NOTE: Should you have landed here as a result of a search ... your password. Multi-factor Authentication (MFA) can help your eServices account remain secure even if someone manages

NOTE Should you have landed here as a result of a search engine (or other) link be advised that these files contain material that is copyrighted by the American Medical Association You are forbidden to download the files unless you read agree to and abide by the provisions of the copyright statement Read the copyright statement now and you will be linked back to here

PART B MEDICARE ADVISORY Latest Medicare News for Part B

Whatrsquos Inside Administration

CMS Quarterly Provider Update 3 Going Beyond Diagnosis 3 eServices News 4 eAudit to Generate Reports for Claims under Complex Medical Review 5 Changes for KEPROrsquos Quality of Care Reviews 6 Get Your Medicare News Electronically 6 Medicare Participating Physicians Directory (MEDPARD) 8 Action Needed Due to Increased CMS Security Requirements eServices Portal Users

Must Sign Up for Multi-Factor Authentication (MFA) by July 1 2017 9 Qualified Medicare Beneficiary Indicator in the Medicare Fee-For-Service Claims

Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure to Processing System 12

Procedure (PTP) Edits Version 231 Effective April 1 2017 14 New Common Working File (CWF) Medicare Secondary Payer (MSP) Type for Liability

Medicare Set-Aside Arrangements (LMSAs) and No-Fault Medicare Set-Aside Arrangements (NFMSAs) 16

Drugs and Biologicals Implementation of New Influenza Virus Vaccine Code 18

Education Educational Events Where You Can Ask Questions and Get Answers from Palmetto GBA 20

Fee Schedules and Reimbursement Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) -

April CY 2017 Update 22

Medicine Medicare Outpatient Observation Notice (MOON) Instructions 24 ICD-10 Coding Revisions to National Coverage Determination (NCDs) 29

Continued gtgt

palmettogbacomJMB

The Part B Medicare Advisory contains coverage billing and other information for Part B This information is not intended to constitute legal advice It is our ofϐicial notice to those we serve concerning their responsibilities and obligations as mandated by Medicare regulations and guidelines This information is readily available at no cost on the Palmetto GBA website It is the responsibility of each facility to obtain this information and to follow the guidelines The Part B Medicare Advisory includes information provided by the Centers for Medicare amp Medicaid Services (CMS) and is current at the time of publication The information is subject to change at any time This bul-letin should be shared with all health care practitioners and managerial members of the provider staff Bulletins are available at no-cost from our website at httpwwwPalmettoGBAcomJMB

CPT only copyright 2016 American Medical Association All rights reserved CPT is a registered trademark of the American Medical Association Applicable FARSDFARS Restrictions Apply to Government Use Fee schedules relative value units conversion factors andor related components are not assigned by the AMA and are not part of CPTreg 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 Code on Dental Procedures and Nomenclature is published in Current Dental Terminology (CDT) Copyright copy 2016 American Dental Association (ADA) All rights reserved

March 2017 Volume 2017 Issue 3

Laboratory Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory

Improvement Amendments (CLIA) Edits 31 Clinical Laboratory Fee Schedule ndash Medicare Travel Allowance Fees for Collection of Specimens 34

Ophthalmoscopy Ophthalmoscopy Reminders 36

Therapy Services Updated Editing of Professional Therapy Services 37

Etcetera MLN ConnectsTM 42

CMS Provider Minute Videos The Medicare Learning Network has a series of CMS Provider Minute Videos (httpswwwcmsgovOutreach-and-EducationMedicareshyLearning-Network-MLNMLNProductsMLN-Multimediahtml) on a variety of topics such as psychiatry preventive services lumbar spinal infusion and much more The videos offer tips and guidelines to help you properly submit claims and maintain suffi cient supporting documentation Check the site often as CMS adds new videos periodically to further help you navigate the Medicare program

CPT codes descriptors and other data only are copyright 2016 American Medical Association (or such other date of publication of CPT) All Rights Reserved Applicable FARSDFARS apply Current Dental Terminology fourth edition (CDT) (including procedure codes nomenclature descriptors and other data contained therein) is copyright by the American Dental Association copy2016 American Dental Association All rights reserved Applicable FARSDFARS apply

2 32017

CMS Quarterly Provider Update

The Quarterly Provider Update is a comprehensive resource published by the Centers for Medicare amp Medicaid Services (CMS) on the first business day of each quarter It is a listing of all non-regulatory changes to Medicare including program memoranda manual changes and any other instructions that could affect providers Regulations and instructions published in the previous quarter are also included in the update The purpose of the Quarterly Provider Update is to

bull Inform providers about new developments in the Medicare program bull Assist providers in understanding CMS programs and complying with Medicare regulations and instructions bull Ensure that providers have time to react and prepare for new requirements bull Announce new or changing Medicare requirements on a predictable schedule bull Communicate the specific days that CMS business will be published in the lsquoFederal Registerrsquo

To receive notification when regulations and program instructions are added throughout the quarter sign up for the Quarterly Provider Update listserv (electronic mailing list) at httpspublicgovdeliverycomaccountsUSCMSsubscribernewpop=tampqsp=566

We encourage you to bookmark the Quarterly Provider Update Web site at wwwcmsgovRegulations-and-GuidanceRegulations-and-PoliciesQuarterlyProviderUpdatesindex html and visit it often for this valuable information

Going Beyond Diagnosis Preventing Payment Errors by

Improving Provider-Payer Communication A failure to communicate is the number one cause of Medicare claims denials Palmetto GBArsquos Going Beyond Diagnosis (GBD) process helps reduce Medicare denials by supporting the dissemination of best practices and process improvements The GBD Blog was established to provide a platform for discussing the challenges and complexities of communicating health care encounters and to provide potential solutions to identify the root causes for specific communication errors

The GBD Blog and Twitter ID BeyondDx are part of Palmetto GBArsquos innovative strategy for increasing the capacity of Medicare providers to improve the quality of healthcare records and effectively decrease the claims payment error rate The success of this social media approach to communicating with healthcare stakeholders depends on your active participation

True innovation requires collaboration Please join the on-line GBD community by visiting the GBD Blog at httppalmgbacomgbd or signing-up to follow us on Twitter BeyondDx

3 32017

eServices News

Did You KnowAre you Responsible for Submitting Appeals for your Practice Facility or Agency

Rather than faxing or mailing your redeterminations or reopenings to Palmetto GBA Part B providers can submit them via our eServices portal eServices gives you greater control over documents by allowing you to type in exactly what you need and attaching the appropriate documentation This will help prevent keying errors and ensure your redetermination or reopenings are routed to the correct department

We also offer an eDelivery option for receiving your redetermination decision letters electronically Imagine getting your Medicare redetermination notices (MRNs) the same day that they are issued delivered directly to your computer You can even choose to get an email to let you know that the letter is waiting for you

How convenient is that

eServices Portal Users Must Sign Up for MFA

Itrsquos easier than you might think for someone to steal your password Multi-factor Authentication (MFA) can help your eServices account remain secure even if someone manages to obtain your password without your knowledge Due to increased CMS security requirements eServices Portal users must sign up for MFA by July 1 2017

Go to bitly2jwBYPO for futher details

Smart Edits to Detect eCBR Billing Patterns

Palmetto GBA providers will receive pre-adjudicated informational only messaging through claim acknowledgement transaction reports (277CA) sent to you your clearinghouse or your billing vendor These eCompare smart edits will assist you in monitoring your specific billing patterns and should serve as a training aide providing detailed provider education for self-auditing purposes

The eCompare smart edits will include links to educational material and will instruct providers to log in to the eServices portal to view your personalized electronic Comparative Billing Report (eCBR) results

A key component of this proactive strategy involves enabling your staff to use the eCompare smart edits listed in the claim acknowledgement transaction reports to identify potential problem areas where you are billing differently than your peers as identified through this internal auditing tool

If you have not already signed up for eServices now is the perfect time to do so

If you have questions about eServices please call our Provider Contact Center at 8556960705 Our representatives will be more than happy to walk you through all of the possibilities

Contact Us

eAudit to Generate Reports for Claims under Complex Medical Review

Electronic Audit (eAudit) is a new function available in the eServices online portal which allows providers the ability to access personal reports of audit results for claims which have been chosen for Complex Medical Review by various Medicare review contractors

eAudit gives providers the opportunity to see what claims may be pending Complex Medical Review currently and the results of any recent review decisions

