1

AAHAM

One-Day @ UF Health

Part A

May 17, 2019

Presented By

First Coast Service Options, Inc.

Provider Outreach & Education

Ursula Weaver

Provider Relations Representative

1

2

Disclaimer All Current Procedural Terminology® (CPT®) only copyright 2019 American Medical Association (AMA). All rights

reserved. CPT® is a registered trademark of the AMA. Applicable Federal Acquisition Regulation/Defense Federal

Acquisition Regulation Supplement restrictions apply to government use. Fee schedules, relative value units,

conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not

recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The

AMA assumes no liability for data contained or not contained herein.

The information enclosed was current at the time it was presented. Medicare policy changes frequently; l inks to the

source documents have been provided within the document for your reference. This presentation was prepared as a

tool to assist providers and is not intended to grant rights or impose obligations. Although every reasonable effort has

been made to assure the accuracy of the information within these pages, the ultimate responsibility for the correct

submission of claims and response to any remittance advice lies with the provider of services.

First Coast Service Options Inc. 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 l iability for the results or

consequences of the use of this guide. This presentation is a general summary that explains certain aspects of the

Medicare program, but is not a legal document. The official Medicare program provisions are contained in the relevant

laws, regulations, and rulings.

No portion or element of this presentation may be copied, in whole or in part, for profit -making purposes without the

express written consent of First Coast Service Options Inc.

First Coast Service Options Inc.'s attendance at this event does not constitute or imply endorsement, recommendation,

or favoring of any specific commercial products, process, or services by trade name, trademark, manufacturer, or

otherwise.

2

Agenda Items

Medicare updates

Review two Medicare Learning Network® (MLN®) Matters®

(MM) articles, one Special Edition (SE) article, and one

common working file (CWF) update

Medicare beneficiary identifier (MBI) Get it! Use it!

Secure Provider Online Tool (SPOT)

Advanced topics

Online resources

3

3

Learning Objectives

At the conclusion of today's session

you'll be able to Define Medicare changes and updates that can have an impact

on your facility

Review MBI implementation requirements

Discuss SPOT enhancements

Utilize online resources to be proactive in your day-to-day

operations

4

Medicare Updates

5

4

MM10983

CWF Provider Queries National Provider Identifier (NPI) and

Submitter Identification (ID) Verification

Effective: 04/01/19 Implementation: 04/01/19

Impacts direct data entry (DDE) users performing eligibility

queries via the CWF Part A eligibility screens

CWF will verify NPI against Provider Enrollment, Chain and

Ownership System (PECOS)

MM10983: https://www.cms.gov/Outreach-and-

Education/Medicare-Learning-Network-

MLN/MLNMattersArticles/Downloads/MM10983.pdf

6

MM11061

Independent Laboratory Billing of Laboratory Tests for End-Stage

Renal Disease (ESRD) Beneficiaries and the Sunset of the CB

Modifier

Effective: 07/01/19 Implementation: 07/01/19

CB modifier to bill separately for renal dialysis laboratory tests no

longer valid for independent laboratories

Claims with CB modifier on or after 07/01/19 returned to provider

(RTP’d)

List with tests subject to consolidated billing:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/ESRDpayment/Consolidated_Billing.html

MM11061: https://www.cms.gov/Outreach-and-

Education/Medicare-Learning-Network-

MLN/MLNMattersArticles/Downloads/MM11061.pdf

7

5

SE19007 (1)

Activation of Systematic Validation Edits for Outpatient Prospective

Payment System (OPPS) Providers with Multiple Service Locations

Impacts OPPS providers with multiple service locations

Requires all addresses, including off-campus, outpatient, and

provider-based departments be enrolled

Activation of edits will verify services are provided at Medicare

enrolled service facility locations

Ensure claims data matches provider enrollment information

Once activated, claims that do not exactly match will RTP

National testing has been conducted and results shared with

Centers for Medicare & Medicaid Services (CMS)

8

SE19007 (2)

Activation of Systematic Validation Edits for OPPS Providers with

Multiple Service Locations (cont.)

How you can prepare

Verify practice addresses in Provider Enrollment, Chain and

Ownership System (PECOS)

If any locations not in PECOS, submit CMS-855A

enrollment form to add locations

Ensure claims are submitted with practice location as listed in

Direct Data Entry (DDE)/PECOS (i.e., Road vs. Rd, Suite vs.

Ste etc.)

April 2019, practice location screen available in DDE

SE19007: https://www.cms.gov/Outreach-and-

Education/Medicare-Learning-Network-

MLN/MLNMattersArticles/Downloads/SE19007.pdf 9

6

SE19007 (3)

Previous information communicated

MM9613: https://www.cms.gov/Outreach-and-

Education/Medicare-Learning-Network-

MLN/MLNMattersArticles/Downloads/MM9613.pdf

MM9907: https://www.cms.gov/Outreach-and-

Education/Medicare-Learning-Network-

MLN/MLNMattersArticles/Downloads/MM9907.pdf

10

CWF Update

CWF Provider Inquiries for Medicare Beneficiary Eligibility Data

Beginning fall of 2019, individuals with CWF and HIPAA

Eligibility Transaction System (HETS) access will lose CWF

query access

Termination of CWF eligibility queries

Beginning July 1, message notifying users about lost access

displayed requiring acknowledgement before proceeding to

eligibility information

11

7

MBI

Get it! Use it!

