Arkansas Healthcare Financial Management Association Fall … · 2015-10-23 · 10/21/2015 1 Arkansas Healthcare Financial Management Association Fall Conference Novitas Solutions,

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Arkansas Healthcare Financial

Management Association

Fall Conference

Novitas Solutions, Inc.

Jurisdiction H

October 30, 2015

Disclaimer

� All Current Procedural Terminology (CPT) only are copyright 2014 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable Federal Acquisition Regulation/ Defense Federal Acquisition Regulation (FARS/DFARS) 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; 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.

� Novitas Solutions 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 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.

� Novitas Solutions does not permit videotaping or audio recording of training events.

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Novitas Solutions Education

� This education contains specific contractor guidance for providers in Medicare Administrative Contractor (MAC):

• Jurisdiction H (JH) include: Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas

� If you are not a provider in JH, please contact your Medicare contractor for specific guidance

Agenda

� Enrollment Basics for the Institutional Provider

� Processing the application

� Frequently Asked Questions (FAQs)

� Helpful Tips

� Resources

� Top Claim Submission Errors and Resolutions

� Comprehensive Error Rate Testing Program

� Important Updates and Reminders

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Objectives

� Review the enrollment guidelines for Institutional Providers

� Explain how to complete the enrollment application for Institutional Providers (CMS-855A)

� Provide resources and tips to assist providers in the enrollment process

• Assist you in recognizing the current top claim errors and providing you with suggestions on how to avoid them

• Understanding the importance of the Comprehensive Error Rate Testing program

Acronym List

Acronym Definition

AO Authorized Official

CFR Code of Federal Regulations

CHOW Change of Ownership

CMS Centers for Medicare & Medicaid Services

DBA Doing Business As

DO Delegated Official

EIN Employer Identification Number

EDI Electronic Data Interchange

EFT Electronic Funds Transfer

IRS Internal Revenue Service

LBN Legal Business Name

LLC Limited Liability Company

MAC Medicare Administrative Contractor

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Acronym List Continued

Acronym Definition

NPI National Provider Identifier

NPPES National Plan and Provider Enumeration System

PECOS Provider Enrollment Chain and Ownership System

PTAN Provider Transaction Access Number

SSA Social Security Administration

SNF Skilled Nursing Facility

SSN Social Security Number

TIN Tax Identification Number

Enrollment Basics for the

Institutional Provider

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Purpose of Institutional Providers

(CMS-855A)

� You will complete the CMS-855A application if you are a health care organization and you:

• Plan to bill Medicare for Part A medical services, or

• Would like to report a change to your existing Part A enrollment data:

� A change must be reported within 90 days of the effective date of the change; per 42 C.F.R. 424.516(e)

� Changes of ownership (CHOW) or control must be reported within 30 days of the effective date of the change

• Reactivating enrollment

• Revalidation activities

Who Should Complete the

CMS-855A Application

� Community Mental Health Center

� Comprehensive Outpatient Rehabilitation Facility

� Critical Access Hospital

� End-Stage Renal Disease Facility

� Federally Qualified Health Center

� Histocompatibility Laboratory

� Home Health Agency

� Hospice

� Hospital

� Indian Health Services Facility

� Organ Procurement Organization

� Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services

� Religious Non-Medical Health Care Institution

� Rural Health Clinic

� Skilled Nursing Facility

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How to Enroll as an Institutional

Provider

� Provider/Supplier completes CMS-855A application

• The provider will use an Employer Identification Number (EIN)

• National Provider Identifier (NPI) is required

• Send all required documentation with application:

� Copy of licenses, certifications and registrations

� Copy of federal, state or local business licenses, certifications and registrations required to operate a health care facility

� CMS-588 (Electronic Funds Transfer Authorization Agreement) with statement from bank confirming bank account information

State Survey Agency

� In addition to completing the 855A, institutional providers must contact their local State Survey Agency

• https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/downloads/state_agency_contacts.pdf

� Certain Home Health agencies may elect voluntary accreditation by a CMS-recognized Accrediting Organization in place of a State survey

• The State Survey Agency must receive notification

� CMS Regional Office makes final approval or denial determination for the enrollment application

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Institutional Provider- Additional

Required Documentation

� Copy of IRS Determination Letter� Attestation Statement (Exhibit 177 – FQHCs only)� Copy of HRSA Notice of Grant Award (FQHCs only)� Attestation Statement (Exhibit 130 and 131 – CMHCs only)� Forty Percent Rule Attestation Statement (CMHCs only)� Qualified Chain Provider letter (if applicable)� Organizational flowchart (if Section 5 is completed)� Copy(s) of all bills of sale or sales agreements (CHOWS,

