NHIC Educational Outreach - ANCO On-Line
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Transcript NHIC Educational Outreach - ANCO On-Line
Welcome to
2006 Updates for ANCO
Presented by NHIC
Provider Education and Outreach
Representatives
January 2006
TMP-EDO-0006 Version 2.0
Fee Schedule Update
November, 2005 published fee schedule
Proposed change before Congressional
Congressional Action – Month end?
www.medicarenhic.com
Medicare Part B
Deductible
2006 Deductible: $124
NPI Enrollment
Choices
Web based application
Paper Application
Electronic file application
https://www.cms.hhs.gov
Chose
1 method only
NPI Transition Time Line
1-3-06 - 10-1-06
PIN only, or
PIN & NPI
10-2-06 – 5-22-07
PIN or NPI
5-23-07
NPI only
NPI Enumerator
Fox Systems, Inc.
1-800-465-3203 (NPI Toll-Free)
1-800-692-2326 (NPI TTY)
[email protected]
NPI Enumerator
PO Box 6059
Fargo, ND 58108-6059
NPI Information
Link from
Our website
National Provider Identifier
(NPI)
http://www.cms.hhs.gov/NationalProvIdent
Stand/ (NEW)
http://www.cms.hhs.gov/MedlearnMattersArticl
es/downloads/SE0528.pdf (NEW)
Medlearn Matters article SE0555 at
http://www.cms.hhs.gov/MedlearnMattersArticl
es/downloads/SE0555.pdf (NEW)
Surrogate UPIN Reporting
Surrogate UPIN # OTH000 will become
invalid as of April 1st, 2006
Claims will reject
Ordered or referred service must
contain a valid UPIN
UPIN Registry
http://www.upinregistry.com/
Appeals Changes
Redetermination
Reconsideration
as of January 1
Administrative Law Judge
Departmental Review Board
Federal Courts
Redetermination – First Level
No
Telephone Review
New form CMS 20027
www.cms.hhs.gov/forms/CMS2002
7.pdf
Written Redeterminations
Copy
of claim
Copy of Remittance Advice
Additional documentation
Pertinent claim information
Reopenings by Telephone
Correct clerical errors – Provider or Carrier
Dates of service entered incorrectly (i.e.,
09152003 instead of 09152004)
Units entered as 0001 instead of 0010
Dollars entered as 2.00 instead of
200.00 (only obvious errors; not just to
increase billed amount)
CMS Medicare Contractor Provider
Satisfaction Survey
• National in scope
• Gather provider’s opinions about
Contractor’s performance
• NHIC’s providers selected to
participate
CMS Medicare Contractor Provider
Satisfaction Survey
Notification packets sent out
Respond on-line, by mail or Fax
Respond by January 25,2006
Further Information:
http://www.cms.hhs.gov/MCPSS/
Recovery Audit Contractor (RAC)
Targets providers in CA, FL, NY
Goal: to identify overpayments and
underpayments
Two recovery audit contractors
MSP- Diversified Collections
Claim Review- PRG Shultz
Recovery Audit Contractor (RAC)
Letters requesting information
Address questions directly to RAC, not
NHIC
RAC has 60 days to review the
documentation
Resource: Medlearn Matters SE0565
http://www.cms.hhs.gov/MedlearnMattersA
rticles/downloads/SE0565.pdf
WEBSITE – www.medicarenhic.com
Join
our
Mailing
List
Reduce Paper RAs
Use ERA
Obtain software free from CMS
“Medicare Remit Easy Print”
http://www.medicarenhic.com/edi/download/mr
epsoftware_1005.htm
Medicare Secondary Payer
Can be billed electronically
Use appropriate fields
Claim will develop for primary RA if
needed
MSP Electronic Claim Submission
Primary payer name & address
Insured’s effective date & termination date
with primary payer
Primary payer allowed amount
Paid amount
Deductible amount
Coinsurance amount when applicable
Disallowed amount
Cost-containment amount when applicable
CR-3916 MSP Denial for Invalid
GHP
Updated MSP info by the Coordination of
Benefits Contractor
Re-process claims
1 year
Automatically