Medicare Audit & Reimbursement Update
21
8/20/2018 1 Medicare Audit & Reimbursement Update Presented by Kim Hitzemann 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 Centers for Medicare & Medicaid Services (CMS) Web site at http://www.cms.gov .
Transcript of Medicare Audit & Reimbursement Update
8/20/2018
1
Medicare Audit &
Reimbursement Update
Presented by Kim Hitzemann
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 Centers for Medicare & Medicaid Services (CMS) Web site at http://www.cms.gov.
8/20/2018
2
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 event
Agenda
• General Organization Update and Contact Information
• MAC Jurisdictions
• PS&R Redesign and Cost Report Update
• HITECH
• Audit Issues
• Provider Based Determinations/Mid Build
• Other Topics/NGSConnex
• Q&A
8/20/2018
3
NGS J6 A&R Offices
• We now have one Audit & Reimbursement staff that serves all of the J6 providers.
• Gary Lukuc manages the team that works on desk reviews, audits and wage index.
• John Stoll manages an audit team and the team that works on Reimbursement activity including tentative settlements, interim rate reviews, Provider Based Determinations, etc.
• John and Gary report directly to Gene Nickerson.
Cost Report Mailing Address
• Street Address:National Government ServicesAttn: Cost Report UnitP.O. Box 9731Portland, ME 04104
FEDEX or courier only:National Government Services, Inc.Attn: Cost Report Unit2 Gannett DriveSouth Portland, ME 04106
8/20/2018
4
Lockbox for Checks
Mailing Address:National Government Services, Inc.
PO Box 809199
Chicago IL 60680-9366
Courier Address:US Bank
Attn: Lockbox No 809199
5635 South Archer Avenue
Chicago IL 60638
J6 A&R Mailing Address
National Government Services
8115 Knue Rd
Indianapolis, IN 46250
8/20/2018
5
Standard Mailboxes
Cost Report Filing
Cost Report Re-openings
Cost Report Appeals
Provider Based Determinations
PS&R
Hospice Caps
Part A Audit & Reimbursement:
NGS Subcontractors
• Kujawa & Batteau (Desk reviews and Audits)
• Medaccountants (Desk reviews and Audits)
• Figlozzi & Company (Desk reviews and Audits)
• Systematic Medical Billing & Credentialing (MSP Audits)
8/20/2018
6
Other Miscellaneous Contact
Information
Credit Balance
1-315-442-4287
Connex Submission
National Government Services, Inc.
Attn: ORU/Credit BalanceP.O. Box 6474
Indianapolis, IN 46206-6474
ERP
Fax: 414-459-6007
National Government Services, Inc.
ATTN: ORU Part A – ERS Requests
P.O. Box 809199
Chicago, IL 60680-9199
11
MAC Jurisdictions
8/20/2018
7
MAC Jurisdictions
• MAC J6 which includes the states of Wisconsin, Illinois, and Minnesota was awarded to NGS.
• MAC J6 Part A WI, IL, HHH transitioned on 7/13/13.
• MAC J6 Part A MN transitioned on 8/10/13
• MAC J6 Part B transitioned on 9/7/13
• CMS has slowed on super MAC transition.
• Under recent legislation contracts are going to be for up to 10 years instead of 5 years.
• CMS has extended NGS 2 years and 5 months for MAC J6. (Now through May 31, 2020.)
14
Jurisdictions for A/B MACs
8/20/2018
8
PS&R/Cost Report
Update
8/20/2018
9
PS&R Redesign
• The system which controls your PS&R user ID (formerly IACS) is EIDM.
• The internet address for accessing PS&R is included below. (https://psr-ui.cms.hhs.gov/psr-ui,
• PS&R Summary data can be requested on-line.
• PS&R detail can be requested on-line and will be sent via CD. First detail request is free.
Passwords
18
• Passwords that NGS encrypts files with can no longer be communicated via email.
• NGS associates will call providers with the password used.
• NGS letter accompanying PS&R detail reports instructs providers to call Lisa Beatty (414-877-0018) for the password.
8/20/2018
10
• 2018 IPPS final rule issued in August 2017, authorizes providers to file with an electronic signature effective for FYEs on/after 12/31/2017.
• Note: IPPS final rule does not change the authorized signatories (CFR §413.24(f)(4)(iv)(C))
• CMS released new MCR transmittals which support e-signature
19
Electronic Cost Report Signature
20
Electronic Cost Report Signature
8/20/2018
11
Medicare Cost Report
electronic Filing (MCReF)
22
MCReF –High Level System Overview
• A new application allows providers to electronically transmit (e-File) your MCR package Available as of 5/1/2018
• Usage is optional. Mail and hand-delivery remain filing options.
• Accessible by your EIDM PS&R Security Official (SO) and Backup Security Official (BSO)
• Your MAC will have access to e-Filed cost report materials
Medicare Cost Report electronic
Filing (MCReF)
8/20/2018
12
Advantages of MCReF for Providers
• Single easy to use webpage• One process for all providers via one submission
portal Available to all Part A providers regardless of MAC
• Beneficial to chain organizations which have providers at multiple MACs, and any time you change MACs
• Reduces confusion, delays, and time you spend on administrative processes
• Immediate feedback on the receivability of your MCR submission. 23
Medicare Cost Report electronic
Filing (MCReF)
MCReF Overview
• System Login: https://mcref.cms.gov• Access is controlled by EIDM. Restricted to EIDM
PS&R SO / BSO• Existing PS&R SOs / BSOs already have access. • Any organization without access to PS&R must
register a PS&R SO with EIDM.– Note: If you want to use MCReF, keep your EIDM SO and
BSO accounts in good-standing. Includes password updates and timely replacement of SOs.