This information can be used for self-assessment of provider performance on Medicare audits utilizing a dashboard which contains the most common denial reasons The eAudit tool currently features CERT contractor claim review data with JM Medicare Administrative Contractor (MAC) Medical Review and JM Appeal review data coming soon

How do I use the eAudit function To get started log into the eServices portal using your user ID and select the eAudit tab which is located under the eReview tab The screen will automatically populate with a summary table of your CERT audit data by error code category Full details can be found in the eServices User Guide at httpwwwPalmettoGBAcomeServicesUserGuide

If you donrsquot already have an eService account register for one today at httpwwwPalmettoGBAcomeServices

Example of eAudit Claims in eServices

5 32017

Cha nges for KEPROrsquos Quality of Care Reviews

KEPRO is the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for 33 states and the District of Columbia and is responsible for all Quality of Care reviews in these areas As the BFCC-QIO KEPRO would like to provide the following information about changes from the Centers for Medicare amp Medicaid Services (CMS) for Quality of Care reviews effective February 1 2017 bull Providers will now have 14 calendar days (theyrsquore currently allowed 30 days) to send in the medical record

once a medical record request is received Because of these tightened time frames KEPRO encourages providers to fax medical records rather than sending them via mail The Quality of Care department at KEPRO has its own dedicated fax number which will be listed on the medical record request

bull After the medical records are received KEPRO has 30 days to complete the review Providers that wish to provide a response when they receive an inquiry from KEPRO will also have a shortened time frame which will be noted on the inquiry letter

bull Medicare beneficiaries or their representatives will have the opportunity to request a second review if they disagree with the original findings similar to the current process in place for providers

For more information please visit wwwkeproqiocom

Get Your Medicare News Electronically The Palmetto GBA Medicare listserv is a wonderful communication tool that offers its members the opportunity to stay informed about

bull Medicare incentive programs bull Fee Schedule changes bull New legislation concerning Medicare bull And so much more

How to register to receive the Palmetto GBA Medicare Listserv Go to httptinyurlcomPalmettoGBAListserv and select ldquoRegister Nowrdquo Complete and submit the online form Be sure to select the specialties that interest you so information can be sent

Note Once the registration information is entered you will receive a confirmationwelcome message informing you that yoursquove been successfully added to our listserv You must acknowledge this confirmation within 3 days of your registration

CallBack Assist CallBack Assist was implemented to improve the wait times during peak calling periods of the day CallBack Assist allows providers to opt out for a same-day callback from a customer service representative (CSR) Typically the callback occurs within one hour This feature is a contact center best practice among the industry Providers are encouraged to try this new option when offered to avoid long wait times for assistance

6 32017

Now You Can Access Your Personal Data to See Who Has Been Using Your NPI

Electronic Utilization (eUtilization) reports are now available in the eServices online provider portal eUtilization reports provide rendering providers and ordering and referring providers access to their personal data This data can be reviewed to ensure providers are aware of when and by whom their NPI

is being used for billing Medicare services and when their NPI is entered on a Medicare claim as the ordering referring physician This will provide providers with the ability to identify possible misuse of their NPI Providers will be able to select a period from 1-12 months for the previous 12 months of data This data will be updated monthly so that providers can trend their data over time

Ordering and Referring This function enables an individual physician to view all Medicare claims billed where their NPI was entered as the ordering and referring provider for a beneficiary The report will also allow providers to click and see a summary by the type of code for the services billed

Rendering This will allow an individual provider who is part of a group practice or multiple groups to pull a data report for their NPI which will enable them to view their utilization for each associated provider ID for a specified time period

How to Sign Up to Receive This Data In order to access your data you will need to have an eServices account You can sign up at httpwwwpalmettogbacomeservices

eDelivery Reminder Are You Getting Your Greenmail

Palmetto GBA would like to remind providers that you have the option to receive letters electronically through eServices Gaining access to these letters is a simple process To start receiving your Medicare letters such as prior authorization or first level redeterminations decision letters electronically you must be signed up for our eServices online provider portal Once you

have signed into eServices select the Admin tab next you can choose your eDelivery preferences Just click the drop down box to choose eDelivery of the letters you would like to receive via greenmail You can also select lsquoUser Email Notificationrsquo to start receiving emails when your letters are available in eServices for you Selecting this choice is so easy and allows you to receive your letters faster

Once you have chosen the eDelivery option all of the letters you selected will come to you electronically even if you sent in your request via fax or mail

7 32017

Medicare Participating Physicians Directory (MEDPARD) The Medicare Participating Physicians Directory (MEDPARD) which contains the listing of names addresses phone number and specialties of all participating providers within the Medicare P art B Program may be accessed through the appropriate statersquos website at bull North Carolina httpswww4palmettogbacompgx_palmettogbacominitMedpardSearchdoinitState=NC bull South Carolina httpswww4palmettogbacompgx_palmettogbacominitMedpardSearchdoinitState=SC bull Virginia httpswww4palmettogbacompgx_palmettogbacominitMedpardSearchdoinitState=VA bull West Virginia httpswww4palmettogbacompgx_palmettogbacominitMedpardSearchdoinitState=WV

You may also visit the CMS MEDPARD listing (physicians only) website at httpwwwcmsgovcenterphysicianasp

MEDPARD paper requests by locality may be submitted to

Palmetto GBA Mail Code AG-310 PO Box 100190 Columbia SC 29202-3190

Wersquod Love Your Feedback Palmetto GBA is committed to continuously improve your customer experience We welcome your feedback on your experiences with the PalmettoGBAcom webshysite and the eServices portal As a visitor to the Palmetto GBAs website you may be presented with an opportushynity to take the website satisfaction survey

The next time the survey is offered to you please agree to participate and provide us with your feedback You have the opportunity to explain your comments share your honest opinions and tell us what you like and what you would like to see us improve If you find a feature or tool specifically helpful let us know including any suggestions for making them simpler to use

We continuously analyze your feedback and develshyop enhancements plans to better assist you with your experience We value your opinion and look forward to hearing from you

8 32017

Action Needed Due to Increased CMS Security Requirements eServices Portal

Users Must Sign Up for Multi-Factor Authentication (MFA) by July 1 2017

Why You Need It Itrsquos easier than you might think for someone to steal your password Multi-

factor authentication (MFA) can help your eServices account remain secure even if someone manages to obtain your password without your knowledge

How It Works The eServices MFA is an extra layer of security Users may log into eServices and access the ldquoMy Accountrdquo tab in order to turn on this optional feature Once activated signing into your eServices account will work a little differently

1 Yoursquoll enter your password as usual

Continued gtgt CPT codes descriptors and other data only are copyright 2016 American Medical Association (or such other date of publication of CPT) All Rights Reserved Applicable FARSDFARS apply Current Dental Terminology fourth edition (CDT) (including procedure codes nomenclature descriptors and other data contained therein) is copyright by the American Dental Association copy2016 American Dental Association All rights reserved Applicable FARSDFARS apply

9 32017

2 Then yoursquoll select your preferred method of delivery between email or a text message

3 Once you receive your verification code you will enter it in the verification box and yoursquore in

Deadline to Sign Up bull Providers have from now through March 31 2017 to sign up for multi-factor authentication for each active

user ID voluntarily bull April 1 2017 to June 31 2017 providers will be required to sign up for multi-factor authentication at

enrollment password reset and recertification bull Effective July 1 2017 if you have not yet signed up for MFA your account will automatically be set to

MFA with the email address associated with the user ID

Note Providers who have linked their accounts will only need to sign up for MFA for their default account

eServices User Guide Please see the eServices User Guide at httpwwwPalmettoGBAcomeServicesUserGuide for more information

10 32017

Medicare Learning Networkreg (MLN) Want to stay informed about the latest changes to the Medicare Program Get connected with the Medicare Learning Networkreg (MLN) ndash the home for education information and resources for health care professionals

The Medicare Learning Networkreg is a registered trademark of the Centers for Medicare amp Medicaid Services (CMS) and the brand name for official CMS education and information for health care professionals It provides educational products on Medicare-related topics such as provider enrollment preventive services claims processing provider compliance and Medicare payment policies MLN products are offered in a variety of formats including training guides articles educational tools booklets fact sheets web-based training courses (many of which offer continuing education credits) ndash all available to you free of charge

