Skip to Main Content

Physicians, Nurses and Allied Health Professionals Open Door Forum


The Physicians, Nurses and Allied Health Professionals Open Door Forum (ODF) addresses the concerns and issues of Medicare and Medicaid physicians, non-physician practitioners, nurses, and other allied health care specialists. This diverse group of providers serves Medicare and Medicaid beneficiaries in almost all service settings, ranging from independent physician offices to specialized departments within larger facilities. The types of issues that come up during this forum are as varied as the providers who participate, but some frequent topics include the Physician Fee Schedule, Stark regulations, care plan oversight, payment and documentation rules, Provider Enrollment Chain Ownership System (PECOS), as well as the roles and responsibilities of different allied health professional staff under CMS regulations. Timely announcements and clarifications regarding important rulemaking, quality program initiatives, and other related areas are also included in the forums.


**Updated November 6, 2015  - The proposed agenda for the next Physician Nurses & Allied Health Open Door Forum is scheduled for Tuesday, November 10, 2015 from 2:00pm-3:00pmET is as follows: Announcements & Updates; Announcements for Medicare: Oct 15-Dec 7 sign-up and Nov 1-Jan 31 signup. Announcement:  As part of our mission to empower and engage consumers, HHS will be hosting a multi-stakeholder convening in early 2016 on the topic of connecting to care and navigating the health care system. Specifically, as we move beyond open enrollment, how can we partner together to make sure that people are understanding and using their insurance coverage, connecting and staying in contact with providers, and effectively navigating the health care system? As a trusted resource for patients, what role do providers have to play in this process? If your organization is interested in participating in this convening or discussing partnerships, please contact us via the email that will be sent shortly after this call, and we will follow up with you; 2016 Value Modifier Informal Review Request Period Extended to November 23, 2015:; Physician Compare Updates; Highlights of CY 16 Physician Fee Schedule Final Rule. If you wish to participate, dial 1-800-837-1935 Conference ID: 8016429. Please see the full participation announcement in the Downloads section below. Thank you for your continued interest in the CMS Open Door Forums.

**Updated November 3, 2015- Special Open Door Forum: Prior Authorization of Representative Scheduled Non-Emergent Ambulance Transport Expansion is scheduled for Tuesday, November 10, 2015. CMS will host a Special Open Door Forum (ODF) to allow ambulance suppliers, other Medicare providers, and additional interested parties to learn about the upcoming expansion of the Prior Authorization of Repetitive Scheduled Non-Emergent Ambulance Transport model to Delaware, the District of Columbia, Maryland, North Carolina, Virginia, and West Virginia. The model began in New Jersey, Pennsylvania, and South Carolina in December 2014. This Special ODF will include information on the prior authorization process and a Q&A period.

The purpose of this model is to test whether prior authorization helps reduce expenditures, while maintaining or improving quality of care. CMS believes a prior authorization process will help ensure services are provided in compliance with applicable Medicare coverage, coding, and payment rules before services are rendered and before claims are submitted for payment. 

Prior authorization will not create new clinical documentation requirements. Instead, it will require the same information necessary to support Medicare payment, just earlier in the process.  Prior authorization allows providers and suppliers to address issues with claims prior to rendering services and to avoid an appeal process. You can find more information on the model by going to: .Questions on the model can be sent to: .We look forward to your participation.If you wish to participate dial: 1-800-837-1935 and reference conference ID: 70012700. Please see the Downloads section below for the full announcement. Thank you for your continued interest in the CMS Open Door Forums.