MPSM Newsletter - November 2023
Program News: Dental MVP Updates: What’s New?
When the MPSM Governance Board met in early November, after careful deliberation, they recommended delaying the launch of the Dental Minimum Viable Product (MVP) from January 2024 targeting sometime later in CY24 Q1.
Though an exact date on which CMS will announce its acceptance of electronic dental claims is still TBD, the dental system will still be in production by early January in order to perform a very limited pilot. Beginning this month, MACs will be performing end-to-end testing of the entire dental system in environments as close to production as possible. They will be submitting claims, pricing or denying the claims accepted into the system, and then verifying that they result in accurate Remittance Advice for providers and Medicare Summary Notices for beneficiaries.
The four MPSM Dental Teams continue to work feverishly to make sure the Dental MVP is ready to ingest, adjudicate, and pay 100% of dental claims for services provided in beginning in 2024. Here is what the teams have been up to this quarter:
Dental Claims Ingestion (Zero Cavity) is focused on supporting the MACs with handling test claims submitted by potential trading partners to the Dental Claims Ingestion Application Programming Interface (API). This will allow MACs the ability to register new dental claim submitters for the electronic processing of dental claims. They are also working on communicating claim rejections that result from validations performed in the system in an EDI-compliant manner via the 277CA transaction.
Last quarter the Dental Beneficiary Validation (Wisdom Warriors) determined that dental claims would only be stored in the dental adjudication system in the cloud. This means that no dental claims-related information will be stored on the CWF legacy system as part of the dental MVP. Instead, CMS will rely completely on the dental adjudication system to store the dental claim details and MACs will access the dental claims adjudication system to view the deductible applied to dental claims.
Therefore, the Modern Claim Adjudication Development Services (MCADS) is developing a dental adjudication system to provide MACs an interface to see accepted claims and to be able to price or deny those claims. The team will focus on ensuring that MACs can complete the minimal necessary functionalities required to adjudicate dental claims as accurately as possible in the cloud so the claims can be paid or denied successfully.
In November and December, the Multi-Carrier System (MCS)/Healthcare Integrated General Ledger Accounting System (HIGLAS) team will participate in end-to-end testing and repair any potentially identified deficiencies prior to the go live date. The team has built the necessary APIs that integrate dental claims and dental provider/bene information received from MCADS. Currently, adjudicated claims from MCADS are being sent to the MCS interface and processed within the MCS and HIGLAS systems. The team is in the process of completing development for APIs to communicate HIGLAS errors or finalized payment information back to the MCADS team.
Team Spotlight: VMS Modernization
Meet MPSM’s newest ADO Team! The VMS Modernization Team was formed to initially focus on two main efforts:
- Modernize the VMS Fee Schedules (i.e., ASP, etc.), partnering with the CMS PCS Team.
- Conduct mainframe modernization proof-of-concepts to explore and assess the viability of performing a mainframe to cloud migration.
The VMS Modernization Team (VMS Mod Squad) has supported the Durable Medical Equipment (DME) legacy system and its’ technology for many years. The team looks forward to participating in the evolving modernization initiatives and developing strategies to create efficient and cost-effective solutions that will position the DME claims processing system to meet the evolving Medicare needs. The team is excited and ready to take the legacy systems to a new technology platform that will position CMS with the agility, usability, sustainability, and integration capabilities required to meet the ever-changing landscape of Medicare. To learn more about the VMS Modernization team (aka the VMS Mod Squad), reach out to Darlene Cochrane and Tammy Howard (Fed PMs), Todd Goeldner (Program Director), or Angela Stewart (Product Owner).
PDS Moving to Source of Truth
The Provider Data Service (PDS) team was introduced to the MPSM Program in 2020 to benefit users (both system and end users, who download Provider Specific File (PSF) data from CMS.gov for public use. The PSF is maintained by the Medicare Administrative Contractors (MACs) and contains information about providers. Originally, the team worked on providing historic PSF data in the cloud for the Web Pricers team to consume and then they developed a PDS API for Cloud Pricers to read for claims processing.
In April 2023, the PDS team began delivering 24/7 real-time read access PSF data to their public end-users using the PDS website. Originally, PSFs were only published quarterly so this was a great improvement allowing MACs and internal CMS teams to have the most accurate PSF data available via a user-friendly interface.
PDS is currently working to establish PDS as the Source of Truth (SoT) so users will have the ability to update, read, and add records to the cloud-based PDS database. The PDS Team plans to transition the PDS Application Programming Interface (API) product to maintenance by the end of January 2024.
Leadership Spotlight
"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 Torris Smith, Acting Director for the Medicare Contractor Management Group (MCMG) and member of the MPSM Product Steering Committee.
WHO IS TORRIS SMITH?
As the Acting Director for MCMG, Torris provides executive leadership necessary to ensure the successful planning, development, and implementation of a comprehensive management program to oversee all MAC activities ensuring contractor activities comply with departmental and agency goals and objectives. He sees this group’s work as a primary driver for building national confidence in Medicare by ensuring the efficiency, effectiveness, and continuity of Medicare FFS Contractor Operations.
WHAT IS THE SIGNIFICANCE OF MODERNIZATION FOR CMS?
“Harnessing new technologies poses a lot of challenges with cost, culture change, and time. However, novel technologies will advance our Agency brand and service. CMS should take advantage of modernizing our legacy systems where it fits logically to increase security, expand capabilities, and improve functionality.”
YOUR CAREER IN 5 WORDS
“Diverse, Satisfying, Engaging, Challenging, and Rewarding”
PAST CMS PROJECTS
“I have had the opportunity to work on many projects at CMS. Some the most notable ones were the implementation of PART D as the California State Captain, the National Provider Identifier (NPI) Standard Implementation in California, and numerous Medicare Administrator Contractor (MAC)Transitions.”
FUN FACT!
“I like to play the Djembe drum, do bushcraft, and woodworking!”
HOBBIES? WHAT DO YOU DO IN YOUR FREE TIME?
“I go to Alaska every year to fish during the summer salmon run. I also like to make use of my vintage Airstream to explore new places and of course bringing my fishing rods with me.”
FAVORITE HOLIDAY TRADITION
“Decorating the tree with ornaments from our family vacations and making fondue with the family on Christmas Eve and New Year’s Eve!”
Research Spotlight: Strat Design Research Future Dental Provider Data Needs
The Strategic Design team completed a research study that looks at the kinds of data Medicare providers most commonly search for and how those findings might be used to anticipate and support the needs of dental providers.
They found that Medicare providers most frequently search for answers related to enrollment, beneficiary eligibility, claim status, claims denials, remittance advice, and appeals status. Providers search for information through self-service channels first and then escalate to a provider contact center customer support representative, provider relations research specialist (PRRS), or other channels as needed. Dental providers will most likely request information on these same topics through the same channels.
The new dental system will lead to new dental provider data needs and accompanying provider support channels that mirror existing options for Medicare providers. There’s an opportunity to take a holistic approach to creating a seamless customer experience as data user groups learn how to integrate with and access dental data.
To view the presentation delivered by the strategic design team during HCD Hour, click here: User support data needs for Providers
Informational Resources: What else is planned for FY24 Q1? Check out the Product Reference Sheet!
The FY24 MPSM Quarterly Planning session was held during the week of September 25, 2023. The MPSM product teams presented their FY23 Q4 accomplishments, goals for Q1, and provided product demos. The MPSM Product Reference Sheet (PRS) provides a high-level summary of how the MPSM product teams are helping to modernize Medicare Payment Systems, along with their recent progress, and goals for this quarter.
Click here to view the latest FY24 Q1 PRS!