The following items may be found on the CMS web page at httpswwwcmsgovOutreach-and-EducationMedicare-Learning-Network-MLNMLNProductsindexhtml bull MLN Catalog is a free interactive downloadable document that lists all MLN products by media format To

access the catalog scroll to the ldquoDownloadsrdquo section and select ldquoMLN Catalogrdquo Once you have opened the catalog you may either click on the title of a product or you can click on the type of ldquoFormats Availablerdquo This will link you to an online version of the product or the Product Ordering Page

bull MLN Product Ordering Page allows you to order hard copy versions of various products These products are available to you for free To access the MLN Product Ordering Page scroll to the ldquoRelated Linksrdquo and select ldquoMLN Product Ordering Pagerdquo

bull MLN Product of the Month highlights a Medicare provider education product or set of products each month along with some teaching aids such as crossword puzzles to help you learn more while having fun

Other resources bull MLN Publications List contains the electronic versions of the downloadable publications These products

are available to you for free To access the MLN Publications go to httpswwwcmsgovOutreach-andshyEducationMedicare-Learning-Network-MLNMLNProductsMLN-Publicationshtml You will then be able to use the ldquoFilter Onrdquo feature to search by topic or key word or you can sort by date topic title or format

MLN Educational Products Electronic Mailing List To stay up-to-date on the latest news about new and revised MLN products and services subscribe to the MLN Educational Products electronic mailing list This service is free of charge Once you subscribe you will receive an e-mail when new and revised MLN products are released

To subscribe to the service 1 Go to httpslistnihgovcgi-binwaexeA0=mln_education_products-l and select the lsquoSubscribe or

Unsubscribersquo link under the lsquoOptionsrsquo tab on the right side of the page 2 Follow the instructions to set up an account and start receiving updates immediately ndash itrsquos that easy

If you would like to contact the MLN please email CMS at MLNcmshhsgov

11 32017

Qualified Medicare Beneficiary Indicator in the Medicare Fee-For-Service Claims Processing System

MLN Mattersreg Number MM9911 Related Change Request (CR) CR 9911 Effective Date for claims processed on or after October 2 2017 Related CR Release Date February 3 2017 Related CR Transmittal R3715CP Implementation Date October 2 2017

Provider Types Affected This MLN Mattersreg Article is intended for physicians providers and suppliers submitting claims to Medicare Administrative Contractors (MACs) including Home Health amp Hospice MACs and Durable Medical Equipment MACs for services provided to Medicare beneficiaries

Provider Action Needed Change Request (CR) 9911 modifies the Medicare claims processing systems to help providers more readily identify the Qualified Medicare Beneficiary (QMB) status of each patient and to support providersrsquo ability to follow QMB billing requirements Beneficiaries enrolled in the QMB program are not liable to pay Medicare cost-sharing for all Medicare AB claims CR 9911 adds an indicator of QMB status to Medicarersquos claims processing systems This system enhancement will trigger notifications to providers (through the Provider Remittance Advice) and to beneficiaries (through the Medicare Summary Notice) to reflect that the beneficiary is enrolled in the QMB program and has no Medicare cost-sharing liability Make sure that your billing staffs are aware of these changes

Background QMB is a Medicaid program that assists low-income beneficiaries with Medicare premiums and cost-sharing In 2015 72 million persons (more than one out of every ten Medicare beneficiaries) were enrolled in the QMB program

Under federal law Medicare providers may not bill individuals enrolled in the QMB program for Medicare deductibles coinsurance or copayments under any circumstances (See Sections 1902(n)(3)(B) 1902(n)(3) (C) 1905(p)(3) 1866(a)(1)(A) 1848(g)(3)(A) of the Social Security Act) State Medicaid programs may pay providers for Medicare deductibles coinsurance and copayments Howev er as permitted by Federal law states can limit provider reimbursement for Medicare cost-sharing under certain circumstances Nonetheless Medicare providers must accept the Medicare payment and Medicaid payment (if any and including any permissible Medicaid cost sharing from the beneficiary) as payment in full for services rendered to an individual enrolled in the QMB program

CR 9911 aims to support Medicare providersrsquo ability to meet these requirements by modifying the Medicare claims processing system to clearly identify the QMB status of all Medicare patients Currently neither the Medicare eligibility systems (the HIPAA Eligibility Transaction System (HETS)) nor the claims processing systems (the FFS Shared Systems) notify providers about their patientrsquos QMB status and lack of Medicare

12 32017

cost-sharing liability Similarly Medicare Summary Notices (MSNs) do not inform those enrolled in the QMB program that they do not owe Medicare cost-sharing for covered medical items and services

CR 9911 includes modifications to the FFS claims processing systems and the ldquoMedicare Claims Processing Manualrdquo to generate notifications to Medicare providers and beneficiaries regarding beneficiary QMB status and lack of liability for cost-sharing

With the implementation of CR 9911 Medicarersquos Common Working File (CWF) will obtain QMB indicators so the claims processing systems will have access to this information

bull CWF will provide the claims processing systems the QMB indicators if the dates of service coincide with a QMB coverage period (one of the occurrences) for the following claim types Part B professional claims Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) claims and outpatient institutional Types of Bill (TOB) 012x 013x 014x 022x 023x 034x 071x 072x 074x 075x 076x 077x and 085x) home health claims (TOB 032x) only if the revenue code for the line item is 0274 029x or 060x and Skilled Nursing Facility (SNF) claims (based on occurrence code 50 date for revenue code 0022 lines on TOBs 018x and 021x)

bull CWF will provide the claims processing systems the QMB indicator if the ldquothrough daterdquo falls within a QMB coverage period (one of the occurrences) for inpatient hospital claims (TOB 011x) and religious non-medical health care institution claims (TOB 041x)

The QMB indicators will initiate new messages on the Remittance Advice that reflect the benefi ciaryrsquos QMB status and lack of liability for Medicare cost-sharing with three new Remittance Advice Remark Codes (RARC) that are specific to those enrolled in QMB As appropriate one or more of the following new codes will be returned bull N781 ndash No deductible may be collected as patient is a MedicaidQualified Medicare Benefi ciary Review

your records for any wrongfully collected coinsurance deductible or co-payments bull N782 ndash No coinsurance may be collected as patient is a MedicaidQualified Medicare Benefi ciary Review

your records for any wrongfully collected coinsurance deductible or co-payments bull N783 ndash No co-payment may be collected as patient is a MedicaidQualified Medicare Benefi ciary Review

your records for any wrongfully collected coinsurance deductible or co-payments

In addition the MACs will include a Claim Adjustment Reason Code of 209 (ldquoPer regulatory or other agreement The provider cannot collect this amount from the patient However this amount may be billed to subsequent payer Refund to patient if collected (Use only with Group code OA (Other Adjustment))

Finally CR 9911 will modify the MSN to inform beneficiaries if they are enrolled in QMB and cannot be billed for Medicare cost-sharing for covered items and services

Additional Information The official instruction CR 9911 issued to your MAC regarding this change is available at httpwwwcmshhsgovRegulations-and-GuidanceGuidanceTransmittals2017DownloadsR3715CPpdf

For more information regarding billing rules applicable to individuals enrolled in the QMB Program see the MLN Matters article SE1128 at httpswwwcmsgovOutreach-and-EducationMedicare-Learning-NetworkshyMLNMLNMattersArticlesdownloadsse1128pdf

13 32017

Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) Edits Version 231

Effective April 1 2017 MLN Mattersreg Number MM9970 Related Change Request (CR) CR 9970 Related CR Release Date February 3 2017 Effective Date April 1 2017 Related CR Transmittal R3708CP Implementation Date April 3 2017

Provider Types Affected This MLN Mattersreg Article is intended for physicians other providers and suppliers who submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries

Provider Action Needed Change Request (CR) 9970 instructs MACs about the release of the latest package of Correct Coding Initiative (CCI) Procedure to Procedure (PTP) edits Version 231 effective April 1 2017 The National Correct Coding Initiative (NCCI) developed by the Centers for Medicare amp Medicaid (CMS) helps promote national correct coding methodologies and controls improper coding

The coding policies developed are based on coding conventions defined in the American Medical Associationrsquos (AMArsquos) Current Procedural Terminology (CPT) manual national and local policies and edits coding guidelines developed by national societies analysis of standard medical and surgical practice and review of current coding practice Make sure that your billing staffs are aware of these changes

Background CMS developed the CCI to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment in Part B claims

The latest package of CCI Procedure to Procedure (PTP) edits Version 231 effective April 1 2017 will be available via the CMS Data Center (CDC) A test file will be available on or about January 31 2017 and a final file will be available on or about February 14 2017

