM program: the Dental Claims Ingestion Team and the Dental Beneficiary Validation Team. These teams will be critical to delivering the Dental MVP, an important agency priority, which will allow CMS to accept, process, and pay dental claims starting January 1, 2024.
Many members of the Dental Claims Ingestion Team, also known as “Zero Cavity,” previously supported the Mainframe Cloud API Migration (MCAM). In their new roles they will focus on creating services to receive, parse, validate, and store 837D dental claims. They will also be responsible for creating acknowledgement transactions and dispersing the claim for downstream processing such as payment and financial systems.
The Dental Beneficiary Validation team, aka the “Wisdom Warriors”, will explore CWF functionality for processing dental claims. They will provide eligibility, entitlement, deductible, and Medicare Secondary Payer (MSP) validation services for the dental claims processing.
The work of both teams will align with the program’s ultimate vision of a Medicare Payment System that has the people, processes, and technical agility to support ever-evolving Medicare policy and program operation needs to best serve providers and beneficiaries.
Zero Cavity and Wisdom Warriors will join forces to support CMS in processing and paying dental claims and it all starts with the development of the dental claims processing MVP. Other teams will likely be called to action to support this effort as we collectively work toward this important goal for the MPSM program.
MPSM Quarterly Planning: What’s on the horizon for FY23 Q2? Check out the Product Reference Sheet!
The FY23 MPSM Quarterly Planning session was held during the week of January 9, 2023. The MPSM product teams presented their FY23 Q1 accomplishments, goals for Q2, and provided product demos.
The MPSM Product Reference Sheet (PRS) has been updated to reflect the progress made during FY23 Q1 and plans for the next quarter.
Click here to view the latest FY23 Q2 PRS!
Team Spotlight: PCS Proof of Concept, Approved!
The Pricing and Coding Services (PCS) team worked on a Proof of Concept (PoC) to reduce redundancies and aid in more efficient updates for fee schedules*. The team engaged in a collaborative effort with the FISS and MCS SSMs and CM/PBG/DDS to propose an iterative solution that could provide a single source for cloud pricing and support contractor fee schedule files.
Pricing as a Service (PaaS) is the API service originally developed to host fee schedule data in the cloud. It houses the Clinical Lab Fee Schedule (CLFS), and ASP Drug pricing data currently used by MCS. Through the Ambulance Fee Schedule PoC, the PCS team aims to improve and extend the functionality offered by PaaS to all eight fee schedules and to the other SSMs.
MACs currently utilize a dual process for updating fee schedules in the cloud. Two versions of the files are produced when a fee schedule needs to be updated: one for the Cloud Team (which is uploaded to PaaS) and one for contractors (which is uploaded by the MCS MACs into each of the 35 Mainframe VSAM files). This duplicate loading and manual file manipulation increased the risk of errors and presented barriers to long-term modernization and maintenance. However, the PCS application proposes a new process where CMS would no longer have to produce the duplicative contractor file. Instead, the cloud version of the file is uploaded to the PCS application and produces the reports needed by the MACs, thus eliminating the need to upload CMS-priced codes to the 35 Mainframe VSAM Files and decreasing reliance on the mainframe.
“I’m looking forward to having the ability to make changes off cycle or off quarter (without MAC effort).” -Tamara Howard, Director, Division of Data Systems
Currently MCS and FISS can successfully retrieve prices from the Cloud PoC, allowing for a future single source for pricing data. Data updates have been enabled, the contractor-priced code report is being developed, and automated testing will be leveraged to ensure accuracy in pricing.
The PCS team plans to have the application production ready by the end of this quarter, including pre-production performance testing. When the PCS API with ambulance fee schedule moves into production, the PCS team plans to move the CLFS and ASP Drug data along with it to use for performance and comparison testing. The PCS API solution is designed to be scalable and will ultimately become the overall solution for use with future fee schedules, allowing CMS to ensure updates to pricing more quickly. Click here to learn more information on the PCS Ambulance Fee Schedule Proof of Concept.
*About Fee Schedules
A fee schedule is a list of service codes and fees used by Medicare Fee for Service to reimburse providers. CMS develops the following fee schedules:
- Physicians
- Ambulance services
- Clinical laboratory services
- Drugs
- Durable medical equipment
- Prosthetics
- Orthotics
- Supplies
Leadership Spotlight: "We Are MPSM" featuring Madhu Annadata
"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 Madhu Annadata, the Director of the Division of Shared Systems Management (DSSM) in the Applications Management Group (AMG).
Career snapshot
“I have been at CMS for approximately 14 years. Before joining the federal service, I worked in the Information Technology departments for ViPS General Dynamics Information Technology, Lucent Technologies, and Kennedy Krieger Institute.”
Your career in five words
Calling, fulfilling, satisfying, exciting, and challenging!
Favorite winter activity
Staying as warm as possible and vacationing in a warm place.
Past CMS projects
“During my career with CMS, I have supported programs related to Medicare Fraud, Waste, and Abuse; Medicare Shared Savings Plan - Accountable Care Organizations, Physician Value, Quality Resource Use Reports; Open Payments and Healthcare Fraud Prevention Partnership initiatives; and Implementation of National Standards.”
Education
George Washington University, Washington, D.C.
- Master of Science (MS), Computer Science
- Master of Business Administration (MBA)
- Master’s Certificate in Program Management
Fun fact
“Despite my extreme fear of heights, I am fascinated by mountains.”
Hobbies
“I love domestic and international travel. I also enjoy hiking, going on walks with our puppy, reading, and spending time with family and friends.”
Who is Madhu Annadata?
Madhu joined CMS in 2009 and has held several leadership positions before taking on his current role as the Director of the Division of Shared Systems Management (DSSM). As Director of DSSM, Madhu directs the development and implementation of software for the Medicare Fee-For-Service Claims processing.
What is the importance of modernization for CMS?
“Modernization of any software system, (hardware, software, and peripherals), should be an integral process to O&M that involves continuous monitoring and evaluation. Modernization is especially important to MPSM as the legacy systems for Medicare FFS claims processing, though robust and fully functional, utilize yesteryear technologies that can gain efficiency by using modern technologies, tools, principles, and practices to become more effective.”