Jurisdiction 6 – Part A

2017 AAHAM/HFMA Payer Panel

National Government Services, Inc.

March 14, 2017

www.NGSMedicare.com

Jurisdiction 6 – Part A

Today’s Presenter

Jean Roberts, RN, BSN, CPC

J6 Provider Outreach & Education Consultant

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Jurisdiction 6 – Part A

Disclaimer

National Government Services, Inc. has produced this material as an

informational reference for providers furnishing services in our contract

jurisdiction. National Government Services employees, agents, and staff

make no representation, warranty, or guarantee that this compilation of

Medicare information is error-free and will bear no responsibility or

liability for the results or consequences of the use of this material.

Although every reasonable effort has been made to assure the accuracy

of the information within these pages at the time of publication, the

Medicare Program is constantly changing, and it is the responsibility of

each provider to remain abreast of the Medicare Program requirements.

Any regulations, policies and/or guidelines cited in this publication are

subject to change without further notice. Current Medicare regulations

can be found on the CMS website at https://www.cms.gov.

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https://www.cms.gov/

Jurisdiction 6 – Part A

No Recording

Attendees/providers are never permitted to

record (tape record or any other method) our

educational events

This applies to our webinars, teleconferences, live events

and any other type of National Government Services

educational events

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Jurisdiction 6 – Part A

Acronyms

Acronyms used in this presentation can be

viewed on the NGSMedicare.com website. On

the Welcome page, click on Provider

Resources > Acronyms.

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Jurisdiction 6 – Part A

Agenda

Presubmitted Questions

General

Specific for J6 NGS/Medicare

Updates

CERT

Wrap Up

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Jurisdiction 6 – Part A

FYI:March is National Kidney Month!

More information is available on the National Institute of Diabetes and Digestive and Kidney Diseases web site: https://www.niddk.nih.gov/health-information/health-communication-programs/nkdep/get-involved/kidney-month/Pages/kidney-month.aspx?utm_source=AND&utm_campaign=2017NKM&utm_medium=Newsletter

National Kidney Foundation

https://www.kidney.org/patients/medicare

2017 World Kidney Disease Theme is Kidney Disease & Obesity

http://www.worldkidneyday.org/2017-campaign/2017-wkd-theme/

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Jurisdiction 6 – Part A

FYI:March: Colorectal Cancer Awareness Month

Centers for Disease Control and Preventive (CDC)

https://www.cdc.gov/cancer/colorectal/sfl/index.htm

Medicare Preventive Services Quick Reference Chart

Interactive Online Version

https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html

Text Only Version

https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS-QuickReferenceChart-1TextOnly.pdf

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Jurisdiction 6 – Part A

General Presubmitted Questions

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Jurisdiction 6 – Part A

General Question #1

1. Question: There seems to be long hold times when calling into payers. What are payers doing to address these long hold times? This is across all payers, however has been noted for some upwards of 40-50 minutes.

Answer: National Government Services average speed of answering an initial call placed to the J6 Provider Contact Center (PCC) is currently less than 1 minute

PCC – telephone # 877-702-0990

Interactive Voice Response (IVR) System: telephone # 877-309-4290

For additional information: www.NGSMedicare.com > Contact US (Directly below search bar)

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Jurisdiction 6 – Part A

General Question #2

2. Question: What is your preferred method of refunding overpayments for a UB04 and 1500 professional claims?

Do you prefer to receive a Corrected or cancellation claim?

Do you have a specific Recoupment form that should be used?

Do you prefer a refund check?

Answer: When an adjusted/corrected/cancel claim will resolve the issue, that is a preferred method. Otherwise, NGS offers several methods to refund an overpayment.

The preferred method is to use the standardized “Immediate recoupment” process. This process allows the avoidance of interest to accrue.

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Jurisdiction 6 – Part A

General Question #2

Submit your request by fax, or by using the Immediate Recoupment Request - Electronic/Email Form.

To request an immediate recoupment by fax, you must complete the Immediate Recoupment Request Form.

A request for immediate offset must be received no later than the 16th day from the date of the initial demand letter.