Version 231 will include all previous versions and updates from January 1 1996 to the present In the past CCI was organized in two tables Column 1Column 2 Correct Coding Edits and Mutually Exclusive Code (MEC) Edits In order to simplify the use of NCCI edit files (two tables) on April 1 2012 CMS consolidated these two edit files into the Column OneColumn Two Correct Coding edit file Separate consolidations have occurred for the two practitioner NCCI edit files and the two NCCI edit files used for OCE It will only be necessary to search the Column OneColumn Two Correct Coding edit file for active or previously deleted edits

CMS no longer publishes a Mutually Exclusive edit file on its website for either practitioner or outpatient hospital services since all active and deleted edits will appear in the single Column OneColumn Two Correct

14 32017

Coding edit file on each website The edits previously contained in the Mutually Exclusive edit file are NOT being deleted but are being moved to the Column OneColumn Two Correct Coding edit file

Additional Information The official instruction CR9970 issued to your MAC regarding this change is available at httpswwwcmsgovRegulations-and-GuidanceGuidanceTransmittals2017DownloadsR3708CPpdf

Refer to the CMS NCCI webpage for additional information at httpwwwcmsgovMedicareCodingNationalCorrectCodInitEdindexhtml

Global Surgery Calculator Self-Service Tool This tool will allow you to calculate both 10 and 90 day global surgery periods You can also look up your 2017 procedure code global days requirement by using this tool Just enter the procedure code in the tool and the global surgery indicator information will appear Access the Global Surgery Calculator tool under Forms Tools on the home page

eServices Makes Asking a Medicare Question Easier Palmetto GBA is pleased to announce the newest addition to our eService options-Secure eChat This innovative feature allows providers to interact with designated Palmetto GBA staff so they can receive real-time assistance locating information on any topics or specialties they are searching for on the Palmetto GBA website or within the eServices online portal The Secure eChat feature also allows users to dialogue with an online operator who can assist with patient or provider specifi c inqu ires or address questions that require the sharing of PHI information Using Secure eChat is simple This free portal is available to all Medicare providers as long as you have a signed Electronic Data Interchange (EDI) Enrollment Agreement on file with Palmetto GBA Once in the eServices portal from the bottom right corner select either Medicare Inquiries or eServices Help If you do not have an eServices account you can get started by clicking this eServices link httpswwwonlineproviderservicescomecx_improvev2The Secure eChat feature is available during business hours to assist providers

15 32017

New Common Working File (CWF) Medicare Secondary Payer (MSP) Type for Liability Medicare Set-Aside

Arrangements (LMSAs) and No-Fault Medicare Set-Aside Arrangements (NFMSAs)

MLN Mattersreg Number MM9893 Related Change Request (CR) CR 9893 Related CR Release Date February 3 2017 Effective Date October 1 2017 Related CR Transmittal R1787OTN Implementation Date October 2 2017

Provider Types Affected This MLN Mattersreg Article is intended for physicians providers and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries

What You Need to Know This article is based on Change Request (CR) 9893 To comply with the Government Accountability Office (GAO) final report entitled Medicare Secondary Payer (MSP) Additional Steps Are Needed to Improve Program Effectiveness for Non-Group Health Plans (GAO 12-333) (httpwwwgaogovproductsGAO-12-333) the Centers for Medicare amp Medicaid Services (CMS) will establish two (2) new set-aide processes a Liability Insurance Medicare Set-Aside Arrangement (LMSA) and a No-Fault Insurance Medicare Set-Aside Arrangement (NFMSA) An LMSA or an NFMSA is an allocation of funds from a liability or an autono-fault related settlement judgment award or other payment that is used to pay for an individualrsquos future medical andor future prescription drug treatment expenses that would otherwise be reimbursable by Medicare

Please be sure your billing staffs are aware of these changes

Background CMS will establish two (2) new set-aide processes a Liability Medicare Set-aside Arrangement (LMSA) and a No-Fault Medicare Set-aside Arrangement (NFMSA)

CR 9893 addresses (1) the policies procedures and system updates required to create and utilize an LMSA and an NFMSA MSP record similar to a Workersrsquo Compensation Medicare Set-Aside Arrangement (WCMSA) MSP record and (2) instructs the MACs and shared systems when to deny payment for items or services that should be paid from an LMSA or an NFMSA fund

Pursuant to 42 USC Sections 1395y(b)(2) and 1862(b)(2)(A)(ii) of the Social Security Act Medicare is precluded from making payment when payment ldquohas been made or can reasonably be expected to be made under a workersrsquo compensation plan an automobile or liability insurance policy or plan (including a self-insured plan) or under no-fault insurancerdquo Medicare does not make claims payment for future medical expenses associated with a settlement judgment award or other payment because payment ldquohas been maderdquo for such

16 32017

items or services through use of LMSA or NFMSA funds However Liability and No- Fault MSP claims that do not have a Medicare Set-Aside Arrangement (MSA) will continue to be processed under current MSP claims processing instructions

Key Points of CR9893 Medicare will not pay for those services related to the diagnosis code (or related within the family of diagnosis codes) associated with the open LMSA or NFMSA MSP record when the claimrsquos date of service is on or after the MSP effective date and on or before the MSP termination date Your MAC will deny such claims using Claim Adjustment Reason Code (CARC) 201 and Group Code ldquoPRrdquo will be used when denying claims based on the open LMSA or NFMSA MSP auxiliary record

In addition to CARC 201 and Group Code PR when denying a claim based upon the existence of an open LMSA or NFMSA MSP record your MAC will include the following Remittance Advice Remark Codes (RARCs) as appropriate to the situation bull N723mdashPatient must use Liability Set Aside (LSA) funds to pay for the medical service or item bull N724mdashPatient must use No-Fault Set-Aside (NFSA) funds to pay for the medical service or item

Where appropriate MACs may override and make payment for claim lines or claims on which bull Autono-fault insurance set-asides diagnosis codes do not apply or bull Liability insurance set-asides diagnosis codes do not apply or are not related or bull When the LMSA and

NFMSA benefits are exhaustedterminated per CARC or RARC and payment information found on the incoming claim as cited in CR9009 (httpswwwcmsgovRegulations-and-GuidanceGuidanceTransmittalsdownloadsR113MSPpdf)

On institutional claims if the MAC is attempting to allow payment on the claim the MAC will include an ldquoNrdquo on the lsquo001rsquo Total revenue charge line of the claim

Additional Information The official instruction CR9893 issued to your MAC regarding this change is available at httpswwwcmsgovRegulations-and-GuidanceGuidanceTransmittals2017DownloadsR1787OTNpdf

The GAO report related to this issue is available at httpwwwgaogovproductsGAO-12-333 CR9009 is available at httpswwwcmsgovRegulations-and-GuidanceGuidanceTransmittalsdownloadsR113MSPpdf

17 32017

Implementation of New Influenza Virus Vaccine Code MLN Mattersreg Number MM9876 Related Change Request (CR) CR 9876 Related CR Release Date February 3 2017 Effective Date July 1 2017 Related CR Transmittal R3711CP Implementation Date July 3 2017

Provider Types Affected This MLN Mattersreg Article is intended for physicians other providers and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries

What You Need to Know Change Request (CR) 9876 provides instructions for payment and edits for the common working fi le (CWF) to include influenza virus vaccine code 90682 (Influenza virus vaccine quadrivalent (RIV4) derived from recombinant DNA hemagglutinin (HA) protein only preservative and antibiotic free for intramuscular use) for claims with dates of service on or after July 1 2017 Make sure that your billing staffs are aware of these instructions

Background Effective for dates of service on and after July 1 2017 influenza virus code 90682 will be payable by Medicare Annual Part B deductible and coinsurance amounts do not apply to this code MACs will bull Effective for dates of service on or after August 1 2017 MACs will pay for code 90682 using the Centers

for Medicare amp Medicaid Services (CMS) Seasonal Influenza Vaccines Pricing at httpswwwcmsgov MedicareMedicare-Fee-for-Service-Part-B-DrugsMcrPartBDrugAvgSalesPriceVaccinesPricinghtml to determine the payment rate for influenza virus vaccine code 90682

bull Pay for vaccine code 90682 on institutional claims as follows bull Hospitals ndash Types of Bill (TOB) 12X and 13X Skilled Nursing Facilities (SNFs) ndashTOB 22X and 23X

