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
