MPSM Newsletter - July 2024
Program News
The CMS Dental Claims Processing System is Live!
As of July 1, 2024, CMS can officially accept electronic 837D dental claims. This is a huge milestone for the MPSM modernization efforts— the ability to accept, process, and pay dental claims in the cloud!
This is a culmination of work that began when the CY2023 Medicare Physician’s Fee Schedule clarification expanded Medicare coverage to include additional medically necessary dental procedures. MPSM embraced this challenge head-on and established four Dental Services Teams to identify necessary functionality and develop the Dental Minimum Viable Product (MVP).
This achievement is representative of the collaborative efforts and expertise of all the MPSM Teams, program management and support teams, as well as our business owners and stakeholders across the agency. Throughout the past 18 months, MPSM leveraged these partnerships to assist with prioritizing the functionality of the MVP and ensuring that key issues, gaps, dependencies, and risks were understood and proactively addressed.
MPSM will continue to engage our partners as we continue this journey. There is still plenty of work to be done! MACs have published 837D Companion Guides and published updates to their web sites to provide guidance for potential dental claim submitters. Meanwhile, Dental teams continue to work on building additional functionality to process paper claims and accurately process adjustments. Additionally, they are working on automating parts of the adjudication process such as allowing MACs to add validations, contractor pricing, and other activities associated with MACs requesting information from providers.
That said, this is truly a moment to pause and celebrate. As MPSM Product Strategist, Sarah Langford put it, “What we've done here is part of something bigger than dental claims processing. And what we've achieved is really critical to our strategy for modernization.”
“MPSM has laid the foundation for modernizing a large part of the healthcare ecosystem in this country. We are building a platform of common components for processing claims and will build out functionality until all medical claim service types are processed by the modern system.” Added Tim Peterson, Deputy Chief Program Officer for MPSM, “Being able to process a dental claim fully in the cloud system represents a huge amount of progress in this direction!”
Team Spotlight
MPSM is Having an Impact
Exciting news! The MPSM Pricing and Coding Services (PCS) Pricers team has made huge strides in enhancing the efficiency and accuracy of payment calculations and user feedback reflects this progress.
The Web Pricer is a public-facing tool that can be used to estimate a claim payment only. The PCS Team recently asked Web Pricer end users to respond to a survey to learn about their experience. The results were overwhelmingly positive and highlight the success of these enhancements with most respondents stating that the tool is easy or very easy to use. The improved system saves an estimated 30-45 minutes per claim, potentially accumulating up to 600 hours of saved time annually! Additionally, users can now complete important tasks related to clarifying, validating, and checking prices in a much more efficient manner.
The MPSM Pricers team began their modernization efforts in 2018. Since then, they have improved the user experience by enabling quick and easy updates to the Cloud, better code maintenance, fewer claims reprocessing, and lower costs with improved pricing accuracy and testing. Providers are paid correctly and sooner with faster logic and rate updates to production.
As one user shared “I use it all of the time. I like having it to give me clues about what written policy changes actually do in practice.” It is encouraging to see the direct impact the modernization efforts are having on the end users.
Leadership Spotlight
"We Are MPSM" offers 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 Tim Peterson who serves as Deputy Chief Program Officer for the MPSM Program.
WHO IS TIM PETERSON?
Tim Peterson was recently named Acting Deputy Director of the Applications Management Group in the Office of Information Technology. In this capacity he will help shape the design, development, and implementation of modernization, enhancement, and maintenance for a complex suite of IT systems. Tim is extremely curious and aims to understand the full end-to-end process/cycle of anything he works on. He is passionate about solving problems and improving how people work. These qualities, combined with his extensive experience in industry and a recent stint with USDS as a Digital Services Expert, will no doubt be valuable in this new role.
WHAT IS THE SIGNIFICANCE OF MODERNIZATION FOR CMS?
“The modernization initiative is critical to ensure that CMS can continue to realize its mission to provide effective health care coverage and promote quality care. Modernizing our claims processing systems ensures that we can help position the agency to meet future opportunities and threats to the American healthcare system.”
CAREER SNAPSHOT
“I joined CMS in late August 2023. My last role prior to starting federal service was at Visa as a director of global product go-to-market.”
PAST CMS PROJECTS?
“I started at CMS assisting the MPSM team implement the 837D electronic claim form. That’s still what I am spending a lot of time on though, I am slowly branching into new areas.”
YOUR CAREER IN 5 WORDS
“Transformative. Meandering. Exciting. Challenging. Rewarding.”
FUN FACT!
“I was lucky enough to live in London for 5 years a few jobs ago. It was amazing!”
HOBBIES? WHAT DO YOU DO IN YOUR FREE TIME?
“In my free time I enjoy reading, watching movies, being outdoors and power lifting!”
THIS YEAR…
“I’m planning a trip to Cape Charles, VA with friends at the end of the summer. And possibly an international getaway later this year.”
Team Spotlight
Model Claims Modernization (MCM) has launched!
In July, the Centers for Medicare and Medicaid Innovation (CMMI) MCM Product Team reached a milestone with the release of the MCM system to production. This achievement supports the delivery of beneficiary and provider model alignment files from CMMI model implementation teams via the MPSM Cloud to the Fee For Service (FFS) mainframe for integration with legacy claim processing. This work directly supports CMMI’s effort for alternative payment models (APMs) which reward health care providers for delivering high-quality and cost-efficient care.
MCM has launched with the introduction of three models:
- ACO Realizing Equity, Access, and Community Health (ACO REACH)
- Guiding and Improved Dementia Experience (GUIDE)
- Making Care Primary (MCP)
MCM provides the following benefits:
- Streamlined delivery of CMMI beneficiary and provider model alignment files to the MPSM AWS Cloud and to the FFS mainframe in advance of claim submissions.
- Flexible and simplified pathway for delivery of alignment files for all future CMMI models.
- Creation of a centralized provider and beneficiary participant repository in the cloud which sets the foundation for future MCM capabilities (currently in development) of model-specific claim stamping and pricing adjustments.
- Leverages cloud technologies and improvements while minimizing legacy system code changes. Greater visibility for model teams into processing results and future analytics.
Informational Resources
What else is planned for FY24 Q4? Check out the Product Reference Sheet!
The FY24 Q4 MPSM Quarterly Planning session was held during the week of June 24, 2024. Following each Quarterly Planning, the MPSM Product Reference Sheet (PRS) is created to provide a high-level summary of how the MPSM product teams are helping to modernize Medicare Payment Systems, along with their recent progress and what they have planned for the coming quarter.
Click here to view the latest FY24 Q4 PRS!