Home Health Agencies (HHAs) ndash TOB 34X hospital-based Renal Dialysis Facilities (RDFs) ndash TOB 72X and Critical Access Hospitals (CAHs) ndash TOB 85X based on reasonable cost

bull Indian Health Service (IHS) Hospitals ndash TOB 12X and 13X IHS CAHs ndash TOB 85X and hospices (81X and 82X) based on the lower of the actual charge or 95 percent of the Average Wholesale Price (AWP)

bull Comprehensive Outpatient Rehabilitation Facility (CORF) ndash TOB 75X and independent RDFs ndash TOB 72X based on the lower of actual charge or 95 percent of the AWP

bull MACs will pay at discretion claims for code 90682 with dates of service July 1 2017 through July 31 2017 bull MACs will return to the provider (RTP) institutional claims if submitted with code 90682 for dates of

service January 1 2017 through June 30 2017 bull MACs will deny Part B claims submitted with code 90682 for dates of service January 1 2017 through

June 30 2017 using the following messages bull Claim Adjustment Reason Code 181 ndash ldquoProcedure code was invalid on the date of servicerdquo bull Remittance Advice Remark Code N56 ndash ldquoProcedure code billed is not correctvalid for the services

billed or the date of service billedrdquo bull Group Code CO (Contractual Obligation)

18 32017

In addition effective for claims with dates of service on or after October 1m 2016 MACs will pay vaccines (Influenza PPV and HepB) to hospices based on the lower of the actual charge or 95of AWP Coinsurance and deductibles do not apply Further MACs will adjust previously processed hospice claims (TOB 81x or 82x) for these vaccines with dates of service on or after October 1 2016

Appeals Calculator Self-Service Tool Did you know you can use the appeals calculator to determine the timely filing date of your appeals request All you have to do is select which level of appeal you are in and enter the date you received the response to your previous appeal After clicking ldquoFind Deadlinerdquo the timely filing limit date will appear This tool is very helpful to assure that you are filing your appeals on time Providers may appeal claims that are partially or fully denied as long as the claim has lsquoappeal rightsrsquo Different levels of appeals have different timelines in which the appeal rights are valid Access the Appeals Calculator tool under FormsTools on the home page to calculate the your claims appeal deadlines

19 32017

Educational Events Where You Can Ask Questions and Get Answers from Palmetto GBA

Donrsquot Miss this Wonderful Opportunity If you are in search of an opportunity to interact with and get answers to your Medicare billing coverage and documentation questions from Palmetto GBArsquos Provider Outreach and Education (POE) department please see these educational offerings which have a question and answer session

Event Title

Nebulizers and Inhalation Medication - an AB MAC and DME MAC Collaboration Webinar March 2017 Medicare Part B Updates Changes and Reminders Webcast

Check out these resources

DateTime

March 8 1230 pm ET

March 9 10 am ET

LocationWebcastTeleconference

httpsattendeegotowebinarcom register1662600499651628290

httpseventon24comeventRegistration EventLobbyServlettarget=reg20

Quarterly Ask the Contractor Teleconferences (ACTs)

httptinyurlcomjkb4458

Quarterly Updates Webcasts

httptinyurlcomgsrb8gt

ACTs are intended to open the communication channels between providers and Palmetto GBA which allows for timely identification of problems and information-sharing in an informal and interactive atmosphere These teleconferences will be held at least quarterly via teleconference

Proceding the presentation providers are given an opportunity to ask questions both on the topics discussed as well as any other question they may have While we encourage providers to submit questions prior to the call this is not required Just fill out the Ask the Contractor Teleconference (ACT) Submit A Question form (httptinyurlcomhjq84dg) Once the form is completed please fax it to (803) 935-0140 Attention Ask-the-Contractor Teleconference

The Quarterly Update Webcasts are intended to provide ongoing scheduled opportunities for providers to stay up to date on Medicare requirements

Providers are able to type a question and have it responded to by the POE department throughout the webcast At the end of the presentation the moderator will also read and respond to questions submitted by attendees in order to share the responses with the group at large

20 32017

Event Registration Portal

Visit our Event Registration Portal to find information on upcoming educational events and seminars

This is a complete listing of both our face-to-face outreach opportunities as well as our teleconference and webcast listings Providers are able to dialogue with POE and get answers to their questions at all of these educational events

If you have a question that you need an answer to today or a claims specific question which requires the disclosure of PII or PHI for response please contact the Provider Contact Center (PCC) at 1-855-696-0705

21 32017

Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April CY 2017 Update

MLN Mattersreg Number MM9977 Related Change Request (CR) CR 9977 Related CR Release Date February 15 2017 Effective Date January 1 2017 Related CR Transmittal R3719CP Implementation Date April 3 2017

Provider Types Affected This MLN Mattersreg Article is intended for physicians providers and suppliers submitting claims to Medicare Adm inistrative Contractors (MACs) for services provided to Medicare beneficiaries and subject to the Medicare Physician Fee Schedule (MPFS)

Provider Action Needed Change Request (CR) 9977 informs MACs about changes to the MPFS payment files While the changes will be implemented in Medicare systems on April 3 the changes are effective January 1 2017 Note that MACs need not search their files to either retract payment for claims already paid or to retroactively pay claims already processed However the MACs will adjust such claims that you bring to their attention Make sure that your billing staffs are aware of these changes

Background Payment files were issued to the MACs based upon the CY 2017 MPFS Final Rule published in the Federal Register on November 15 2016 to be effective for services furnished between January 1 2017 and December 31 2017

Below is a summary of the changes for the April update to the 2017 MPFSDB These changes are effective for dates of service on or after January 1 2017 CPTHCPCS Code MOD ACTION G0477 Procedure Status = I G0478 Procedure Status = I G0479 Procedure Status = I 22867 Assistant Surgery Indicator = 2 22869 Assistant Surgery Indicator = 2 76519 26 Bilateral Surgery Indicator = 3 92136 26 Bilateral Surgery Indicator = 3 97161 Non-facility amp Facility PE RVU = 100 97162 Non-facility amp Facility PE RVU = 100 97163 Non-facility amp Facility PE RVU = 100 97165 Non-facility amp Facility PE RVU = 132 97166 Non-facility amp Facility PE RVU = 132

22 32017

97167 Non-facility amp Facility PE RVU = 132 97168 Non-facility amp Facility PE RVU = 093

In addition the following new codes have been added to the HCPCS file effective February 1 2017 The HCPCS file coverage code is C (carrier judgment) for these new codes Coverage and payment will be determined by the MAC (they are not part of the MPFS)

CPT Code Short Descriptor Long Descriptor 0001U RBC DNA HEA 35 AG

11 BLD GRP Red blood cell antigen typing DNA human erythrocyte antigen gene analysis of 35 antigens from 11 blood groups utilizing whole blood common RBC alleles reported

0002U ONC CLRCT 3 UR METAB ALG PLP

Oncology (colorectal) quantitative assessment of three urine metabolites (ascorbic acid succinic acid and carnitine) by liquid chromatography with tandem mass spectrometry (LC-MS MS) using multiple reaction monitoring acquisition algorithm reported as likelihood of adenomatous polyps

0003U ONC OVAR 5 PRTN SER ALG SCOR

Oncology (ovarian) biochemical assays of fi ve proteins (apolipoprotein A-1 CA 125 II follicle stimulating hormone human epididymis protein 4 transferrin) utilizing serum algorithm reported as a likelihood score

Additional Information The official instruction CR9977 issued to your MAC regarding this change is available at httpswwwcmsgovRegulations-and-guidanceGuidanceTransmittals2017DownloadsR3719CPpdf

23 32017

Medicare Outpatient Observation Notice (MOON) Instructions

MLN Mattersreg Number MM9935 Revised Related Change Request (CR) CR 9935 Related CR Release Date January 27 2017 Effective Date February 21 2017 Related CR Transmittal R3698CP Implementation Date February 21 2017

Note This article was revised on February 2 2017 to reflect a revised CR9935 issued on January 27 In the article the CR release date transmittal number and the Web address for accessing the CR were revised All other information remains the same

Provider Types A ffected This MLN Mattersreg Article is intended for hospitals including Critical Access Hospitals (CAHs) submitting claims to Medicare Administrative Contractors (MACs) for outpatient observation services provided to Medicare beneficiaries

Provider Action Needed Change Request (CR) 9935 updates Chapter 30 of the ldquoMedicare Claims Processing Manualrdquo to include the Medicare Outpatient Observation Notice (MOON) CMS-10611 and related instructions Providers should use the MOON to inform Medicare beneficiaries when they are an outpatient receiving observation services and are not an inpatient of the hospital or a Critical Access Hospital (CAH) The instructions included in Chapter 30 provide guidance for proper issuance of the MOON The updated Chapter 30 is attached to CR9935