Acquisition/Mergers, and Consolidations only)� Copy(s) of all documents that demonstrate meeting capitalization

requirements (HHAs only)� Copy of an attestation for government entities and tribal

organizations (if applicable)� Exhibits are located in the IOM Publication 100-07, Chapter 9,

Medicare State Operations Manual• http://cms.gov/Regulations-and-

Guidance/Guidance/Manuals/Downloads/som107c09_exhibitstoc.pdf

Additional Enrollment

Requirements

� Additional enrollment requirements for Part A Institutional Providers are located in the enrollment guide on the Novitas website

• http://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00004828

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Methods of Submitting

� There are two ways for providers/suppliers to submit the application:

• Internet-based Provider Enrollment Chain and Ownership System (PECOS) web

� https://pecos.cms.hhs.gov

• Paper application

� http://www.novitas-solutions.com/webcenter/spaces/MedicareJH/page/pagebyid?contentId=00004821

Implementation of Pay.gov

Application Fee Collection Process

Through PECOS

� Special Edition Article SE1130

• Revised 4/30/2014

� Key Points:

• Application fee of $553 for 2015

• Utilize Pay.gov to make electronic payment

• Website address

� https://pecos.cms.hhs.gov/pecos/feePaymentWelcome.do

� Reference

• http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1130.pdf

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Internet-based PECOS

� Internet-based PECOS can be used in lieu of the Medicare enrollment application (i.e., paper CMS-855) to:

• Submit an initial Medicare enrollment application

• View or change enrollment information

• Track enrollment application through the web submission process

• Add or change a reassignment of benefits

• Submit changes to existing Medicare enrollment information

• Reactivate an existing enrollment record

• Withdraw from the Medicare Program

• Submit a Change of Ownership (CHOW) of the Medicare-enrolled provider

Advantages of Internet-based

PECOS

� Faster than paper-based enrollment (45 day processing time in most cases, vs. 60 days for paper)

� Tailored application process means you only supply information relevant to YOUR scenario

� Gives you more control over your enrollment information

� Easy to check and update your information for accuracy

� Less staff time and administrative costs to complete and submit enrollment to Medicare

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Supporting Documentation

� If using Internet-based PECOS, all required documentation may be uploaded:

• Copy of licenses, certifications and registrations

• Statement from bank confirming bank account information or a voided check for EFT

• Copy of IRS Determination letter

• Copy of an attestation for government entities and tribal organizations (if applicable)

Mailing Address for Hardcopy

Applications

� Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas

Novitas Solutions Inc.

Provider Enrollment Services

P.O. Box 3095

Mechanicsburg, PA 17055-1813

� Revalidation

Novitas JH Provider Enrollment P.O. Box 44137 Jacksonville, FL 32231

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Processing the Application

Medicare Enrollment Application

for Institutional Providers (CMS-

855A)

� Medicare Enrollment Application for

Institutional Providers (CMS-855A)

• https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms855a.pdf

� Tutorial step by step guide

• http://www.novitas-solutions.com/webcenter/spaces/MedicareJH/page/pagebyid?contentId=00004873

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Application Form Checklist

� Review application before sending:

• Is the correct form being used

• Verify all of the correct fields were completed

• Is all required documentation enclosed/attached

• Be sure to print or type all information so it is legible

� Do not use pencil

� Blue ink is preferred

• Sign and date the application

� Submit the application with the original signature

Step 1 Receipt/Initial Screening

� Applications are:

• Received and date stamped

• Reviewed for specific criteria, if not met it is logged and returned with a letter stating reason

� Examples for a returned application

� Applications received more than 60 days in advance of the effective date

� An application is not needed for the transaction being requested

• A Document or Correspondence Control Number (DCN or CCN) is assigned

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Step 2 Review/Development

� CMS requires contractors to review each enrollment application in accordance with the IOM Publication 100-08, Chapter 15 and 42 CFR Part 491:

• If information is missing the provider will be contacted

• In most instances, missing information may be faxed

• A cover sheet will be included

� The cover sheet will advise if the information needs to be faxed or mailed

� Include the cover sheet with your response

Site Visits Required

� Site visits are conducted by MSM Security, LLC who also sub-contracts with Computer Evidence Specialists, LLC and Health Integrity, LLC

