Transcript Medicare Part B Winter Update
Medicare Part B Winter Update Palmetto GBA Provider Outreach & Education
Ohio / West Virginia February 2010
Disclaimer
This presentation was current at the time it was published or uploaded onto the Palmetto GBA Web site. Medicare policy changes frequently so links 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. The Centers for Medicare & Medicaid Services (CMS) 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 guide. This publication 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.
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Objectives
• Provide an overview of the Affordable Care Act of 2010 (ACA) • Discuss the Medicare Physician Fee Schedule (MPFS) • Review Medicare incentive programs • Provide an update on existing Medicare programs • Share Medicare Data • Provide Medicare references and resources Palmetto GBA - February 2011 3
Affordable Care Act of 2010
Maximum Period for Submission of Medicare Claims
Annual Wellness Visit with Prevention Plan
Elimination of Deductibles & Coinsurance for Preventive Services
Payment Reduction For Advanced Imaging Services (TC)
ACA
Physician Referral For Imaging Services
HPSA Surgery Incentive Payments (HSIP)
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Primary Care Incentive Payments (PCIP)
4
Affordable Care Act of 2010
Annual Wellness Visit (AWV) including Personalized Prevention Plan Services (PPPS) • Beginning 1/1/2011 • Frequency limitations – Payable after first 12 months of eligibility – 12 months since last physical exam • HCPCS codes G0438 and G0439 – Refer to coverage criteria for specific services included • Deductible and coinsurance do not apply www.cms.gov/MLNMattersArticles/downloads/MM7079.pdf
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Affordable Care Act of 2010
• Beginning 1/1/2011 for: – The “Welcome to Medicare” Physical* – Ultrasound Screening for AAA – Cardiovascular Disease Screening – Diabetes Screening – Medical Nutrition Therapy – Screening Pap and Pelvic – Screening Mammography – Bone Mass Measurement – Colorectal Cancer Screening* – Prostate Cancer Screening* – Flu/Pnuemo/Hep B Vaccines – HIV Screening – Smoking/Tobacco Cessation – Annual Wellness Visit www.cms.gov/MLNMattersArticles/downloads/MM7012.pdf
Palmetto GBA - February 2011 Elimination of Deductibles & Coinsurance for most Preventive Services 6
Affordable Care Act of 2010
• Effective for services 1/1/2011 – 12/31/2015 • Primary care specialties – Family, internal, geriatric and pediatric medicine – NPs, PAs and CNSs • Primary care services 60% of allowed Part B charges – CPT codes 99201 – 99215 – CPT codes 99304 – 99340 – CPT codes 99341 – 99350 • Eligibility based on 2009 claims data • 10% quarterly incentive – Paid in addition to HPSA www.cms.gov/MLNMattersArticles/downloads/MM7060.pdf
Palmetto GBA - February 2011 Primary Care Incentive Payment Program (PCIP) 7
Affordable Care Act of 2010
• Effective for services 1/1/2011 – 12/31/2015 • Surgical procedures with 10- or 90-day post op period • General Surgery specialty • Rendered in HPSA • HCPCS modifier AQ – Areas not identified as automatic HPSA • 10% quarterly incentive – Paid in addition to HPSA HPSA Surgery Incentive Payment Program (HSIP) www.cms.gov/MLNMattersArticles/downloads/MM7063.pdf
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Affordable Care Act of 2010
Physician Self-Referral of Certain Imaging Services • Effective 1/1/2011 • Provider of MRIs, CT and PET scans • Must provide patient with list of suppliers in area providing same service – Must be provided at time of referral – Include 5 suppliers – Name, address and phone number http://edocket.access.gpo.gov/2010/pdf/2010-27969.pdf
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Affordable Care Act of 2010
Payment Reduction on Technical Component (TC) of Advanced Imaging Services • Effective 1/1/2011 • Consolidation of imaging families • When two or more services furnished in a session • Full payment on TC of highest priced procedure • 50% payment on TC of each additional procedure www.cms.gov/MLNMattersArticles/downloads/MM6993.pdf
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Affordable Care Act of 2010
Maximum Period for Submission of Medicare Claims • Effective dates of service 1/1/2010 – Services must be submitted within one calendar year of the date of service • Dates of service prior to 1/1/2010 – must be submitted by 12/31/2010 • Services submitted outside of these timeframes will be denied www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf
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Affordable Care Act of 2010
Other provisions include
• Improvements to the Physician Quality Reporting System – Formerly known as