If you have already submitted a request for all future recoupments, you no longer need to request an immediate recoupment for each demand letter you receive.

Please Note: You can terminate the immediate recoupment process at any time; however, the request to terminate must be in writing.

Additional Information: www.NGSMedicare.com > Overpayment

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Jurisdiction 6 – Part A

General Question #3

3. Question: Does each facility have a specific provider representative that we can go to with complicated issues that are not resolved by the initial contact with the provider call centers? If so, who do we contact to get the name of our provider representative? If not, can we get one?

Answer: NGS does not assign a specific Provider Outreach Education (POE) representative to a facility. Per CMS requirements you must make all initial inquiries via self-service technology, the Interactive Voice Response (IVR) system, or the Provider Contact Center.

www.NGSMedicare.com > Contact Us (under search bar)

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Jurisdiction 6 – Part A

General Question #3

If at least 30 days have elapsed since contact with the Provider Customer Care Department and you either have not received a response or are dissatisfied with the response, please contact the Provider Outreach Department at J6.Provider.Training@anthem.com with:

Question/Description of issue and include any reason codes involved

Activity number assigned by Customer Care

Date you opened the request

Your facility’s Medicare legacy provider number

What you have been told by Customer Care

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Jurisdiction 6 – Part A

General Question #4

4. When a previously submitted claim denies requiring medical notes or an EOB (Explanation of Benefits) it requires the Provider to submit the additional documentation to adjudicate the claim, but since there are no occurrence codes to add no additional changes can be add on the UB04 claim form. Due to no changes being made on the UB04 claim form some Insurance payers require an appeal/adjustment claim form to be completed and that documentation is either mailed or faxed in for reprocessing of the claim manually. The occurrence code could be a useful tool for the provider to add an occurrence code on the UB04 claim (additional documentation) to enable the provider to submit a replacement claim using the MN AUC form to comply with the necessary documentation needed to adjudicate the claim vs. writing up an appeal/adjustment claim form and submitting either snail mail or faxing.

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Jurisdiction 6 – Part A

General Question #4

NGS articles:

www.NGSMedicare.com > Claims & Appeals > About Appeals > select article title from side

“Submit an Adjustment to Correct Claims Partially Denied by Automated LCD/NCD Denials”

Process only applies to line items denied for 55A00, 55A01, 52NCD, 53NCD, 54NCD

“Reopenings for Minor Errors and Omissions”

Clerical error/omission reopenings are granted at the discretion of the contractor

Note: If the above articles do not apply you will need to file an appeal via NGSConnex (preferred method); eSMD; or hard copy

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Jurisdiction 6 – Part A

General Question #55. When insurance companies send out new cards we are noting that not all cards

contain the EDI number. This is a very helpful item to have on the card for us to be able to identify where the claim needs to go. And to ensure the correct coverage is selected. We even scan a copy of the card and attach it in our system.

Will payors consider ensuring this is on the cards? Some payers are not sending new cards when coverages have changed – so

the patient continues to carry the OLD card which creates an issue if anything has changed (from the group number to the discount logos etc). Short of having to look up every patient on a website, this is creating some concerns. And the use of digital copies (a picture of the card on a patient’s phone) is very difficult for us to save a copy of the card.

Is it just the cost savings of printing and mailing the cards that is prompting these changes?

What suggestions would the payers have to overcome some of these difficulties?

Answer: Does not apply to Medicare

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Jurisdiction 6 – Part A

Your Presubmitted Questions for NGS

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Jurisdiction 6 – Part A

Presubmitted NGS Question 1: MSP

Question: MSP claims-particularly no-fault claims. We follow the MSP Billing and Adjustment guide – Process A-J from your website, which is very helpful. There is one billing scenario that does not seem to apply to any of the Process flows:a) The patient supplies the MVA billing information and claim

number to the provider. The claim(s) are billed. The issues starts when the patient does not provide the insurer with the necessary paperwork that is required. This can go on for a very long time. Numerous letters are sent to the patient by the MVA payer and by the provider.

b) The provider has no denial. The MSP record shows a No-Fault carrier. What process would we follow to bill Medicare – and what Value Code(s) and Remark code would be appropriate?