� Site visits are required for:

• Moderate level of categorical screening

� Community mental health centers

� Comprehensive outpatient rehabilitation facilities

� Hospice organizations

� Revalidating home health agencies

• High level of categorical screening

� Newly enrolling HHAs

� https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1520.pdf

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Step 3 Data Entered into PECOS

� Once your application is reviewed

• Internet-based PECOS Application

� Information submitted will be migrated to PECOS

• Paper Application

� Information will be entered in PECOS

Step 4 Tie-In Notice

� After a Medicare contractor has issued a recommendation for a Part A provider to CMS, the contractor relies on CMS to return the Tie-In/Tie Out notice to them in order to finalize processing:

• Can take upwards of 6-9 months to be finalized by the State/CMS

� Providers can check status by calling the State and/or Regional CMS office

� Recommendation letter should have a state agency number for easier contact

� Novitas cannot give status of review

• Contractor is required to complete processing within 21 days of receipt of CMS notification

� The remaining enrollment activities will be completed with the issuance of a welcome letter from Provider Reimbursement

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Step 5 Update Medicare Claims

Processing System

� Information is exported from PECOS and received in claims processing system

� Supplementary information is added to the file to ensure claims are processed correctly

Step 6 Issuance of Notification

� Notification letter (Welcome Letter), including reimbursement rates, will be issued after information has been entered into PECOS and the Medicare claims processing system

� The letter will provide valuable information regarding steps to take to begin submitting claims to Medicare

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Step 7 Finalization

� The accuracy of all Provider Enrollment Chain and Ownership System (PECOS) /supplementary information is verified in the claims processing system

� The provider can start submitting claims

• Separately enroll with Electronic Data Interchange (EDI) for submission of electronic claims


Deactivations

� Deactivations may occur if:

• A provider or supplier fails to report a change to information supplied on the enrollment application within 90 days of when the change occurred

• A provider or supplier fails to report a change in ownership or control within 30 calendar days

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Processing Timeframes for Paper

Applications

� Initial Enrollments, Revalidations and Reactivations:

• 60-210 calendar days from receipt

• 80% of applications will be processed within 60 – 80 calendar days

� Reassignments/Change Requests:


• 80% of applications will be processed within 60 calendar days

� Processing timeframes will vary contingent upon the number of development requests and whether or not a site visit is required:

• To help avoid delays ensure all sections of the enrollment applications are completed and any supporting documentation is provided

Processing Timelines for Internet-

based PECOS Applications

� Initial Enrollments, Revalidation, Reactivations:


• 80% of applications will be processed within 45 – 80 calendar days

� Reassignments and Change Requests:


• 90% of applications will be processed within 45 calendar days

� Processing timeframes will vary contingent upon the number of development requests and whether or not a site visit is required:

• To help avoid delays ensure all sections of the enrollment applications are completed and any supporting documentation is provided

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Fingerprint-Based Background

Check

� Special Edition Article SE1427

• Effective: August 6, 2014

� Key Points:

• Required for all individuals with a 5 percent or greater ownership interest in a provider or supplier that falls into the high risk category and is currently enrolled in Medicare or has submitted an initial enrollment application

• Conducted in phases

• 30 days to be fingerprinted

� Reference

• http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1427.pdf

Incorporation of Certain Provider Enrollment

Policies in CMS-4159-F into Pub. 100-08,

Program Integrity Manual (PIM), Chapter 15

� Change Request # 8901

• Effective: March 18, 2015

� Key Points:

• CMS may deny/revoke an enrollment application if:

� Drug Enforcement Administration (DEA) Certificate of Registration to dispense a controlled substance is currently suspended or revoked

� The ability to prescribe drugs has been suspended or revoked, and it is in effect on the date of the submission

� The pattern or practice is abusive or represents a threat to the health and safety of Medicare beneficiaries

� The pattern or practice of prescribing fails to meet Medicare requirements

� Reference

• http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8901.pdf

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Frequently Asked Questions

(FAQs)

Provider Enrollment FAQs

� FAQs can be found on the Novitas Website

• http://www.novitas-solutions.com/webcenter/portal/FAQs_JH/Frequently+Asked+Questions+(FAQs)

� Provider Enrollment FAQ Categories:

• Completing Paper CMS 855 Applications FAQs

• General Enrollment FAQs

• Provider Enrollment, Chain, and Ownership System (PECOS) Web FAQs

• Revalidation

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FAQ 1

� Am I required to designate a contact person on the enrollment application?