Background The MOON is mandated by the Federal Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act) passed on August 6 2015 This law amended Section 1866(a)(1) of the Social Security Act by adding new subparagraph (Y) that requires hospitals and CAHs to provide written notification and an oral explanation of such notification to individuals receiving observation services as outpatients for more than 24 hours at the hospitals or CAHs

Scope Hospitals and CAHs must provide the MOON to beneficiaries in Original Medicare (Fee-For-Service) who receive observation services as outpatients for more than 24 hours (Note MA plans are to follow MOON instructions outlined in CR9935Section 400 of Chapter 30 of the Medicare Claims Processing Manual

All beneficiaries receiving services in hospitals and CAHs must receive a MOON no later than 36 hours after observation services as an outpatient begin For purposes of these instructions the term ldquobenefi ciaryrdquo means either beneficiary or representative when a representative is acting for a benefi ciary

This also includes beneficiaries in the following circumstances

24 32017

bull Beneficiaries who do not have Part B coverage bull Beneficiaries who are subsequently admitted as an inpatient prior to the required delivery of the MOON bull Beneficiaries for whom Medicare is either the primary or secondary payer

The statute expressly provides that the MOON be delivered to beneficiaries receiving observation services as an outpatient for more than 24 hours In other words the MOON should not be delivered to all beneficiaries receiving outpatient services The MOON is intended to inform beneficiaries who receive observation services for more than 24 hours that they are outpatients receiving observation services and not inpatients and the reasons for such status and must be delivered no later than 36 hours after observation services begin

However hospitals and CAHs may deliver the MOON to an individual receiving observation services as an outpatient before such individual has received more than 24 hours of observation services Allowing delivery of the MOON before an individual has received 24 hours of observation services affords hospitals and CAHs the flexibility to deliver the MOON consistent with any applicable State law that requires notice to outpatients receiving observation services within 24 hours after observation services begin The flexibility to deliver the MOON any time up to but no later than 36 hours after observation services begin also allows hospitals and CAHs to spread out the delivery of the notice and other hospital paperwork in an effort to avoid overwhelming and confusing beneficiaries

Hospitals Affected by These Instructions These instructions apply to hospitals as well as CAHs per Section 1861(e) and Section 1861(mm) of the Social Security Act

Medicare Outpatient Observation Notice The MOON is subject to the Paperwork Reduction Act (PRA) process and approved by the Office of Management and Budget (OMB) OMB-approved notices may only be modified as per their accompanying form instructions as well as per guidance in this section of the manual Unapproved modifications cannot be made to the OMB-approved standardized MOON The notice and accompanying form instructions are available at httpwwwcmsgovMedicareMedicare-General-InformationBNI

Alterations to the Notice In general the MOON must remain two pages except as needed for the additional information fi eld discussed below or to include State-specific information below Hospitals and CAHs subject to State law observation notice requirements may attach an additional page to the MOON to supplement the ldquoAdditional Informationrdquo section in order to communicate additional content required under State law or may attach the notice required under State law to the MOON The pages of the notice can be two sides of one page or one side of separate pages but must not be condensed to one page

Hospitals may include their business logo and contact information on the top of the MOON Text may not be shifted from page 1 to page 2 to accommodate large logos address headers or any other information

Completing the MOON Hospitals must use the OMB-approved MOON (CMS-10611) Hospitals must type or write the following information in the corresponding blanks of the MOON

25 32017

bull Patient name bull Patient number bull Reason patient is an outpatient

Hospital Delivery of the MOON Hospitals and CAHs must provide both the standardized written MOON as well as oral notifi cation Oral notification must consist of an explanation of the standardized written MOON The format of such oral notification is at the discretion of the hospital or CAH and may include but is not limited to a video format However a staff person must always be available to answer questions related to the MOON both in its written and oral delivery formats

The hospital or CAH must ensure that the beneficiary or representative signs and dates the MOON to demonstrate that the beneficiary or representative received the notice and understands its contents Use of assistive devices may be used to obtain a signature

Electronic issuance of the MOON is permitted If a hospital or CAH elects to issue a MOON viewed on an electronic screen before signing the beneficiary must be given the option of requesting paper issuance over electronic issuance if that is what the beneficiary prefers Regardless of whether a paper or electronic version is issued and regardless of whether the signature is digitally captured or manually penned the benefi ciary must be given a paper copy of the MOON with the required benefi ciary specific information inserted at the time of notice delivery

Refusal to Sign the MOON If the beneficiary refuses to sign the MOON and there is no representative to sign on behalf of the benefi ciary the notice must be signed by the staff member of the hospitalCAH who presented the written notifi cation The staff memberrsquos signature must include the name and title of the staff member a certification that the notification was presented and the date and time the notification was presented The staff member annotates the ldquoAdditional Informationrdquo section of the MOON to include the staff memberrsquos signature and certification of delivery The date and time of refusal is considered to be the date of notice receipt

MOON Delivery to Representatives The MOON may be delivered to a beneficiaryrsquos appointed representative A beneficiary may designate an appointed representative via the ldquoAppointment of Representativerdquo form the CMS-1696 which can be found at httpswwwcmsgovMedicareCMS-FormsCMS-Formsdownloadscms1696pdf See Chapter 29 Section 2701 of the ldquoMedicare Claims Processing Manualrdquo at httpswwwcmsgovRegulations-and-GuidanceGuidanceManualsdownloadsclm104c29pdf for more information on appointed representatives

The MOON may also be delivered to an authorized representative Generally an authorized representative is an individual who under State or other applicable law may make health care decisions on a benefi ciaryrsquos behalf (for example the beneficiaryrsquos legal guardian or someone appointed in accordance with a properly executed durable medical power of attorney)

Notification to a beneficiary who has been deemed legally incompetent is typically made to an authorized representative of the beneficiary However if a beneficiary is temporarily incapacitated a person (typically

26 32017

a family member or close friend) whom the hospital or CAH has determined could reasonably represent the beneficiary but who has not been named in any legally binding document may be a representative for the purpose of receiving the MOON Such a representative should act in the benefi ciaryrsquos best interests and in a manner that is protective of the beneficiary and the beneficiaryrsquos rights Therefore a representative should have no relevant conflict of interest with the benefi ciary

In instances where the notice is delivered to a representative who has not been named in a legally binding document the hospital or CAH should annotate the MOON with the name of the staff person initiating the contact the name of the person contacted and the date time and method (in person or telephone) of the contact

Note There is an exception to the in-person notice delivery requirement If the MOON must be delivered to a representative who is not physically present to receive delivery of the notice the hospitalCAH is not required to make an off-site delivery to the representative The hospitalCAH must complete the MOON as required and telephone the representative bull The information provided telephonically should include all contents of the MOON bull Note the date and time the hospital or CAH communicates (or makes a good faith attempt to communicate)

this information telephonically to the representative is considered the receipt date of the MOON bull Annotate the ldquoAdditional Informationrdquo section to reflect that all of the information indicated above was

communicated to the representative bull Annotate the ldquoAdditional Informationrdquo section with the name of the staff person initiating the contact

the name of the representative contacted by phone the date and time of the telephone contact and the telephone number called

A copy of the annotated MOON should be mailed to the representative the day telephone contact is made

A hard copy of the MOON must be sent to the representative by certified mail return receipt requested or any other delivery method that can provide signed verification of delivery (for example FedEx or UPS) The burden is on the hospital or CAH to demonstrate that timely contact was attempted with the representative and that the notice was delivered

If the hospital or CAH and the representative both agree the hospital or CAH may send the notice by fax or e-mail however the hospital or CAHrsquos fax and e-mail systems must meet the Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy and security requirements

Ensuring Benefi ciary Comprehension The OMB-approved standardized MOON is available in English and Spanish If the individual receiving the notice is unable to read its written contents andor comprehend the required oral explanation hospitals and CAHs must employ their usual procedures to ensure notice comprehension Usual procedures may include but are not limited to the use of translators interpreters and assistive technologies

Hospitals and CAHs are reminded that recipients of Federal financial assistance have an independent obligation to provide language assistance services to individuals with Limited English Proficiency (LEP) consistent with Section 1557 of the Affordable Care Act and Title VI of the Civil Rights Act of 1964 In addition recipients of Federal financial assistance have an independent obligation to provide auxiliary aids and services to individuals