PQRI
• Medicare payment for Certified Nurse Midwife services increased to 100% of MPFS • Expand Round 2 of the DMEPOS Competitive Bidding Program metropolitan statistical areas (MSAs) – From 70 to 91 MSAs 12 Palmetto GBA - February 2011
MPFS
• 2011 Medicare Physicians Fee Schedule
• Medicare and Medicaid Extenders Act of 2010 – Stabilizes physician payments through 2011 • 0 percent update to physician fee schedule • CF must be changed to make RVUs budget neutral • 2011 dates of service expected to process with no delays – Includes funding to automatically adjust claims affected by the CF change • Dates of service 1/1/2010 – 5/31/2010 – Also includes the following to continue through 2011 • Exceptions process for outpatient therapy caps • Physician mental health add-on payment • Payment for TC of certain physician pathology services 13 Palmetto GBA - February 2011
2011 Deductible & Coinsurance 2010 Part A Premium Part A Deductible
$461 $1,100
Part B Premium Part B Deductible
$110.50
$155
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2011
$450 $1,132 $115.40
$162
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Medicare Incentive Programs
• Physician Quality Reporting System (PQRS) • Electronic Prescribing (eRx) • Electronic Health Records (EHR) Incentive Program Palmetto GBA - February 2011 15
PQRS
• CY 2011 Reporting – 1% Incentive Payment – Reporting Mechanisms for Individual EPs • Claims (at least 50% of patients seen) • Qualified Registry (at least 80% of patients seen) • Qualified EHR (at least 80% of patients seen) – Reporting Periods for Individual EPs • Jan. 1, 2011 - Dec. 31, 2011 • Jul. 1, 2011 - Dec. 31, 2011 (claims and registry-based reporting only) – Individual EPs may report individual PQRS measures or measures groups Palmetto GBA - February 2011 16
PQRS
• CY 2011 Reporting – 194 measures • 5 new measures for claims and registry reporting • 11 new registry-only measures • 4 new measures for EHR-based reporting only – 20 EHR measures – 14 measures groups • 1 new measures group (asthma) – New options for Group Practice Reporting • GPRO I for self-nominated groups with 200+ EPs • GPRO II (pilot) for self-nominated groups with <200 EPs • Information regarding PQRS Incentive Program – www.cms.gov/PQRI/ Palmetto GBA - February 2011 17
PQRS
• Additional .5% incentive available for 2011
– For the Jan 1, 2011-Dec 31, 2011 reporting period – Physicians who satisfactorily report PQRS measures if • The physician reports more frequently than is required or • Maintain board certification status - Participates in a Maintenance of Certification Program and - Successfully completes a qualified Maintenance of Certification Program practice assessment – Watch for more details once they are available!
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PQRS
• Informal Review Process – Mandated by the Affordable Care Act – EPs that did not meet PQRS requirements can request a review of the determination – Requests for an informal review must be emailed to the QualityNet Help Desk at [email protected]
• Within 90 days of the release of the EP’s 2011 feedback report – A written response will be provided within 60 days of receiving the original request.
• Public Reporting of PQRS Data – Mandated by MIPPA – Post names of EPs and group practices who satisfactorily report • 2011 information will be posted on the Physician Compare Web site • Available after the 2011 incentive payments made in 2012 Palmetto GBA - February 2011 19
eRx
• CY 2011 Reporting – 1% Incentive Payment • Not available to professionals receiving 2011 incentive from Medicare EHR Incentive Program • > 10% of EPs charges based on codes on next slide – Reporting Mechanisms for Individual EPs • Claims • Qualified registry • Qualified EHR – Reporting Period for Individual EPs • Jan 1, 2011- Dec 31,2011 – Group Reporting Options available for eRx • Must participate in GPRO I or GPRO II under PQRS Palmetto GBA - February 2011 20
eRx
• CY 2011 Reporting – EPs or group practices must have a qualified eRx system to participate – Report the eRx measure for at least 25 events • Numerator: HCPCS code G8553 – At least one prescription created during the encounter was generated and transmitted electronically using a qualified eRx system • Denominator: CPT codes 90801 90802 90804 90805 90806 90807 90808 90809 90862 92002 92004 92012 92014 96150 96151 96152 99201 99202 99203 99204 99205 99211 99212 99213 99214 99215 99304 99305 99306 99307 99308 99309 99310 99315 99316 99324 99325 99326 99327 99328 99334 99335 99336 99337 99341 99342 99343 99344 99345 99347 99348 99349 99350 G0101* G0108* G0109* CPT only copyright 2010 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use.
