Version date: October 23, 2017 Frequently Asked Questions for OPTIMISTIC Facilities and Practitioners Topics covered: Project Administration Clinical Facility and practitioner agreements of participation, p.1 Change in Condition assessment and certification, p.5 Resident Eligibility, p.2 Rural Health Clinics and Practioners, p.2 Resident Opt-Out requirement, p.2 Billing Data Medicare Part B billing submission, p.3 Data submission, p.6 Medicare codes and payment amounts for this initiative, p.3 Question Answer PROJECT ADMINSTRATION What are the agreements for Facilities are assigned as OPTIMISTIC Clinical + Payment or OPTIMISTIC participation with OPTIMISTIC? Payment Only facility. Clinical + Payment will have the OPTIMISTIC clinical model with OPTIMISTIC clinical staff and access to the new Medicare Part B codes. Payment Only will have access to the Medicare Part B codes only. Memorandum of Agreements (MOAs) with facilities were required during the application phase in year 1 (2016). MOA are renewed annually; CMS will review partnerships on an annual basis (September) to determine facility engagement and make determination about continuation. Copies of signed MOA are available upon request. Data Use agreements with facilities were required in the application phase. No renewal is required through the duration of the program. Copies of signed DUA are available upon request. Practitioner Letter of Intent (LOI) are required for practitioner to be approved to bill for services under this initiative. New practitioners may submit LOI monthly (by 10th of month) to . Approval can take several weeks to complete. Facilities and practitioners will be notified when approval is complete. Practitioners will be vetting using the individual’s National Provider Identifier (NPI) and Tax Identification Number (TIN) What are the expectations for Facilities will participate in OPTIMISTIC’s engagement process. engagement in OPTIMISTIC? As outlined in the MOA, all facilities will be expected to bill the new Medicare Part B codes for qualifying events and submit required data to OPTIMISTIC. For Payment Only facilities, you will receive a brief monthly survey & participate in a 30 minute call. For our Clinical + Payment facilities, you will meet with the OPTIMISTIC Program Administrator quarterly and when needed. Learning Community opportunities will be provided for OPTIMISTIC facilities and approved practitioners. All participating facilities and practitioners will be invited to the annual OPTIMISTIC Stakeholder Summit (held in September)
Version date: October 23, 2017 Frequently Asked Questions for OPTIMISTIC Facilities and Practitioners Topics covered: Project Administration Facility and practitioner agreements of participation, p.1 Resident Eligibility, p.2 Rural Health Clinics and Practioners, p.2 Resident Opt-Out requirement, p.2 Billing Medicare Part B billing submission, p.3 Medicare codes and payment amounts for this initiative, p.3 Clinical Change in Condition assessment and certification, p.5 Data Data submission, p.6 Question Answer PROJECT ADMINSTRATION What are the agreements for participation with OPTIMISTIC? Facilities are assigned as OPTIMISTIC Clinical + Payment or OPTIMISTIC Payment Only facility. Clinical + Payment will have the OPTIMISTIC clinical model with OPTIMISTIC clinical staff and access to the new Medicare Part B codes. Payment Only will have access to the Medicare Part B codes only. Memorandum of Agreements (MOAs) with facilities were required during the application phase in year 1 (2016). MOA are renewed annually; CMS will review partnerships on an annual basis (September) to determine facility engagement and make determination about continuation. Copies of signed MOA are available upon request. Data Use agreements with facilities were required in the application phase. No renewal is required through the duration of the program. Copies of signed DUA are available upon request. Practitioner Letter of Intent (LOI) are required for practitioner to be approved to bill for services under this initiative. New practitioners may submit LOI monthly (by 10th of month) to . Approval can take several weeks to complete. Facilities and practitioners will be notified when approval is complete. Practitioners will be vetting using the individual’s National Provider Identifier (NPI) and Tax Identification Number (TIN) What are the expectations for engagement in OPTIMISTIC? Facilities will participate in OPTIMISTIC’s engagement process. As outlined in the MOA, all facilities will be expected to bill the new Medicare Part B codes for qualifying events and submit required data to OPTIMISTIC. For Payment Only facilities, you will receive a brief monthly survey & participate in a 30 minute call. For our Clinical + Payment facilities, you will meet with the OPTIMISTIC Program Administrator quarterly and when needed. Learning Community opportunities will be provided for OPTIMISTIC facilities and approved practitioners. All participating facilities and practitioners will be invited to the annual OPTIMISTIC Stakeholder Summit (held in September)
OPTIMISTIC_FAQ_20171023_(4).docx