– EIDM credential issues are not a valid reason for late MCR filing.
24
Medicare Cost Report electronic
Filing (MCReF)
8/20/2018
13
MCReF Additional Details
• Effective 7/2/2018, only 2 CMS-approved methods of MCR submission:– Electronic submission via MCReF
– Physical submission via mail or hand-delivery
• Providers will not receive an extension for system issues preventing e-Filing.
• Additional information is available on the CMS website including a video presentation. 25
Medicare Cost Report electronic
Filing (MCReF)
Common Cost Report Submission
Issues
• No signature on worksheet S or signature is not original
Recommend signing in blue ink
• The CD or thumb drive has an executable program to gain access to the files. We cannot open executable files.
• Multiple cost reports are filed in one package.
Include a cover letter identifying the different cost reports filed together.
• CD or thumb drive blank or broken
Include a cover letter with a POC so we can contact you.
8/20/2018
14
Common Cost Report Submission
Issues
• Incorrect Fiscal period; incorrect subunits included on CR – review your reminder
letter
• Filing late – results in payment suspension• File early – if cost report is rejected, will receive grace
period to re-submit prior to payment suspension being initiated
• Cost Report Receipt Date is date signed Worksheet S is received. Postmark date is used to determine interest
assessment for late-filed cost reports.
Amended Cost Report
Submissions
• Amended submissions require the same documents and follow the same acceptance process as initial submissions
• Amended cost reports should be filed on the most recent software version.
• Normally amended cost report requests are accepted if the desk review has not started.
8/20/2018
15
Audit Update
SSI Update
• FY 2015 SSI Published July 2017 by CMS
Held NPRs through wage index season to allow for any wage adjustments to be included in final package (similar approach as last year)
This also allowed any amended cost reports for S-10 revisions to be included in the NPR
Settlements due by October 2018 (90%) and April 2019 (10%)
8/20/2018
16
Letters going out to Providers
• A provider may request changes to the Medicare cost report data from the time of initial filing to be considered in the final settlement. All requested changes, unless directed otherwise, must be made by submitting an amended cost report. NGS will consider accepting the submission of an amended Medicare cost report so long as it is prior to the start the start of the desk review (i.e. when the Medicare auditor begins their audit analysis of the cost report filed data). An exception to this would be if CMS were to issue a subsequent deadline for specified cost report revisions
• To aid certain provider types on the projected deadline to amend, NGS may send an initial request letter
• A listing of providers along with the applicable due dates that have received the letters can be found out on our website under Cost Reports -> Amending Medicare Cost Reports Prior to Desk Review
Reopening's
• NGS continues to use a dedicated reopening team to review and process reopening requests.
• This has resulted in more consistency on reopening decisions throughout NGS.
• Reopenings or correspondence relating to reopenings can be submitted to NGS at the following mailbox. [email protected]
8/20/2018
17
Reimbursement
• Tentative settlements are completed within 60 days of acceptance.
• Interim rate reviews are completed twice a year for CAHs
• Requests for additional interim rate reviews should be rare and are generally done within 30 days of receipt. This can be delayed during high cycle periods.
Provider Based Attestations
• A request for Provider-Based status is voluntary.
• Submission in PECOS of the location is needed to begin the process. (Main provider’s name on attestation should match the PECOS record.)
• There are on campus and off campus provider based locations.
8/20/2018
18
Provider Based Attestations
• The financial operations of all locations of the organization must be integrated into the financial system of the main provider.
• A copy of the main provider’s chart of accounts and a copy of the main provider’s working trial balance are needed.
• All department cost centers are listed properly on the cost report.
• The clinic can be traced to an appropriate cost center on the cost report.
Provider Based Attestations
• The provider based facility is held out to the public as part of the main provider.
• When patients enter a provider based facility they are entering the main provider and billed accordingly.
• Beneficiary co-insurance policy must include information regarding providing the notice to the beneficiary’s authorized representative.
• Beneficiary co-insurance notice must include the estimate of actual cost for the visit.
8/20/2018
19
Calculators and Fee Schedules
• Providers can find pricing information for various Medicare rates including IPPS, OPPS, fee schedules by going to the link on our web site.
• The page is titled Fee Schedules and Pricers
• Can be timing issues with updates
• Most link to CMS Pricers
• Providers can check IPPS payments on DDE disclosure screen
Connex Provider Portal
8/20/2018
20
39
What is Connex?
• Secure web portal providers may use to deliver information and documentation to NGS.
• Currently in use by other NGS functions.– Claim status, Beneficiary eligibility, Financial
data, Provider demographics, order remittances
• More secure than shipping, no need to encrypt PHI/PII.
• Submission is instantaneous.
• Save shipping time and cost.
40
Two Way Connex
• Development for two way portal is under way.
• For those providers that are signed up for Connex all A&R correspondence can go through the portal once implemented.
• So for example interim rate letters, tentative settlements, adjustment reports and even final cost reports.
8/20/2018
21
Contact Information
• John Stoll, Audit & Reimbursement Manager 262-202-6053 [email protected]
• Kim Hitzemann, Audit & Reimbursement Lead
262-456-7122 [email protected]
Questions?
