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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
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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.
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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
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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
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Medicare Updates
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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
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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
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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)
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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
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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
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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
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MBI
Get it! Use it!
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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
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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
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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
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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
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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: [email protected]
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
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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
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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
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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)
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Advanced Topics
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Topics of Concern
Incarcerated beneficiaries
Liability takebacks
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Online Resources
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First Coast Provider Website medicare.fcso.com
or medicareespanol.fcso.com
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First Coast Resources
Processing issues https://medicare.fcso.com/Processing_issues_sortable/index.asp
Events calendar https://medicare.fcso.com/Events/139814.asp
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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
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CMS
www.cms.gov
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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
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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
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Question and Answer Session
What questions do you have?
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Thank You for Participating
First Coast values your feedback Please complete your evaluation form and return it before
leaving
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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
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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
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