• Yes. Designating a contact person with whom Medicare can speak regarding information on the application will expedite the processing of the enrollment. The contractor should use the contact person listed in section 13 of the CMS-855 for all communications specifically related to the provider’s submission of a CMS-855 initial enrollment, change of information request, etc. All other provider enrollment-oriented matters shall be directed to the correspondence address. If the application is returned for any reason, it will be returned to the contact person listed.

FAQ 2

� Can I fax or e-mail my CMS-855 enrollment application?

• No. Since the CMS-855 enrollment application must contain an original signature, the enrollment form must be sent through the U.S. mail, FEDEX, or another direct mailing to Novitas Solutions

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FAQ 3

� Can I send additional information needed to process my CMS-855 enrollment form through email?

• No. While we can e-mail a letter to the contact person listed on the application explaining what is missing/required, we cannot accept a response to that letter via e-mail. The contact person will receive instructions how to respond to our request.

FAQ 4

� Can I use a stamp to sign my CMS-855 enrollment form?

• No. An original signature must always be present when the application is initially submitted. Copies of the signature or stamped signatures are not acceptable on initial submissions. In addition to an original signature, the signature must also be dated.

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Helpful Tips

Internet-based PECOS Signature

Submissions

� Two options for completing certification statement signatures when submitting application via PECOS:

• Electronic Signature

� Allows the provider or Authorized/Delegated Official to electronically sign

� Faster application submission resulting in an earlier effective date

• Hardcopy Certification Statement

� After “Submission Receipt” page appears, print the 2-page Certification Statement

� Sign, date, and mail to the MAC

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How to Access Development

Letters/Correspondence Emailed

from Provider Enrollment

� Email address provided on the CMS-855A application is used for the development letter:

• Sent in secure email using IronPort technology

• Email sent from [email protected]

� Automated email box therefore do not send reply via this email address

� First time email is sent for development, the provider must register before retrieving any secure messages

� Follow registration link and complete required fields

� Registration link is valid for only 10 days.

Physician-Owned Hospitals

� Physician-owned hospitals seeking to comply with whole hospital or rural provider exceptions to the physician self-referral law must submit an annual report containing detailed description of specific ownership and investment information

� Hospitals requesting an exception may submit request: • Electrically to [email protected]

� Hospital must also submit an original hard copy of the required certification

• Mail original and one copy of request to:� Centers for Medicare & Medicaid Services

7500 Security Boulevard

Mailstop C4-25-02, ATTN: Physician-Owned Hospital Exceptions

Baltimore, MD 21244-1850

� For more information• http://www.cms.gov/Medicare/Fraud-and-

Abuse/PhysicianSelfReferral/Physician_Owned_Hospitals.html

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Resources

Form Location and Tutorials

� Enrollment Application for Institutional Providers (CMS-855A)

• http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855a.pdf

• Tutorial step by step guide


� CMS-588 Electronic Funds Transfer Authorization Agreement (CMS-588)

• http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS588.pdf

• Tutorial step by step guide


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Provider Enrollment Status Inquiry

Tool

� Enrollment Status Tool


Resources

� Novitas Solutions Enrollment Center • http://www.novitas-solutions.com/webcenter/spaces/Enrollment_JH

� Novitas Solutions Podcast Series• http://www.novitas-

solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00083399

� Internet Only Manual, Medicare Program Integrity Manual, Publication 100-08, Chapter 15

• http://www.cms.gov/manuals/downloads/pim83c15.pdf

� Medicare Provider/Supplier Enrollment• http://www.cms.gov/MedicareProviderSupEnroll

� Medicare Enrollment and Submission Guidelines• http://www.cms.gov/Outreach-and-Education/Medicare-Learning-

Network-MLN/MLNProducts/downloads/MedicareClaimSubmissionGuidelines-ICN906764.pdf

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Additional Resources

� The Basics of Medicare Enrollment for Institutional Providers

• http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MedEnroll_InstProv_FactSheet_ICN903783.pdf

� Internet Only Manual, State Operations Manual, Publication 100-07

• http://cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS1201984.html?DLPage=1&DLSort=0&DLSortDir=ascending

� Internet-based PECOS

• https://pecos.cms.hhs.gov

� National Plan and Provider Enumeration system (NPPES)

• https://nppes.cms.hhs.gov/NPPES/Welcome.do

Top Claim Submission Errors

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Reason Code 30940

� Description:

