sd mgma third party payer day medicare hot topics 2018 - south dakota state medical ... · 2019. 9....
TRANSCRIPT
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SD MGMAThird Party Payer Day
Medicare Hot Topics 2018 Part A/B Provider Outreach and Education
November 2018
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Disclaimer
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This information release is the property of Noridian Healthcare Solutions, LLC. It may be freely distributed in its entirety but may not be modified, sold for profit or used in commercial documents.
The information is provided “as is” without any expressed or implied warranty. While all information in this document is believed to be correct at the time of writing, this document is for educational purposes only and does not purport to provide legal advice.
All models, methodologies and guidelines are undergoing continuous improvement and modification by Noridian and CMS. The most current edition of the information contained in this release can be found on the Noridian website at https://med.noridianmedicare.com and the CMS website at https://www.cms.gov.
The identification of an organization or product in this information does not imply any form of endorsement.
CPT codes, descriptors, and other data only are copyright 2018 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
November 2018
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Agenda
• Hot topics – Medicare updates
• Part A/B– Noridian updates
• Educational corner– Resources and tools
3November 2018
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Medicare Updates
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CMS Patients Over Paperwork• Reduce administrative burden to improve customer
experience– https://www.cms.gov/About-CMS/story-page/patients-over-
paperwork.html• CMS efforts
– Proposed rule to lift unnecessary regulations, ease burden on providers
– Requests for information process, including progress in addressing comments
– Engaging customers through customer centered workgroups– Proposed and final rules to save money/reduce burden hours– Documentation simplification efforts– Other initiatives, Meaningful Measures initiative and
MyHealthEdata
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Medicare Beneficiary Identifier (MBI)New Medicare Card
• April 1, 2018– SSN replaced by new MBI– Cards issued by geographic
location
• Allowing new MBI?– Noridian will accept HICN or
MBI until December 31, 2019
• Learn more:– https://www.cms.gov/Medica
re/New-Medicare-Card/index.html
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Obtaining the MBI
• Ask beneficiary to bring in new insurance card• New secure web interface MBI look up tool• New remittance advice (RA) updates• Learn more:
– https://www.cms.gov/Medicare/New-Medicare-Card/Providers/Getting-MBIs.html
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MBI Beneficiary Promotional Materials for Providers
• CMS promotional materials • Tear-off pads/posters
– You’re Getting a New MedicareStill Waiting for Your New Card– Card– "10 Things to Know About Your New Medicare Card" handout
• CMS MBI Materials– https://www.cms.gov/Medicare/New-Medicare-Card/Outreach-
and-Education/Outreach-and-education.html– https://www.cms.gov/Medicare/New-Medicare-Card/Outreach-
and-Education/Products-to-share-with-beneficiaries.html
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Promotional Materials
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MBI Resources for Beneficiaries
• 1-800-Medicare– (1-800-633-4227)
• MyMedicare.gov– https://www.mymedicare.gov
– Card mailing status– View or print card
• Card must be mailed
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MBI Lookup Tool• Noridian Medicare Portal
(NMP)• Input values
– Select TIN, NPI, PTAN, Program
– Legal First/Last name– Date of Birth (DOB) – Social Security Number
(SSN)• No two beneficiaries will
have same MBI
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MBI Lookup Results
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Part A Remittance Advice (RA)
• October 1, 2018 RA provides MBI
• FISS– MID field/line 32 =
Medicare ID (HICN submitted)
– MBI field/line 66 = MBI• PC Print
– MID field = Medicare ID (HICN submitted)
– CORR MID= MBI
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Part B Remittance Advice (RA) • October 1, 2018 RA
provides MBI• MCS
– MID field = Medicare ID (HICN submitted)
– MBI field = MBI• MREP
– First line MID field = Medicare ID (HICN submitted)
– Second line MID field = MBI
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Noridian MBI Webpage
• Noridian Website– https://med.noridianmedicare.com
• Jurisdiction F• Medicare Part A/B• Browse by Topic
– Medicare BeneficiaryIdentifier (MBI)
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New 2019 Influenza Virus Vaccine Code
• Effective January 1, 2019– CR 10871
• 2019 influenza virus vaccine code – CPT 90689 – Not retroactive to August 1, 2018
• No claim will be accepted for CPT 90689 between DOS August 1, 2018 and December 31, 2018
• Payment allowance information CR 10914
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Provider Enrollment PECOS Process Change
• Effective October 1, 2018– CR 10845
• Provider enrollment certification statements may be uploaded into Provider Enrollment Chain and Ownership System (PECOS)
• Check the CR for signature requirement changes
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Supplemental Medical Review Contractor (SMRC)
• Noridian – New Contractor– Review claims to lower improper payment rates and
claim errors– Conduct nationwide medical review
• Part A• Part B• Durable Medical Equipment (DME)
– Notify CMS of improper payments and noncompliance of documentation requests
– May result in claim adjustments completed by MACs
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Unified Program Integrity Contractor (UPIC)
• Effective May 1, 2018• CMS selects “Qlarant Integrity Solution”• UPIC West
– Replaces Zone 1 and 2 for Zone Program Integrity Contractor (ZPIC)
• Purpose is to detect, prevent, deter, reduce and make referrals to recover fraud, waste and abuse
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Noridian Updates
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Noridian Call Center Triage Process
• POE does not accept claim inquiry calls or emails– Contact Provider Contact Center customer service
• Per CMS, specific rules for inquiries must follow triage process
• IOM 100-09, Chapter 6, Sections 30.1– http://www.cms.gov/Regulations-and-Guidance/
Guidance/ Manuals/ Downloads/com109c06.pdf• Insures proper tracking/monitoring of inquiries
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EDISS Ended Supportof Dial-up Modem Technology
• Noridian no longer supports dial-up modem functionally – Effective October 1, 2018
• Providers need to find alternative methods for connectivity– Network Service Vendors (NSVs)
• http://www.edissweb.com/cgp/news/modem.html
• Noridian and EDISS cannot assist with making decisions for your organization – Research within your facility to determine which NSV
will fit your needs
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Improved Noridian Websitehttps://med.noridianmedicare.com
Part A Part B
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Like What We’re Doing?
