Read MPSM's May 2023 Newsletter
MSPM Milestone: PDS Goes Live! - Real-time Provider Data in Production
The Provider Data Service (PDS) Team’s API for Outpatient and Inpatient Provider Specific File (PSF) data has gone LIVE! As of April 2023, PDS completed integration with the Data Modernization (DMod) Team and is now delivering 24/7 real-time read access PSF data to their public end-users using the PDS website. This means that Medicare Administrative Contractors (MACs), external users, and internal CMS teams (Policy, CM, CMMI, CPI) can obtain up-to-date Inpatient and Outpatient PSFs rather than having to wait quarterly for the records. Any changes made to the PSF such as location, bed size, or other factors that affect payment computation, are pushed to PDS API, for end-users to access in real time.
The modernization efforts for the PDS Team began in 2020 to reimagine PSF’s outdated methods as a unified product that can be continually updated and served to users in real-time through a cloud-hosted API, eliminating quarterly lag. In addition, PDS has improved user experience by offering a user-friendly interface to read and export historic and real-time PSF data and will continue to improve user engagement with PSFs through user feedback. Congratulations to the PDS and DMod teams!
Click here to view a recorded demo of how the User Interface works (Passcode: !3TM2kdw).
New MPSM Dental Team
MPSM is introducing a third ADO Team to support the development of the dental claims processing MVP. The Modern Claim Adjudication Development Services (MCADS) team will be led by Product Manager Sumera Rownak and will join the Dental Claims Ingestion Team (Zero Cavity) and the Dental Beneficiary Validation team (Wisdom Warriors) as they continue to identify and build the functionality necessary to receive, process, and pay for dental claims by January 1, 2024.
MCADS will build upon the services provided by Wisdom Warriors to perform the necessary checks to adjudicate claims, develop the interface where MACs can review and price the claims in the cloud, and help determine how the 837D claim information will be transmitted to the HIGLAS interface via MCS. (See Dental MCS HIGLAS Integration article below.)
But we’re sure the real question on everyone’s mind is, what whimsical nickname did the MCADS team come up with? Please allow us to introduce “The Floss Bosses!”
Dental MCS HIGLAS Integration
MPSM’s dental Application Development Organizations (ADO) Teams are building a cloud based dental claims processing system that will ingest, validate, and process 837D dental claims. MPSM is planning to leverage MCS integrations with HIGLAS to process adjudicated dental claims from the cloud-based Dental Claims System for payment issuance and remittance generation. The new dental system in the cloud will provide an interface where MACs can review and price the claims. Once the 837D claims are adjudicated in the cloud, the 837D claim information along with beneficiary data (271 interface) and Provider Data (274 interface) will be sent to the HIGLAS interface via MCS.
This is an exciting collaboration between the modernization teams and the shared system maintainers. MPSM Product Strategist Sarah Langford notes, “As we incrementally modernize Medicare payment systems, seamless integration with other CMS systems, including HIGLAS and legacy claims processing systems, is crucial for success. This is a great opportunity to make progress towards integrating cloud claims processing with the existing accounting system and processes.”
Team Spotlight: Get to Know the Agile Coaches!
The Agile Coaches see themselves as partners in MPSM’s learning and strategy. In 2019 when MPSM adopted the Agile project management approach there was just one Agile Coach. As the program has grown, so has the Agile Coaching Team.
Shannon Gueringer, Jim Gross, and Jackie Hossler work together to support CMS Agile transformation by guiding CMS employees and their contractors to adopt repeatable and sustainable continuous delivery methods. They aim to promote an environment of open communication where team members are empowered to make decisions to improve their ability to deliver innovative, high-quality, high value, working software to providers and beneficiaries. Let’s meet the team!
- Shannon is a newly ordained CrossFit trainer. She also plays guitar and is an extraordinary boy-mom. Fun Fact: Shannon is committed to her workouts; she likes to use a cold plunge every morning after working out.
- Jim is a performer in musical theater, plays ice hockey, and is an awesome girl-dad. Fun Fact: Jim played the role of Beetlejuice for over 2 years at Universal Studios Orlando (many years ago).
- Jackie just wants to be outside all the time, hiking, biking, kayaking, and skiing. She also enjoys playing with her three grandchildren. Fun Fact: Jackie was an award-winning color guard in high school.
What is an accomplishment related to the program that you are proud of or excited about?
We are excited that we successfully launched Quarterly Planning for MPSM, which was a huge win. We also continue to refine meetings such as the Scrum of Scrums (SoS) and grow the Product Manager (PM) role.
Can you tell us more about the Agile Maturity Assessment (AMA) and how it supports MPSM’s mission?
Part of incremental improvement in an agile environment is to periodically get feedback about our processes. We conduct the AMA periodically so that the collective MPSM team can self-assess proficiency in CMS Agile best practices and identify current pain points and areas for future changes and experiments to become more effective. Every role in the program plays a part in our collective success, especially leadership. Questions should be answered to the best of your knowledge with respect to whether most practices are generally met within MPSM.
As a part of your role on MPSM, you also support DSSM. Can you share a little about your efforts?
We have a holistic agile transformation approach for AMG claims processing. We are currently focused on strengthening the Product Manager role and are continuously enforcing agile principles and practices to reduce redundancy and impediments across the organization.
"We Are MPSM" featuring Larry Young
Who is Larry Young?
As SES Director of the MCMG, Larry’s primary responsibilities are focused on the procurement, management, coordination, and oversight of 16 Medicare Administrative Contracts (MACs)which employ approximately 9,000 employees across the country forming the backbone of the traditional FFS Medicare program. Larry has had a long career at CMS including working in what used to be known as Beneficiary Services. A role Larry recalls fondly, “It really helped me to understand beneficiary real-world problems. Helping solve their problems was very meaningful for me, and it still motivates me to this day. We are charged with taking care of those that come before us and some of the most vulnerable segments of our population—nothing could be more noble. I’mvery proud of the work we all do at this good place.”
What is the significance of modernization for CMS?
“It’s absolutely critical! Medicare is the largest single payer of healthcare benefits in the country. We have a tremendous direct impact on the healthcare system, but the indirect influence we have is arguably even larger in terms of how other payers and providers leverage Medicare’s payment and coverage policies. Our ability to adapt our systems quickly to incorporate new policy direction and, in some cases, react to emerging healthcare challenges (e.g., COVID-19) is vital to our core mission.”
Career Snapshot
“This is my 33rd year at CMS! I have spent the last 18 years in MCMG and have been in my current role since 2014. As SES Director, I provide leadership and direction ensuring continuity of operations for Medicare fee-for-service (FFS) operations which serve over 34 million Medicare FFS beneficiaries.”
Your Career in Five Words
“Mission-driven, fulfilling, dynamic, exhausting, grateful!”
This Year, I Hope…
“…to shoot a 77. My personal best golf score is 78. I have had this aspiration for a few years now—one day it will happen!”
Past CMS Projects
“Before my current position, I was a Program Management Division Director within MCMG. Before MCMG, I worked in the Dallas Regional Office on a variety of things including as a program safeguard contractor GTL in CPI, as a data analyst and database designer, an MSP policy analyst, and a Medicare Advantage plan manager.”
Fun Fact
“I consider myself an introvert. I truly enjoy the great people I work with and the work we do, but I could be quite content reading a book all day with little human interaction.”
Hobbies
“I like to read, golf, travel, and spend time with my amazing wife!”