* Denotes HCPCS codes Palmetto GBA - February 2011 21
eRx
• CY 2012 eRx Payment Adjustment
– EPs or group practices who are NOT successful e-prescribers • 1% reduction in MPFS in 2012 – To avoid the payment adjustment • Report eRx code on at least 10 claims – Jan 1, 2011 through Jun 30, 2011 • Adjustment will not apply if <100 of the codes in denominator comprised of codes on previous slide – Those opting to participate in EHR Incentive instead must also report eRx code to avoid payment adjustment Palmetto GBA - February 2011 22
eRx
• CY 2012 eRx Payment Adjustment – Implementation of adjustment will depend on EPs taxonomy code in NPPES • Providers must verify that NPPES files are correct – EPs that do not have prescribing privileges • Report HCPCS code G8644 on one claim prior to Jun 30, 2011 – Hardship situation evaluated case by case • HCPCS code G8642 – The eligible professional practices in rural area with limited high speed internet access • HCPCS code G8643 – The eligible professional practices in an area with limited available pharmacies for electronic prescribing • EPs must report applicable HCPCS code to request exemption – Groups must submit request at self-nomination process Palmetto GBA - February 2011 23
eRx
• Public Reporting of eRx Data
– Mandated by MIPPA – Post names of EPs and group practices who satisfactorily report • 2011 information will be posted on the Physician Compare Web site • Available after the 2011 incentive payments made in 2012
• Information regarding the eRx incentive payment program
• www.cms.gov/ERXincentive/ 24 Palmetto GBA - February 2011
PQRS and eRx Help
• Contact the
QualityNet Help Desk
– How to begin participating – Accessing feedback reports – Explanation of feedback reports • 866-288-8912 • 7:00 a.m. – 7:00 p.m. CT M-F • [email protected]
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EHR
Electronic Health Records Incentive Program
– Promotes EHR through incentive payments for the “meaningful use” of certified electronic health records technology – Meaningful Use - DEFINED • Using Certified EHR Technology to – Improve quality, safety, efficiency, and reduce health disparities – Engage patients and families in their health care – Improve care coordination – Improve population and public health – While maintaining privacy and security 26 Palmetto GBA - February 2011
EHR
• The Medicare EHR Incentive
– Participation can begin as early as 2011 – EPs can receive up to $44,000 over a five-year period…more in HPSAs • To get maximum, participation must begin by 2012 – EPs that do not successfully demonstrate “meaningful use” will have an adjustment made to their Medicare reimbursement • Beginning 2015 • Reduction starts at 1% – Increases each year to maximum of 5% 27 Palmetto GBA - February 2011
EHR
CALENDAR YEAR First Year in which EP receives an EHR Incentive CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 and after
2011 $18,000 2012 $12,000 $18,000 2013 2014 2015 2016
MAX TOTALS
$8,000 $4,000 $2,000
$44,000
$12,000 $8,000 $4,000 $2,000
$44,000
$15,000 $12,000 $8,000 $4,000
$39,000
$12,000 $8,000 $4,000
$24,000
$0 $0
$0
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EHR – The Path to Payment
Attest for Incentive Payments Are you an Eligible Professional?
Be a Meaningful User www.cms.gov/EHRIncentivePrograms Medicare Or Medicaid?