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Jurisdiction 6 – Part A

Answer to Presubmitted NGS Question 1: MSP

Answer: a) CMS IOM Pub 100-05, Medicare Secondary Payer Manual, Chapter 5, Section 40.6.2 states:

“Note: Individuals are not required to file a claim with a liability insurer or required to cooperate with a provider in filing such a claim. However, beneficiaries are required to cooperate in the filing of no-fault and workers’ compensation claims. If the beneficiary refuses to cooperate in filing of no-fault or workers’ compensation claims Medicare does not pay. Conditional benefits are not payable if payment cannot be made under no-fault insurance because the provider or the beneficiary failed to file a proper claim. (See Chapter 1, §20, for definition.) Exception: When failure to file a proper claim is due to mental or physical incapacity of the beneficiary, and the provider could not have known that a no-fault claim was involved, this rule does not apply.”

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Jurisdiction 6 – Part A

Answer to Presubmitted NGS Question 1: MSP

CMS IOM 100-05, Chapter 1, Section 10 states: “When Medicare is the secondary payer, the provider, physician, or other supplier, or beneficiary must first submit the claim to the primary payer.” Therefore: If the beneficiary was involved in an accident and no-fault

insurance is available, the beneficiary is responsible for filing a claim with the no-fault insurer.

If the beneficiary has filed a claim with the no-fault insurer, and has given the provider the name, address and necessary information regarding the no-fault insurer, then the beneficiary is being cooperative.

However, if the no-fault insurer is requesting additional information from the beneficiary and the beneficiary is not responding to those requests, the provider may opt to go

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Jurisdiction 6 – Part A

Answer to Presubmitted NGS Question 1: MSP

ahead and submit a conditional claim to Medicare, as long as 120 days have passed since the provider first billed the no-fault insurer. The provider should use an explanation code of ‘DA’ in the Remarks field along with the date the no-fault was billed.

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Jurisdiction 6 – Part A

Answer to Presubmitted Question 1: MSP

b) In this situation: If the provider billed but did not receive information from the

beneficiary regarding the no-fault insurer, the provider can go ahead and submit a claim to the no-fault insurer.

If the beneficiary has not provided information, but the provider finds sufficient information on the beneficiary’s MSP record at the common working file (CWF), the provider can submit a claim to the no-fault insurer.

If 120 days have passed and no payment or denial has been received, the provider can go ahead and submit a conditional claim to Medicare, using the 14 value code with zero amount, the 02 occurrence code with date of accident, a ‘C’ payer code with the name of the no-fault insurer, and a ‘DA’ explanation code along with the date the no-fault insurer was billed in the Remarks field.

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Jurisdiction 6 – Part A

MSP Resources www.NGSMedicare.com > Claims & Appeals > Claims> Medicare

Secondary Payer

CMS IOM Pub 100-05, Medicare Secondary Payer Manual, Chapter 5, Section 40.6.2

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/msp105c05.pdf

CMS IOM Pub 100-05, Medicare Secondary Payer Manual, Chapter 1, Section 10 and 20

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/msp105c01.pdf

CMS Fact Sheet: Medicare Secondary Payer for Providers, Physicians, Other Suppliers, and Billing Staff, ICN 006903 https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MSP_Fact_Sheet.pdf

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Jurisdiction 6 – Part A

Presubmitted NGS Question 2: Crossover

Question: Why does Medicare crossover to more than one payer? This creates credit balances for the provider.

Answer: The Coordination of Benefits Agreement (COBA) Program established a standard contract between CMS and other health insurance organizations that defines the criteria for transmitting enrollee eligibility data and Medicare adjudicated claim data for the purposes of coordinating benefits. In 2006, CMS consolidated the automatic or eligibility file-based crossover process under the Medicare Benefits Coordination and Recovery Center (BCRC). Medicare will cross over to all identified payers, with a cross-over agreement, to ensure that all Medicare claims are properly adjudicated for each beneficiary across all eligible payers