27 32017

with disabilities free of charge consistent with Section 1557 of the Affordable Care Act and Section 504 of the Rehabilitation Act of 1973

Completing the Additional Information Field of the MOON This section may be populated with any additional information a hospital wishes to convey to a benefi ciary Such information may include but is not limited to bull Contact information for specific hospital departments or staff members bull Additional content required under applicable State law related to notice of observation services bull Part A cost-sharing responsibilities if a beneficiary is admitted as an inpatient before 36 hours following

initiation of observation services bull The date and time of the inpatient admission if a patient is admitted as an inpatient prior to delivery of the

MOON bull Medicare Accountable Care Organization information bull Hospital waivers of the beneficiaryrsquos responsibility for the cost of self-administered drugs bull Any other information pertaining to the unique circumstances regarding the particular beneficiary

If a hospital or CAH wishes to add information that cannot be fully included in the ldquoAdditional Informationrdquo section an additional page may be attached to the MOON

Notice Retention for the MOON The hospital or CAH must retain the original signed MOON in the beneficiaryrsquos medical record The beneficiary should receive a paper copy of the MOON that includes all of the required information Electronic notice retention is permitted

Intersection with State Observation Notices Hospitals and CAHs in States that have State-specific observation notice requirements may add State-required information to the ldquoAdditional Informationrdquo field attach an additional page or attach the notice required under State law to the MOON

Additional Information The official instruction CR9935 issued to your MAC regarding this change is available at httpswwwcmsgovRegulations-and-GuidanceGuidanceTransmittals2017DownloadsR3698CPpdf As mentioned earlier the notice and accompanying instructions are available at httpwwwcmsgovMedicareMedicare-General-InformationBNI

Document History bull January 24 2017 - Initial issuance bull February 2 2017 - The article was revised to reflect a revised CR9935 issued on January 27 2017 In the article the CR release

date transmittal number and the Web address for accessing the CR were revised All other information remains the same

28 32017

ICD-10 Coding Revisions to National Coverage Determination (NCDs)

MLN Mattersreg Number MM9861 Related Change Request (CR) CR 9861 Effective Date October 1 2016 - Unless otherwise noted in individual requirements Related CR Release Date February 3 2017 Related CR Transmittal R1792OTN Implementation Date March 3 2017 - MAC local systems April 3 2017 - FISS MCS CWF Shared systems

Provider Types Affected This MLN Mattersreg Article is intended for physicians and other providers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries

Provider Action Needed Change Request (CR) 9861 is the 10th maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs) The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CRs specifically CR7818 CR8109 CR8197 CR8691 CR9087 CR9252 CR9540 CR9631 and CR 9751 while others are the result of revisions required to other NCD-related CRs released separately MLN Mattersreg Articles MM7818 (httpswwwcmsgovoutreach-and-education medicare-learning-network-mlnmlnmattersarticlesdownloadsMM7818pdf) MM8109 (httpswwwcms govoutreach-and-educationmedicare-learning-network-mlnmlnmattersarticlesdownloadsMM8109pdf) MM8197 (httpswwwcmsgovoutreach-and-educationmedicare-learning-network-mlnmlnmattersarticles downloadsMM8197pdf) MM8691 (httpswwwcmsgovoutreach-and-educationmedicare-learning-networkshymlnmlnmattersarticlesdownloadsMM8691pdf) MM9087 (httpswwwcmsgovoutreach-and-education medicare-learning-network-mlnmlnmattersarticlesdownloadsMM9087pdf) MM9252 (httpswwwcms govoutreach-and-educationmedicare-learning-network-mlnmlnmattersarticlesdownloadsMM9252pdf) MM9540 (httpswwwcmsgovoutreach-and-educationmedicare-learning-network-mlnmlnmattersarticles downloadsMM9540pdf) MM9631 (httpswwwcmsgovoutreach-and-educationmedicare-learning-networkshymlnmlnmattersarticlesdownloadsMM9631pdf) MM9751 (httpswwwcmsgovoutreach-and-education medicare-learning-network-mlnmlnmattersarticlesdownloadsMM9751pdf) contain information pertaining to these CRrsquos

Background The translations from ICD-9 to ICD-10 are not consistent 1-1 matches nor are all ICD-10 codes appearing in a complete General Equivalence Mappings (GEMS) mapping guide or other mapping guides appropriate when reviewed against individual NCD policies In addition for those policies that expressly allow MAC discretion there may be changes to those NCDs based on current review of those NCDs against ICD-10 coding There may be certain ICD-9 codes that were once considered appropriate prior to ICD-10 implementation that are no longer considered acceptable as of October 1 2015

No policy-related changes are included with these updates Any policy-related changes to NCDs continue to be implemented via the current long-standing NCD process Edits to ICD-10 and other coding updates specific

29 32017

to NCDs will be included in subsequent quarterly releases as needed

CR9861 makes adjustments to the following 16 NCDs bull NCD 401 - Diabetes Outpatient Self-Management Training bull NCD 407 - Outpatient Intravenous Insulin Treatment bull NCD 802 - Photodynamic Therapy (also NCD 8021 803 8031 ) bull NCD 8011 - Vitrectomy bull NCD 1001 - Bariatric Surgery bull NCD 1104 ndash Extracorporeal Photopheresis bull NCD 11018 - Aprepitant bull NCD 11023 - Stem Cell Transplantation bull NCD 1801 - Medical Nutrition Therapy bull NCD 1901 ndash Histocompatibility Testing bull NCD 2103 - Colorectal Cancer Screening bull NCD 2204 - Mammograms bull NCD 220617 - Positron Emission Tomography (PET) for Solid Tumors bull NCD 26031 - Islet Cell Transplants bull NCD 2605 - Intestinal and Multi-Visceral Transplants bull NCD 2706 - Infrared Therapy Devices

The spreadsheets for the above NCDs are available at httpswwwcmsgovMedicareCoverageDeterminationProcessdownloadsCR9861zip

You should remember that coding and payment areas of the Medicare Program are separate and distinct from coverage policycriteria Revisions to codes within an NCD are carefully and thoroughly reviewed and vetted by the Centers for Medicare amp Medicaid Services and are not intended to change the original intent of the NCD The exception to this is when coding revisions are released as official implementation of new or reconsidered NCD policy following a formal national coverage analysis

Your MACs will use default Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE) messages where appropriate Remittance Advice Remark Code (RARC) N386 with Claim Adjustment Reason Code (CARC) 50 96 andor 119 with Group Code PR (Patient Responsibility) or Group Code CO (Contractual Obligation) as appropriate

Your MAC will not search their files to adjust previously processed claims but will adjust any claims that you bring to their attention if found appropriate to do so

Additional Information The official instruction CR 9861 issued to your MAC regarding this change is available at httpswwwcmsgovRegulations-and-GuidanceGuidanceTransmittals2017downloadsR1792OTNpdf

30 32017

Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory

Improvement Amendments (CLIA) Edits MLN Mattersreg Number MM9946 Related Change Request (CR) CR 9946 Related CR Release Date February 3 2017 Effective Date January 1 2017 Related CR Transmittal R3701CP Implementation Date April 3 2017

Provider Types Affected This MLN Mattersreg Article is intended for clinical diagnostic laboratories submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries

Provider Action Needed Change Request (CR) 9946 informs MACs about the HCPCS codes for 2017 that are both subject to and excluded from CLIA edits and includes the HCPCS codes discontinued as of December 31 2016 Make sure your billing staffs are aware of these CLIA-related changes for 2017

Background The Clinical Laboratory Improvement Amendments (CLIA) regulations require a facility to be appropriately certified for each test performed To ensure that Medicare and Medicaid only pay for laboratory tests performed in certified facilities each claim for a HCPCS code that is considered a CLIA laboratory test is currently edited at the CLIA certificate level The HCPCS codes that are considered a laboratory test under CLIA change each year

The codes in table 1 were discontinued on December 31 2016

Table 1 HCPCS Codes Discontinued on December 31 2016 HCPCS Code

Descriptor

80300 Drug screen non tlc devices 80301 Drug screen class list a 80302 Drug screen prsmptv 1 class 80303 Drug screen onemult class 80304 Drug screen onemult class 81280 Gene analysis (long QT syndrome) full sequence analysis 81281 Gene analysis (long QT syndrome) known familial sequence variant 81282 Gene analysis (long QT syndrome) duplication or deletion variants