Use Certified EHR Technology Get Registered Palmetto GBA - February 2011 Verify NPI and PECOS Enrollment 29
EHR – Important Dates
JAN APR MAY JUL SEP OCT NOV DEC FEB
•Reporting year begins for EPs (1/1/2011) •Registration for Medicare EHR program begins (1/3/2011) •Attestation for Medicare EHR program begins (4/2011) •EHR Incentive Payments expected to begin (5/2011) •Last day for eligible hospitals to begin their 90-day reporting period for the 2011 program (7/3/2011) •Reporting period ends for eligible hospitals (9/30/2011) •Last day for EPs to begin their 90-day reporting period for the 2011 program (10/1/2011) •Last day for eligible hospitals to register and attest to receive 2011 incentive payment (11/30/2011) •Reporting period ends for EPs (12/31/2011) •Last day for EPs to register and attest to receive 2011 incentive payment (2/29/2012) Palmetto GBA - February 2011 30
EHR
Reminder…
All providers must: – Register (select the
Registration
link on the EHR Web page) – Have an active NPPES account (and National Provider Identifier (NPI)) – Use certified EHR technology – Be enrolled in PECOS Additional Information: – www.cms.gov/EHRIncentivePrograms – Certification, certified EHRs, and other ONC programs designed to support providers: http://healthit.hhs.gov
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Existing Medicare Programs
• Medicare Administrative Contractors (MACs) • Recovery Audit Contractors (RACs) • ICD-10-CM • ANSI 5010 / 5010A1 • Ordered / Referred Services Palmetto GBA - February 2011 32
MAC Update
Medicare Administrative Contractors • Medicare work administered by MACs – 19 contracts to transition by October 2011 • 15 Part A/B, Home Health & Hospice contracts; 4 DME contracts • Jurisdiction 11 – Awarded to Palmetto GBA May 21, 2010 – Protest filed June 1, 2010 – GAO denied protest September 9, 2010 – Palmetto GBA to resume transition activities • Jurisdiction 15 – Awarded to CIGNA Government Services July 9, 2010 – Several protest filed against award decision – GAO decision expected by November 3, 2010 33 Palmetto GBA - February 2011
MAC Update
Jurisdiction 11 – Palmetto GBA • Operational date
– June 18, 2011
• Automatic registration for J11B e-mail updates • No need for new Electronic Funds Transfer (EFT) agreement if you are already enrolled • Watch for transition news!
– Meeting dates 34 Palmetto GBA - February 2011
www.PalmettoGBA.com/J11B Palmetto GBA - February 2011 35
MAC Update
Jurisdiction 15 – CIGNA Government Services • Operational date – June 18, 2011 • Preparing for Transition from Carrier to MAC – Special Edition MLN Matters ® article SE1017 • Identifies transition impact to providers • Includes pre- and post-cutover activities • Provides charts to help track dates of certain tasks www.cms.gov/MLNMattersArticles/downloads/SE1017.pdf
• Automatic registration for J15 e-mail updates • Watch for information on EFT agreements, Local Coverage Determinations (LCDs) and more!
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www.cignagovernmentservices.com/j15/ Palmetto GBA - February 2011 37
RACs
Recovery Audit Contractors
• Process applies to FFS Medicare • Claims reviewed post-payment (previously reviewed claims are excluded) • All RAC issues approved by CMS and posted on RAC Web sites
RAC for Ohio:
CGI Technologies and Solutions, Inc.
(877) 316-7222 e-mail: [email protected]
Web site: http://racb.cgi.com
RAC for West Virginia:
Connolly Consulting, Inc.
(866) 360-2507 e-mail: [email protected]
Web site: www.connolly.com/healthcare/Pages/CMSRA CProgram.aspx
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Current CMS-approved listing of services submit to RAC review
RACs
Type in applicable Claim Type Palmetto GBA - February 2011 39
RACs
Scroll through to find specific issues (or ‘Control / F’ to search keywords Current CMS-approved listing of services submit to RAC review Palmetto GBA - February 2011 40
RACs
• RAC Reminders – RAC “Blackout” Period • Occurs when Part A and/or Part B workload is transitioned to a (new) MAC contractor • RAC cannot request records 3 months before AND 3 months after a MAC transition (to a new MAC contractor) – Applies to OH (Part A and Part B) and WV (Part A) workloads – Does NOT apply to WV (Part B) workload – RAC “look-back” period • Claims paid on or after October 1, 2007 – Option when overpayment found • Pay by check • Allow recoupment (withholding) from future payments • Request an extended payment plan • File an appeal (if done timely, overpayment process delayed) Palmetto GBA - February 2011 41
ICD-10-CM
• New HIPAA standard for coding diagnoses – ICD-10-CM will replace ICD-9-CM Volumes 1 & 2 – ICD-10-PCS will replace ICD-9-CM Volume 3 • 14,025 ICD-9-CM codes versus 68,069 ICD-10 CM codes – Reduces need for extra documentation • Conducive to EHR and ANSI version 5010 • Mandated implementation date is October 1, 2013 42 Palmetto GBA - February 2011