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0909.pdf

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Jurisdiction 6 – Part A

Crossover Resources

CMS Coordination of Benefits Agreement web page https://www.cms.gov/Medicare/Coordination-of-Benefits-and-

Recovery/COBA-Trading-Partners/Coordination-of-Benefits-

Agreements/Coordination-of-Benefits-Agreement-page.html

CMS Special Edition article SE0909 “Important Information

Regarding the Centers for Medicare & Medicaid Services

(CMS) National Claims Crossover Process”

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-

Network-MLN/MLNMattersArticles/downloads/SE0909.pdf

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Jurisdiction 6 – Part A

Presubmitted NGS Question 3: PO Modifier

Question: We have off-site provider based clinics. Do services ordered at an off-site provider based clinic but are performed at our hospital require a PO modifier? For example blood drawn at off-site clinic and sent to hospital lab to perform the actual test.

Answer: The determinative factor is whether or not the item or service is being paid through the OPPS. If an item or service is being provided by an applicable provider and is being paid through the OPPS, then the PO modifier should be applied.

For instance, a drug with an OPPS status indicator of “K” or a laboratory test that is packaged into an OPPS service should have the PO modifier applied.

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Jurisdiction 6 – Part A

Answer to Presubmitted NGS Question 3: PO Modifier

Answer, continued:

If a service is not paid through the OPPS, such as a laboratory test paid separately through the Clinical Laboratory Fee Schedule, it should not have the PO modifier applied.

Note that the Medicare Claims Processing Manual Chapter 4 20.6.11 was updated in July 2015 to read: “This modifier is to be reported with every HCPCS code for all outpatient hospital items and services furnished in an off-campus provider-based department a hospital.”

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Jurisdiction 6 – Part A

PO Modifier Resources

When service is not bundled Check Status Indicator (SI) for specific HCPCS code: https://www.cms.gov/Medicare/Medicare-Fee-For-Service-Payment/HospitalOutpatientpps/Addendum-A-and-Addendum-B-Updates.html

SI A = Services furnished to a hospital outpatient that are paid under a fee schedule or payment system other than OPPS, for example: Clinical Diagnostic Laboratory Services

• CMS FAQs https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/PO-Modifier-FAQ-1-19-2016.pdf

• CMS IOM 100-04, Medicare Claims Processing Manual, Chapter 4, Section 20.6.11: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/PO-Modifier-FAQ-1-19-2016.pdf

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https://www.cms.gov/Medicare/Medicare-Fee-For-Service-Payment/HospitalOutpatientpps/Addendum-A-and-Addendum-B-Updates.html

Jurisdiction 6 – Part A

Updates

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Jurisdiction 6 – Part A

CMS Medicare Administrative Contractors and New Recovery Audit Contractors

Medicare Administrative Contractors (MACs)

https://www.cms.gov/Medicare/Medicare-

Contracting/Medicare-Administrative-Contractors/Who-are-

the-MACs.html

Recovery Audit Contractors:

https://www.cms.gov/Research-Statistics-Data-and-

Systems/Monitoring-Programs/Medicare-FFS-Compliance-

Programs/Recovery-Audit-Program/index.html

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Jurisdiction 6 – Part A

Recovery Audit Contractor Regions

https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Downloads/Medicare-FFS-RAC-map-November-2016-clean.pdf

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Jurisdiction 6 – Part A

J6 Region Recovery Audit Contractor

Cotiviti, LLC

Awarded 10/31/2016

States: IL, MN, WI, NE, IA, KS, MO, CO, NM, TX, OK, AR,

LA, and MS

Website: http://www.cotiviti.com/RAC/Welcome

• http://www.cotiviti.com/cotiviti-healthcare/cms-rac-provider-resources

• Slides from recent educational sessions:

http://www.cotiviti.com/sites/default/files/docs/cms/workingwithcotiviti

-01072017.pdf

Email: RACInfo@Cotiviti.com

Telephone Number: 1‐866-360-2507

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Jurisdiction 6 – Part A

Region 5: Durable Medical Equipment and Home Health/Hospice Recovery Audit Program

Performant Recovery, Inc.