• Let us know what you like andwhat we can improve on– Jurisdiction F:
https://survey.foreseeresults.com/survey/display?cid=wtsU0tp0khBZxlUgcpcMxA==&sid=link-noridian-jf
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Noridian Site Tour
• High-level overview • Information• Part A site tour
– JF: https://med.noridianmedicare.com/web/jfa/help/site-tour
• Part B site tour– JF:
https://med.noridianmedicare.com/web/jfb/help/site-tour
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Provider Based Billing
• Poster available– Add facility logo
• Noridian website• Educational resources
– https://med.noridianmedicare.com/documents/10538/18067468/Provider-Based+Billing+Poster
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Medicare Eligibility/Entitlement Webpage
• Eligibility/entitlement information– Different patient eligibility – Entitlement types– Points of contact to request additional details and
status updates• Noridian Website
– Jurisdiction F– Part A/B– Browse By Topic– Claims
• Eligibility and Entitlement for Persons with Medicare
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Medically Unlikely Edit (MUE) Tool
• Part A/B providers aid in billing processes
• Enter CPT/HCPCS • MUE tool returns
frequency limitation as established by CMS
• Education & Outreach– Tools
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Global Surgery Date Calculator
• New Part A/B resource tool
• Providers enter surgery date – Receive 10-day and 90-
day post-operative period
• Learn More– Part B Global surgery
webpage– Education & Outreach
• Tools
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Noridian Medicare Portal (NMP)
• Quick link• Keep up to date • Notifications & updates
– https://www.noridianmedicareportal.com– Have new users?
• Get registered
• Functionality– Verify eligibility– Check claim status– Reopening– Submit an appeal
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Additional Documentation Inquiry
• ADR Information: https://www.brainshark.com/noridian/vu?pi=zH8zvFC7ezYOHfz0
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NMP Eligibility Denial Details
• Claim status - Related Inquiries– Medicare Secondary Payer (MSP)– Medicare Advantage/Health Maintenance Organization (HMO)– Hospice– Home Health– Entitlement (No Medicare coverage)– Date of Death
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Medicare Diabetes Prevention Program (MDPP) NMP Enhancement
• Part B only• NMP eligibility inquiry feature offers MDPP
details – Active, inactive, deductible and coinsurance
period• Provider registered as an MDPP ‘D1'
specialty type• Learn More
• https://med.noridianmedicare.com/web/jfb/topics/preventive-services/mdpp
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MDPP
• Part B Webpage• Core sessions,
beneficiary eligibility, provider requirements, HCPCS codes, documentation, reimbursement and more – https://med.noridianmedi
care.com/web/jfb/topics/preventive-services/mdpp
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Educational Corner
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Noridian Websitehttps://med.noridianmedicare.com
• Free site• Resources
– Jurisdiction F– Medicare Part A/B
• Browse By Topic• Browse By Specialty• Fees &News• Policies• Medical Review• Education & Outreach• Enrollment • Forms
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Part A/B Upcoming Webinars
• Earn CEUs• Webinars
– Part A• https://med.noridianmedicare.com/web/jfa/education/
training-events– Part B
• https://med.noridianmedicare.com/web/jfb/education/training-events
– After Hours Part A/B webinars• 7:00 PM CT
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Online Provider Education
• Education on Demand– View self-paced tutorials
at your convenience– Keep up to date/refresher
• Certificate emailed upon completion
• Learn more– Education & Outreach
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Social Media Growth
• Facebook– Noridian Jurisdiction F
• Give us a ‘Like' and ‘Follow' us to stay connected
• YouTube– https://www.youtube.com/channel/U
CcmjLoqW4RyRVjOYDxQCNtA
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Sign Up - Medicare News!
• Receive most recent Noridian/CMS news – MLNs are posted under Latest Updates– Tuesday/Friday – Simple/quick signup
November 2018 40
Located at the bottom of every page
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Ask the Contractor Teleconference
• ACT – Call in to ask question on any topic• Noridian staff available to answer• Part B Next call: November 14, 2018• No registration required• Call information
– Part B • https://med.noridianmedicare.com/web/jeb/education/act
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Collaboration with External Entities Form
• Form for Associations• Send to:
[email protected]– Subject line:
Collaboration Request
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Questions?
Thank you!