ICD-10-CM
• ICD-10-CM has 3 – 7 digits – Alpha (not case sensitive) or numeric • Numbers 0 –9 are used • Letters O and I not used to avoid confusion with numbers 0 and 1 • More info: – General Equivalence Mappings (GEM) • Tool developed to assist with conversion from ICD-9 to ICD-10 • Also called a “crosswalk,” linking important information from one system to the other – CMS Web site: www.cms.gov/ICD10/ • Select
Educational Resources
for tools and guides • Complete ICD-10-CM and PCS systems –
Contacts & Resource
packet for quick reference tool Palmetto GBA - February 2011 43
ANSI Version 5010
• New HIPAA-mandated electronic format – Base version is ANSI 5010 – Errata version is ANSI 5010A1 • Compliance date established by final rule is January 1, 2012 –
ANSI 5010 will NOT be tested for Ohio providers
•
Testing will be conducted by CIGNA after the J15 cutover
–
ANSI 5010 WILL be tested for West Virginia providers
• •
After 5010A1 is loaded on April 4, 2011 Watch Web site for details
• Version 5010A1 is essential for use of ICD-10 44 Palmetto GBA - February 2011
ANSI Version 5010
• 5010 HIPAA Implementation Guides
– Professional (Part B) Electronic Claim (837P) – Electronic Remittance Advice (835) – Claim Status and Response (276 / 277) – Eligibility Inquiry and Response (270 / 271)
• Side-by-side comparisons (4010A1
5010)
– www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp
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Ordered / Referred Services
Ordering / Referring Providers Editing Process
• Specialties that can order / refer: Doctor of Medicine or Osteopathy Doctor of Dental Surgery Doctor of Optometry Physician Assistant Nurse Practitioner Certified Nurse Midwife Doctor of Dental Medicine Doctor of Podiatric Medicine Doctor of Chiropractic Medicine Certified Clinical Nurse Specialist Clinical Psychologist Clinical Social Worker 46 Palmetto GBA - February 2011
Ordered / Referred Services
Ordering / Referring Editing Process • Phase I (began October 2009) – Remark Code N264 on remittance advice • Missing/incomplete/invalid ordering provider name • Name is not an exact match with name as it appears in PECOS – Avoid unnecessary designations and initials, i.e., M.D., Jr.
– Submit hyphenated names only if noted in PECOS or on our files – Submit name in proper sequence – Remark Code N265 on remittance advice • Missing/incomplete/invalid ordering provider identifier – The NPI is not in PECOS – Physician reported cannot order/refer due to specialty – NPI submitted is for a group practice – not an individual • Phase II ( placeholder date: July 5, 2011 ) – Claims will be rejected • No ordering/referring NPI reported • Ordering/referring provider not in PECOS • Ordering/referring provider not of a specialty that can order/refer 47 Palmetto GBA - February 2011
Ordered / Referred Services
Ordering / Referring Providers
• Interns and Residents – Supervising physician must be identified as the ordering/referring physician • VA physicians – Must be enrolled in Medicare if they order/refer services for Medicare patients • MLN Matters ® articles: – MM6417: www.cms.gov/MLNMattersArticles/downloads/MM6417.pdf
– SE1011: www.cms.gov/MLNMattersArticles/downloads/SE1011.pdf
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Ordered / Referred Services
Ordering / Referring Providers • CMS file for NPIs/names of physicians/NPPs listed in PECOS *and* permitted to order/refer for Medicare – This file contain approximately 800,000 records • If a provider is not listed, please suggest that they revalidate • Separate file containing NPI and name of pending initial applications for physicians and NPPs • www.cms.gov/MedicareProviderSupEnroll/ – Select the
Ordering Referring Report
link • Job aid on how to verify PECOS enrollment – www.cms.gov/MedicareProviderSupEnroll/Downloads/Instructions forviewingpractitionerstatus.pdf
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Other Notables…
• Advance Beneficiary Notice of Non-Coverage (ABN) and Complex Medical Review – Effective January 12, 2011 – Claims in medical review that include an ABN – ABN will be reviewed for correctness when service denied for medical necessity • This is being done to establish financial responsibility – Review ABN information in not present an ABN to patient CARC 50 –
Contacts & Resources
– HCPCS modifier GZ: Effective 7/1/2011 • Provider expects service to deny for medical necessity but did • Claim lines will be denied contractual obligation (CO) with
These services are non-covered services because this is not deemed a ‘medical necessity’ by the payer
• These claims will not be subject to complex medical review Palmetto GBA - February 2011 50
Other Notables…