Awarded 10/31/2016

Nationwide for DMEPOS/HHA/Hospice

Website:

https://www.performantrac.com/PROVIDERPORTAL.aspx

Email: info@Performantrac.com

Telephone: 1‐866‐201‐0580

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Jurisdiction 6 – Part A

Upcoming Education Opportunities

J6 Part A Ask The Contractor (ACT) call

March 30, 2017 at 12 Noon CT (no preregistration)

• You may submit questions in advance; deadline: March 16

J6 Virtual Conference (must preregister)

May 2, 2017

Next In-person seminar: SNF CB

Tentative Date and location

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Jurisdiction 6 – Part A

Enhanced NGS Tool: Reason Code Look Up

New! Redesigned and expanded self-service

tool on www.NGSMedicare.com

Starting with Part A top 20 denial, RTP, reject reason codes

Will expand to cover most/all denial, RTPs, reject reason

codes

• Reason Code, Description, Provider Action to Correct, Tips to Avoid

Error, Related Resources

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http://www.ngsmedicare.com/

Jurisdiction 6 – Part A

Enhanced NGS Tool: Reason Code Look Up

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Jurisdiction 6 – Part A38

Enhanced NGS Tool:

NGS CERT Denial Reason Finder

Jurisdiction 6 – Part A

NGS Tools:

Reason Code Look Up & NGS CERT Denial Reason Finder

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Jurisdiction 6 – Part A

Coming Soon – “Look and Feel” Upgrade

When is this happening?

Estimated launch: 1st quarter 2017

What isn't changing?

Functionality

What will you see?

Refreshed visual design

Simplified, intuitive and consistent navigation

Revised logout process

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Jurisdiction 6 – Part A

Multifactor Authentication What is MFA?

Who is impacted?

All providers who utilize NGSConnex

When is this happening?

Estimated launch: 1st quarter 2017

What do you need to do now?

Verify User Profile email address

Email address must be unique to you

If applicable, update email address

My User Profile tab

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Jurisdiction 6 – Part A

Provider Enrollment Revalidation

Who All providers five years after initial enrollment or last revalidation

When Only when notified and before due date

Notices are mailed 2-3 months prior to due date

Unsolicited revalidation applications returned if received more than 6 months prior due date

What Verify entire Medicare enrollment record

Why Avoid payment hold or deactivation of Medicare billing privileges by

responding promptly

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Jurisdiction 6 – Part A

Provider Enrollment Revalidation

Check PECOS https://pecos.cms.hhs.gov/pecos/login.do

Check CMS website Information: https://go.cms.gov/MedicareRevalidation

Medicare Revalidation Look Up Tool: https://data.cms.gov/revalidation

Due date will display or “TBD” (To Be Determined) if not currently due

MLN Matters article SE1211

MLN Matters article SE1605

MLN Matters article SE1126

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Jurisdiction 6 – Part A

NGS You Tube Channel

https://www.youtube.com/user/NGSMedicare

Many helpful videos available: Examples Using Multi-Factor Authentication (MFA) in NGSConnex

Coming Soon - New and Improved NGSConnex

The New Medical Policy Center Experience

NGSConnex: How to Register a New User Account

NGSConnex: Credit Balance Reporting (Part A Only)

NGSConnex: How to check MSP Records

What is an Advance Beneficiary Notice of Noncoverage (ABN)?

The Usage of an Advance Beneficiary Notice of Noncoverage (ABN)

Includes links to “CMS Provider Minute” videos

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Jurisdiction 6 – Part A

CMS ICD-10 Resources

CMS has merged all up-to-date content from our

Road to 10 website to our main ICD-10 site:

cms.gov/ICD10 is your one-stop site for official

CMS ICD-10 resources

The Road to 10 site is being phased out with an

anticipated completion date of April 3.

