Credentialing & Privileging | Health Plan Enrollment | Peer Review
CONFIDENTIAL: Protected by CA Evidence Codes 1156 & 1157
|
|
Office of Medical Affairs and Governance Credentialing & Privileging | Health Plan Enrollment | Peer Review CONFIDENTIAL: Protected by CA Evidence Codes 1156 & 1157 |
| Medicare/Medi-Cal Online Registration and Delegation Acknowledgement | |||||||||||||
|
Medicare Enrollment
Physicians, non-physician practitioners, and other Part B suppliers must enroll in the Medicare Program to order, refer, and receive Medicare benefits for the covered services they furnish to Medicare beneficiaries. As a University of California San Francisco Provider, your Medicare enrollment authorizes UCSF to bill and receive payment for the covered services you furnished to Medicare beneficiaries. |
|||||||||||||
|
Centers for Medicare & Medicaid Services (CMS) Revalidation Initiative
In accordance with Section 6401 (a) of the Patient Protection and Affordable Care Act, all new and existing Providers must be reevaluated under the new guidelines in order to continue billing with Medicare. Medicare requires all enrolled providers to revalidate enrollment information every 5 years. Selection for revalidation is off-cycle for program integrity purposes. To ensure compliance with these requirements, the Medical Staff Services Office (MSSO) is making an effort to revalidate each provider’s enrollment information using Internet – based Provider Enrollment, Chain, and Ownership System (PECOS). |
|||||||||||||
|
EHR Incentive Programs
The Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs will provide incentive payments to eligible professionals as they demonstrate adoption, implementation, upgrading, or meaningful use of certified EHR technology. These incentive programs are designed to support providers and organizations implementing EHRs in this period of Health IT transition and instill the use of EHRs in meaningful ways to help our nation to improve the quality, safety, and efficiency of patient health care. |
|||||||||||||
|
Delegation of Registration
In consideration of my employment and/or volunteer service with UCSF, I hereby authorize the Medical Staff Services Office and the Meaningful Use Program staffs to create, access, attest, and update the state and federal provider identification systems listed below for the purpose of Medicare/Medi-Cal enrollment, CMS revalidation, and Electronic Health Records (EHR) attestation. These provider identification systems include, but are not limited to, the following: |
|||||||||||||
Center for Medicare and Medicaid (CMS)
|
|||||||||||||
California Department of Health Care Services (DHCS)
|
|||||||||||||
| If User ID and password information for these systems is not already on file, providers will be contacted. | |||||||||||||
|
Delegation of Medicare Enrollment and EHR Attestation
I authorize the staff of the Medical Staff Services Office to create, delegate, revalidate, enroll, and reactivate my Medicare and Medi-Cal enrollment status in the Identity & Access Management System (I&A), Provider Enrollment, Chain, and Ownership System (PECOS), and Provider Application and Validation for Enrollment (PAVE) systems. Enrollment and Revalidation applications can be obtained by contacting the Medical Staff Services Office. Furthermore, when I complete the requirements to demonstrate meaningful use of an EHR, I authorize staff of the Meaningful Use Program to attest on my behalf. Attestation documents can be obtained by contacting the Meaningful Use Program. |
|||||||||||||
|
Acknowledgment
I hereby acknowledge that, pursuant to the terms of my employment and/or volunteer service, I reassign all my Medi-Cal and Medicare benefits to the University of California, San Francisco and any Organization and Tax Identification Number (TIN) assigned to UCSF for the purpose of funding the implementation and continued operations at UCSF. I also attest that I am not permitting any other entity to claim Medi-Cal and Medicare benefits attributable to me. This authorization to access provider identification systems and this acknowledgment of reassignment of benefits shall continue until such time that my employment with the University of California at San Francisco terminates or the revalidation initiative concludes, whichever occurs first. |
|||||||||||||
|
|||||||||||||
|
|||||||||||||