• A provider is not permitted to adjust a partially or fully medically denied claim

� Resolution:

• If the line(s) is found to be altered (even accidentally altered)

• If using DDE for claim submission, the RTP claim will need to be suppressed and resubmitted

• If the claim is submitted electronically and the provider has access to DDE a new adjustment can be submitted through FISS (DDE)

• If the provider only has access to electronic submission and no access to DDE cancel the original claim and rebill

� Claims can only be referred to processing in the following scenarios:

• If the adjustments are Medicare Secondary Claims (MSP)

• If the original claim does not have any medical denials

Reason Code 39011

� Description:

• The claim in question was not filed in a timely manner

� Resolution:

• Verify the timely filing requirements for Medicare claims and resubmit accordingly. Please remember failing to file a claim in a timely manner is not grounds for an appeal. You can review the timely filing guidelines at the links provided below

� Reference:


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Reason Code 17712

� Description:

• The attending physician National Provider Identifier (NPI) must not be the same as the billing provider’s NPI

� Resolution:

• Verify, correct, and resubmit

Reason Code 12206

� Description:

• The sum of covered and noncovered days does not equal the days calculated between the statement covers ''From' and 'Through' date

� Resolution:

• Verify the covered and noncovered days, the statement covers 'From' and 'Through' dates and patient status

• If patient status code 30 is reported, add an additional day

• Please correct and resubmit

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Reason Code 19301

� Description:

• When billing Revenue Codes 36x, 45x, or 76x on bill type 11x or 13x filed with a principle procedure, an operating physician NPI, last name, and first initial are required

� Resolution:

• When billing Ambulatory Surgical Center /surgical procedures, an operating physician is required on your claim

• Ensure the last name, and first initial are included along with the NPI number

• To find an NPI number, visit the following website

� https://nppes.cms.hhs.gov/NPPESRegistry/NPIRegistryHome.do

Reason Code 30905

� Description:

• An incoming adjustment claim is submitted and the original claim cannot be found

� Resolution:

• Verify that the first two positions of the type of bill, provider number, admit date, from date, and Health Insurance Claim (HIC) Number of the adjustment claim is identical to those fields on the original claim

• Please correct and resubmit

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Reason Code 38038

� Description:

• An outpatient claim is billed for the same date of service for the same provider number

� Resolution:

• Verify the service date and services in question

• If a 12x ancillary claim has been billed, ensure only services not billable on a 12x TOB are included on the 13x TOB

� For example, emergency room charges with Revenue Code 0450

Reason Code 15202

� Description:

• For inpatient or skilled nursing facility claims, the number of “covered days” on page one of the claim, must equal the number of accommodation units associated with accommodation revenue codes on page two of the claim

� Resolution:

• Verify the information in the Health Insurance Query Access (HIQA) or HIPAA Eligibility Transaction System (HETS) file for the most current benefit days available

• Make sure the covered days on page one of the claim equal the covered accommodation units on page two and non-covered days on page one of the claim equal the non-covered accommodations on page two

• Make necessary corrections and resubmit the claim

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Reason Code 38119

� Description:

• A Skilled Nursing Facility (SNF) claim or a Non-Prospective Payment System (PPS) Inpatient claim has been submitted

• The statement covers from date is greater than the admission date and there is no claim pending with a through date one day less than this claim from date

� Resolution:

• SNF and Non-PPS providers are required to bill in sequential order. This claim cannot process until the prior claim(s) is processed

• Resubmit this claim once the previous month’s claims have processed

Reason Code 32061

� Description:

• The dates of service on the claim overlap the fiscal year end date

� Resolution:

• Verify the “From” and “Through” dates on the claim, your fiscal year end date and that the patient status is correct

• Correct and resubmit

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Comprehensive Error Rate Testing

(CERT) Program

Comprehensive Error Rate Testing

(CERT)

� Program developed by CMS to monitor the accuracy of claims processing

� Designed to protect the Medicare trust fund and determine error rates nationally and regionally

� Random audits conducted on a monthly basis

� AdvanceMed request medical records for claims selected as part of the monthly random sample

� Medical record documentation supporting claim must be returned in designated time frame