12

New MBI: Get it! Use it!

SE18006: https://www.cms.gov/Outreach-and-Education/Medicare-

Learning-Network-MLN/MLNMattersArticles/Downloads/SE18006.pdf

Ask your patient for their card

If not received, have them contact 1-800-MEDICARE (1-800-

633-4227)

Sign into MyMedicare.gov to get their number or print their

official card

Use First Coast's portal lookup tool

Register for SPOT

Check remittance advice

Claims submitted with active Health Insurance Claim Number

(HICN) return MBI on remittance advice

13

8

Remittance Advice

October 2018 through transition

period When submitting claim using patient HICN, both HICN and MBI

will be returned on remittance advice

MBI will be in same place you currently get "Changed HICN"

835 Loop 2100, Segment NM1 (Corrected Patient/Insured

Name), Field NM109 (Identification Code)

Message field on eligibility transaction responses will indicate

when new Medicare card mailed to each person

Eligibility service provider can give you this information

14

Effective 01/01/20

Must use MBI on all claims With a few exceptions when you can use either the HICN or MBI

for fee-for-service claims

Appeals -- Use either HICN or MBI for claims appeals and

related forms

Claim status query -- Use HICN or MBI to check status of

claim

Span-date claims -- If "from date" is before end of transition

(12/31/19)

Use HICN for 11X-Inpatient hospital, 32X-Home health,

41X-Religious non-medical health care institution claims

15

9

MBI Information and Resources

CMS resources New Medicare cards web page

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

Card/index.html

New Medicare cards Open Door Forums

https://www.cms.gov/Medicare/New-Medicare-Card/Open-

Door-Forums.html

First Coast resources First Coast home page banner

https://medicare.fcso.com

MBI lookup in SPOT is here

https://medicare.fcso.com/SPOT_News/0408572.asp 16

SPOT

17

10

Getting Started

Two steps Getting started frequently-asked question (FAQ)

https://medicare.fcso.com/faqs/answers/241528.asp

Step 1

Create an Enterprise Identity Management (EIDM) account

Approver organization must be established with EIDM

Step 2

Complete your request for SPOT access

Request 'end user' access under organization

SPOT registration help Email: FCSOSpotHelp@fcso.com

Call: 855-416-4199 18

Approval Process

Organization provides approval to

additional users All new SPOT users access is managed by designated approver

within their organization

Responsible parties

Designated approvers

Back-up approvers

SPOT help desk is no longer responsible to add additional users

19

11

Profiles

SPOT users no longer add new

profiles Effective 03/22/19

SPOT approvers control this function

Existing user sub-profiles were transitioned to approvers with

same billing information

SPOT end-users request additional access to other

organizations from an approver

No longer create sub-profiles

20

Coming Soon 2019

3rd quarter View/print demand letters

Submit credit balance report

Request Internal Revenue Service (IRS)-1099 replacement

4th quarter Billed in error

Allow users to select adjustments for claim lines billed in

error

New look and feel for data reports

21

12

SPOT Resources

Join eNews https://medicare.fcso.com/Header/137525.asp

SPOT news https://medicare.fcso.com/SPOT_News/

SPOT help desk https://medicare.fcso.com/faqs/answers/255026.asp

Learning On Demand https://medicare.fcso.com/Header/137525.asp

04/10 – Gaining access to SPOT (A/B)

22

Advanced Topics

23

13

Topics of Concern

Incarcerated beneficiaries

Liability takebacks

24

Online Resources

25

14

First Coast Provider Website medicare.fcso.com

or medicareespanol.fcso.com

26

First Coast Resources

Processing issues https://medicare.fcso.com/Processing_issues_sortable/index.asp

Events calendar https://medicare.fcso.com/Events/139814.asp

27

15

Tallahassee: June 25-26 Registration open: June 25-26

https://medicare.fcso.com/Landing/0435030.asp

Tampa: August 20-21 Registration opening soon

Building a stronger Medicare community through education

Medicare Speaks 2019

28

CMS

www.cms.gov

29

16

CMS Resources

Hospital center https://www.cms.gov/Center/Provider-Type/Hospital-Center.html

Hospital OPPS https://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/HospitalOutpatientPPS/index.html

Transmittals https://www.cms.gov/Regulations-and-

Guidance/Guidance/Transmittals/index.html

30

Summary of Today's Topics

Today we have Defined Medicare changes that can have an impact on your

facility

Reviewed MBI implementation requirements

Discussed SPOT enhancements

Utilized online resources to be proactive in your day-to-day

operations

31

17

Question and Answer Session

What questions do you have?

32

Thank You for Participating

First Coast values your feedback Please complete your evaluation form and return it before

leaving

33

18

Acronym List

CMS The Centers for Medicare & Medicaid Services

CWF Common working file

DDE Direct data entry

EIDM Enterprise Identity Management

ESRD End stage renal disease

FAQ Frequently asked question

HETS HIPAA Eligibility Transaction System

HICN Health insurance claim number

HIPAA Health Insurance Portability and Accountability Act

ID Identifier

IRS Internal Revenue Service

34

Acronym List (Cont.)

MBI Medicare beneficiary identifier

MLN® Medicare Learning Network®

MM MLN Matters®

NPI National provider identifier

OPPS Outpatient prospective payment system

PECOS Provider Enrollment, Chain and Ownership System

RTP Return to provider

SE Special Edition MM article

SPOT Secure Provider Online Tool

35