Be sure to update all your bookmarks and links for

Roadto10.org to point to cms.gov/ICD10

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Jurisdiction 6 – Part A

National Uniform Billing Committee (NUBC)

• The Official UB-04 Data Specifications Manual is

available directly from the NUBC Web site at

http://www.nubc.org– The National Uniform Billing Committee (NUBC) maintains the

codes needed to complete the Form CMS-1450 (UB-04 claim)

and compliant X12N 837 institutional claim

– The NUBC is responsible for the design and printing of the UB-

04 form. The NUBC is a voluntary, multidisciplinary committee

that develops data elements for claims and claim-related

transactions, and is composed of all major national provider

and payer organizations (including Medicare)

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Jurisdiction 6 – Part A

Reminder: RARC & CARC Code Updates

Remittance Advice Remark Code (RARC) and

Claim Adjustment Reason Code (CARC) lists

Code updates are published three times per year: around

March 1, July 1, and November 1

• CARC and RARC lists are made available on the

Washington Publishing Company (WPC) website

http://www.wpc-edi.com/reference/

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Jurisdiction 6 – Part A

CERT A/B MAC Outreach & Education Task Force

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Jurisdiction 6 – Part A

CERT A/B MAC Outreach & Education Task Force

The goal of the A/B MAC Outreach & Education Task Force is to ensure consistent communication and education to reduce the Medicare Part A and Part B error rates.

A joint collaboration of the A/B MACs to communicate national issues of concern regarding improper payments to the Medicare Program.

Partnership to educate Medicare providers on widespread topics affecting most providers and complement ongoing efforts of CMS, the MLN and the MACs individual error-reduction activities within its jurisdictions

Disclaimer: The CERT A/B MAC Outreach & Education Task Force is independent from the CMS CERT team and CERT contractors, which are responsible for calculation of the Medicare fee-for-service improper payment rate.

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Jurisdiction 6 – Part A

CERT A/B MAC Outreach & Education Task Force

CMS works closely with the CERT A/B MAC Task Force and the CERT DME MAC Outreach & Education Task Force CMS has a web page dedicated to education developed by the CERT

A/B MAC Outreach & Education Task Force

• https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/CERT-Outreach-and-Education-Task-Force.html

NGS CERT Task Force Web Page Go to our website, https://www.NGSMedicare.com; in the About Me

drop down box, select your provider type and applicable state, click on Next, accept the Attestation. Choose the Medical Policy & Review tab, then choose CERT, the CERT Task Force link is located to the right of the web page.

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https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/CERT-Outreach-and-Education-Task-Force.htmlhttp://www.ngsmedicare.com/

Jurisdiction 6 – Part A

www.NGSMedicare.com > Medical Policy & Review > CERT >

CERT Task Force

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Jurisdiction 6 – Part A

https://www.cms.gov/outreach-and-education/medicare-

learning-network-mln/mlnproducts/providercompliance.html

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Jurisdiction 6 – Part A

Email Updates

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Subscribe to receive the latest Medicare information.

Jurisdiction 6 – Part A

Website Survey

This is your chance to have your voice heard—

click on “Yes, I’ll give feedback” when you see

this pop-up so NGS can make your job easier!

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Jurisdiction 6 – Part A

Medicare University

Interactive online system available 24/7

Educational opportunities available

Computer-based training courses

Teleconferences, webinars, live seminars/face-to-face

training

Self-report attendance

Website

http://www.MedicareUniversity.com

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http://www.medicareuniversity.com/

Jurisdiction 6 – Part A

Medicare University Self-Reporting Instructions

Log on to National Government Services’ Medicare

University

http://www.MedicareUniversity.com

• Topic = MN AAHAM/HFMA Meeting

• Medicare University Credits (MUCs) = 1

• Catalog Number = AA-C-03774

• Course Code = 17073OAJMR1

Visit our website for step-by-step self-reporting instructions

Click on the Education tab, then the Medicare University

Course List tab, click on the Get Credit link. This will open

the Get Credit for Completed Courses web page

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http://www.medicareuniversity.com/

Jurisdiction 6 – Part A

Continuing Education Credits

All National Government Services Part A and Part B

Provider Outreach and Education attendees can

now receive one CEU from AAPC for every hour of

National Government Services education received.

If you are accredited with a professional

organization other than AAPC, and you plan to

request continuing education credit, please contact

your organization not National Government

Services with your questions concerning CEUs.

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Jurisdiction 6 – Part A

Thank You!

Questions?

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