• Signatures on requisitions for clinical diagnostic lab tests – Effective January 1, 2011 – Physicians and non-physician practitioners • • • www.cms.gov/ClinicalLabFeeSched/ • CMS MLN Provider Compliance Educational Products – Created to inform providers how to avoid common billing errors and other improper activities www.cms.gov/MLNProducts/45_ProviderCompliance.asp
• New Home Health Certification Requirement – Effective with starts of care on or after January 1, 2011 – Certifying physician or NPP must document that she/he had a face-to-face encounter with patient www.cms.gov/MLNMattersArticles/downloads/SE1038.pdf
• Services Rendered in Place of Service ‘Home’ – Effective January 1, 2011 – Claim must include 5- (or 9-) digit Zip Code – Electronic (ANSI 5010 format) and paper claims Palmetto GBA - February 2011 51
Medicare Data
• Comprehensive Error Rate Testing • Top Denial Reasons • Top Rejections • Top Provider Phone Inquiries
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CERT
Comprehensive Error Rate Testing • Established to monitor the accuracy of payments made by Medicare FFS contractors • Goal: protect Medicare Trust Fund and promote correct coding • Outcomes used to identify educational needs • November 2010 report not available
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CERT
Hot issues: • Signatures in medical records
– Web article: Signature Logs and Attestations
• E/M services
– Documentation does not match submitted code: E/M Scoring Tools
• Documentation for ordered services
– “intent” not documented – Signature must meet Medicare guidelines 54 Palmetto GBA - February 2011
CERT
Reminders…
• The CERT Documentation Contractor is Livanta • The CERT Review Contractor is AdvanceMed • Respond to all requests within 75 days • Be sure to include the
complete
medical record • Return the original bar-coded page • Palmetto GBA is required by law to collect overpayments...and reimburse underpayments • It is not a HIPAA violation to send records • Utilize established Appeals process 55 Palmetto GBA - February 2011
CERT
Resources • CMS CERT Web page
– www.cms.gov/CERT/ • All published CERT reports from previous years
• CERT Documentation Contractor (CDC) Web page
– www.CERTProvider.org
• Sample CERT letters • Verify contact information with CDC 56 Palmetto GBA - February 2011
Top Denials
160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0
OH/WV Top Denial Reasons: Oct 2010 - Dec 2010
143,968 105,423 103,293 90,346 73,191 HMO MSP Not covered by chiro CCI 66,585 Entitlement Noncovered services Palmetto GBA - February 2011 57
Top CSEs
OH/WV Top Claim Submission Errors: Oct 2010 - Dec 2010
300,000 250,000 200,000 150,000 100,000 50,000 0 238,480 92,563 52,861 37,439 31,351 All Eligibility Errors All Provider Number Errors MSP - Missing Primary Payer Info Procedure Code Errors Invalid/Missing Modifier Palmetto GBA - February 2011 58
Top Phone Inquiries
OH/WV Top Phone Inquiries Oct 2010 - Dec 2010
16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 13,544 4,414 2,968 1,871 1,561 All Eligibility and Entitlement Rejected: CO Not Met Denials: Coding Err/ Modifiers Palmetto GBA - February 2011 Duplicates Staus / Explanation / Resolution 59
Online Provider Services (OPS)
627,467 Total Errors
Eliminate rejections, denials and questions related to: • Eligibility • MSP • Hospice • Home Health OPS provides
FREE
real-time information over the Web for the following online services: – Eligibility – Claims Status – Remittances – Financial Information Palmetto GBA - February 2011 60
Palmetto GBA - February 2011 Check details of your patient’s eligibility: Deductibles Preventive services eligibility dates Medicare Advantage plan enrollment Insurance primary to Medicare (MSP) Home Health dates Hospice dates Inpatient / Skilled Nursing Facility (SNF) 61
Online Provider Services (OPS)
Who Can Participate?
• Providers with an EDI Enrollment Agreement on file
– The EDI Enrollment Agreement is a form that is included in the EDI Enrollment Packet – – www.PalmettoGBA.com/boh (Ohio) www.PalmettoGBA.com/bwv (West Virginia) • Under
EDI / Enrollment
–
Reminder: there are Rules of Behavior for accessing eligibility information
» IOM 100-04, Chapter 31, Section 10.3
» www.cms.gov/manuals/downloads/clm104c31.pdf
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Online Provider Services (OPS)
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Other Web Tools
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Contacts & Resources
• Contacting Palmetto GBA • IVR Flowchart • Preventive Services Reference Guide • For Your Medicare Patients • Advance Beneficiary Notice of Non-coverage • MSP Type Indicators • Making the Internet Work for You!
•
Listserv Registration Form – see LAST page
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New ways to stay connected!
Social Networking
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Questions???
Please complete the evaluation!
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