� JH CERT page

• http://www.novitas-solutions.com/webcenter/spaces/CERT_JH

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Part A Common Errors

� Insufficient documentation:• Missing valid physician’s order• Missing documentation to

support minimum 15 hours per week of combined therapy

• Diagnosis insufficient to support procedure or service billed

• Missing Skilled Nursing Facility (SNF) 3 day qualifying stay

• Missing or illegible documentation and/or physician signature

• No valid certification for therapy services

� Medical necessity errors:• Documentation did not support

inpatient stay

� Other errors:• Incorrect Diagnosis Related

Group (DRG) billed• Discharge disposition code• Resource Utilization Group

(RUG)• Laboratory services billed

incorrectly• Debridement codes

CERT Appeals vs. Claim

Adjustments

� Providers may not cancel or adjust claims selected in the CERT review process

� Notify CERT if an error has been made on a claim, do not cancel or adjust claims

� Novitas initiate adjustments for necessary denials

� CERT adjustments in FISS appear as XXH Bill Type

� Appeal denials on XXH Bill Type as a means of submitting corrections to claims using the Medicare Part A Redetermination Request Form

� JH Article:


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Important Updates and

Reminders

ICD-10 Implementation

� Free assistance and advice:

• Providing ICD-10 and ICD-10-PCS coding advice

• Does not replace learning how to code

• www.codingclinicadvisor.com

� ICD-10 billing tips:

• Use ICD-10 codes with dates of service on and after October 1, 2015

• Use proper qualifiers on the proper codes- ICD-10 qualifiers (ABK/ABF)

• May not use ICD-9 codes with dates after 10/1/15

• Bill separate claims for September and October dates of service

� CMS ICD-10 Implementation Page

• http://www.cms.gov/Medicare/Coding/ICD10/index.html

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Increasing Your Bottom Line: How

Much Does Rework Cost?

� Cost savings for providers by reducing the need for Clerical Error Reopening requests:

• Correct minor errors

• Omissions of claim specific information

� Education Initiatives:

• Articles published to assist with proper use of specific modifiers

� New Web page dedicated to help you reduce rework and increase your bottom line:

• http://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00092539

New Investigational Device

Exemption (IDE) Submission

Process

� Fax IDE application packets to Novitas at 410- 891-5231

� Hard copy application packets sent via mail will no longer accepted

� To obtain status of IDE application, send an e-mail to:

• [email protected]

• Responses within 10 business days

� For more information:

• http://www.novitas-solutions.com/webcenter/spaces/MedicareJL/page/pagebyid?contentId=00080346

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Policy Search Application

� Updated customized “Policy Search Application”:

• Current, retired or draft policies

• ICD-9 LCDs and Articles

• ICD-10 LCDs and Articles

• National Coverage Determinations (NCDs)

� Gives more search power, more accurate results, the new options allows for search by date of service

� Search results only return policies based on search criteria entered

� JH Policy Search:

• http://www.novitas-solutions.com/webcenter/spaces/MedicareJH/page/LcdSearch

Novitas is Now Accepting Part A

Appeal Request Forms by Fax

� Faxing Part A Redeterminations/Clerical Reopening requests:

• Available 24 hours, 7 days a week , fax 1-888-541-3829

• On-line form available- Part A Redetermination and Clerical Error Reopening (Form 1000)

• Submit one form for each claim in question

• Do not copy the form

• Do not submit more than 1,500 pages per fax

� JH online tutorial available:


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Stay Up-to-Date

� Visit our website at http://www.novitas-solutions.com

� E-mails of the latest Medicare Updates

� Podcasts

� Educational Videos and Tutorials

� Calendar of Events

Website Satisfaction Surveys

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Centers for Medicare & Medicaid

Services (CMS)

� The CMS website offers valuable resources such as

• CMS Internet Only Manuals (IOMs)

• Medicare Learning Network (MLN) Matters Articles

• Open Door Forum

• http://www.cms.gov/

Summary

� Discussed and reviewed the enrollment guidelines for Institutional Providers

� Explained how to complete the enrollment application for Institutional Providers (CMS-855A)

� Gave valuable resources and tips to assist providers in the enrollment process

� Recognize common claim errors

� Learn how to resolve claim submission errors

10/21/2015

39

Provider Outreach & Education

Contact Information

Denise Church

Provider Outreach and Education [email protected]

Gregory Hart

Jurisdiction H Provider Outreach and Education [email protected]

Tanya Brooks

Jurisdiction H Provider Outreach and Education [email protected]

Thank you for your participation!

Documents

Arkansas Healthcare Financial Management Association Fall … · 2015-10-23 · 10/21/2015 1 Arkansas Healthcare Financial Management Association Fall Conference Novitas Solutions,