31 32017

0010M Oncology (high-grade prostate cancer) biochemical assay of four proteins (total psa free psa intact psa and human kallidrein 2 (hk2)) plus patient age digital rectal examination status and no history of positive prostate biopsy utilizing plasma prognostic algorithm reported as a probability score

The following HCPCS codes were removed from the Clinical Laboratory Fee Schedule (CR 9909) effective on January 1 2017 bull G0477 - Drug tests(s) presumptive any number of drug classes any number of devices or procedures

(eg immunoassay) capable of being read by direct optical observation only (eg dipsticks cups cards cartridges) includes sample validation when performed per date of service

bull G0478 ndash Drug tests(s) presumptive any number of drug classes any number of devices or procedures (eg immunoassay) read by instrument-assisted direct optical observation (eg dipsticks cups cards cartridges) includes sample validation when performed per date of service and

bull G0479 ndash Drug tests(s) presumptive any number of drug classes any number of devices or procedures by instrumented chemistry analyzers utilizing immunoassay enzyme assay TOF MALDI LDTD DESI DART GHPC GC mass spectrometry) includes sample validation when performed per date of service

The HCPCS codes listed in table 2 are new for 2017 and subject to CLIA edits The list does not include new HCPCS codes for waived tests or provider-performed procedures The HCPCS codes listed in table 2 require a facility to have either a 1 CLIA certificate of registration (certificate type code 9) 2 CLIA certificate of compliance (certificate type code 1) 3 CLIA certificate of accreditation (certificate type code 3)

The following facilities are not permitted to be paid for the tests in table 2 bull A facility without a valid current CLIA certificate bull A facility with a current CLIA certificate of waiver (certificate type code 2) bull A facility with a current CLIA certificate for provider-performed microscopy procedures (certifi cate type

code 4)

Table 2 New HCPCS Codes Subject to CLIA Edits for 2017 HCPCS Code

Descriptor

G0499 Hepatitis b screening in non-pregnant high risk individual includes hepatitis b surface antigen (hbsag) followed by a neutralizing confirmatory test for initially reactive results and antibodies to hbsag (anti-hbs) and hepatitis b core antigen (anti-hbc)

G0659 (Drug test(s) definitive utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers) including but not limited to GCMS (any type single or tandem) and LCMS (any type single or tandem) excluding immunoassays (eg IA EIA ELISA EMIT FPIA) and enzymatic methods (eg alcohol dehydrogenase) performed in a single machine run without drug or class specific calibrations qualitative or quantitative all sources includes specimen validity testing per day)

80305 Drug test prsmv dir opt obs

32 32017

80306 Drug test prsmv instrmnt 80307 Drug test prsmv chem anlyzr 81327 Methylation analysis (Septin9) 81413 Test for detecting genes associated with heart disease 81414 Test for detecting genes associated with heart disease 81422 Test for detecting genes associated with fetal disease 81439 Test for detecting genes associated with inherited disease of heart muscle 81539 Measurement of proteins associated with prostate cancer 84410 Testosterone level 87483 Test for detecting nucleic acid of organism causing infection of central nervous system

MACs will not search their files to either retract payment for claims already paid or retroactively pay claims but will adjust claims that you bring to their attention

Global Surgery Denial Tool If the procedure code was denied with remittance message CO-B15CO-97 (claimservice deniedreduced because this procedureservice is not paid separately OR payment is included in the allowance for another serviceprocedure) then use the following worksheet to see what if any corrections you can make to your claim Just answer a few questions and the tool will provide you with information to help you with your service Access the Global Surgery Denial tool under FormsTools on the home page

eServices Claim Status

To check on a particular claim status please enter the HICN and other required beneficiary information as well as the date(s) of service Should you not know the exact date of service you are able to enter a span or range of up to 45 days Please keep in mind retrieving claims older than six months takes a little longer than something more current Claims older than three years may not be searchable For more information about eServices and the many services it offers please visit our website at httpwwwPalmettoGBAcomeServices

33 32017

Clinical Laboratory Fee Schedule ndash Medicare Travel Allowance Fees for Collection of Specimens

MLN Mattersreg Number MM9960 Related Change Request (CR) CR 9960 Related CR Release Date February 10 2017 Effective Date January 1 2017 Related CR Transmittal R3717CP Implementation Date May 12 2017

Provider Types Affected This MLN Mattersreg Article is intended for physicians providers and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries

Provider Action Needed Change Request (CR) 9960 revises the payment of travel allowances when billed on a per mileage bas is using Health Care Common Procedure Coding System (HCPCS) code P9603 and when billed on a fl at-rate basis using HCPCS code P9604 for Calendar Year (CY) 2017 Make sure that your billing staffs are aware of these changes

Background Medicare Part B allows payment for a specimen collection fee and travel allowance when medically necessary for a laboratory technician to draw a specimen from either a nursing home patient or homebound patient under Section 1833(h)(3) of the Act Payment for these services is made based on the clinical laboratory fee schedule

Key Changes The travel codes allow for payment either on a per mileage basis (P9603) or on a flat-rate per trip basis (P9604) Payment of the travel allowance is made only if a specimen collection fee is also payable The travel allowance is intended to cover the estimated travel costs of collecting a specimen including the laboratory technicianrsquos salary and travel expenses MAC discretion allows the contractor to choose either a mileage basis or a fl at rate and how to set each type of allowance Because audits have shown that some laboratories abused the per mileage fee basis by claiming travel mileage in excess of the minimum distance necessary for a laboratory technician to travel for specimen collection many MACs established local policy to pay based on a flat-rate basis only

Under either method when one trip is made for multiple specimen collections (for example at a nursing home) the travel payment component is prorated based on the number of specimens collected on that trip This applies to both Medicare and non-Medicare patients either at the time the claim is submitted by the laboratory or when the flat rate is set by the MAC bull Per Mile Travel Allowance (P9603) - The per mile travel allowance is to be used in situations where the

average trip to the patientsrsquo homes is longer than 20 miles round trip and is to be prorated in situations where specimens are drawn from non-Medicare patients in the same trip

The allowance per mile was computed using the Federal mileage rate of $0535 per mile plus an additional $045 per mile to cover the technicianrsquos time and travel costs MACs have the option of

34 32017

establishing a higher per mile rate in excess of the minimum $099 per mile ($0985 is rounded up for system purposes) if local conditions warrant it The minimum mileage rate will be reviewed and updated throughout the year as well as in conjunction with the Clinical Laboratory Fee Schedule (CLFS) as needed At no time will the laboratory be allowed to bill for more miles than are reasonable or for miles that are not actually traveled by the laboratory technician

bull Per Flat-Rate Trip Basis Travel Allowance (P9604) - The per flat-rate trip basis travel allowance is $985

The Internal Revenue Service (IRS) determines the standard mileage rate for businesses based on periodic studies of the fixed and variable costs of operating an automobile

Medicare Physician Fees Lookup Tool Use the Medicare Physician Fee Lookup Tool located on our home page The Physician Fee Schedule tool saves our customers time and money by providing a lsquoone stop shoprsquo Customers can locate fees for the 2013 through 2017 throughout the United States The tool can search up to five codes and each code shows the allowance all of the indicator rules such as the Global Surgery modifiers and Multiple Surgery rules This tool helps customers research more than a fee they can determine if the wrong modifier was appended to a service or if the service was subject to multiple surgery rules The fees and indicator files are downloadable and customers can easily save the data to their systems for future use

35 32017

Ophthalmoscopy Remin ders

Prevent unnecessary appeals by submitting your initial claim correctly See the reminders below

CPT code 92226 -Ophthalmoscopy extended with retinal drawing (for retinal detachment melanoma) with interpretation ad report Coding Instructions

When the service is performed bilaterally bull Submit code on a single detail line with lsquo2rsquo in the daysunits (quantity billed) field when billed bilaterally bull Bilateral rules do not apply code pays at 200 when performed bilaterally bull Use modifier 50 when billed on a single detail line and rendered bilaterally

When the service is performed unilaterally bull Allowed once per day per eye per date

CPT code 92250 - Fundus Photograph When the service is performed bilaterally bull Submit code on a single detail line with lsquo1rsquo in the daysunits (quantity billed) field bull CPT modifier 50 is invalid because CPT code 92250 is already considered a bilateral service

When the service is performed unilaterally bull Submit on a single detail line with CPT modifier 52 (reduced service) in situations where fundus photography

was performed on one eye bull It is not necessary to submit documentation supporting the use of CPT modifier 52 for fundus photography

Palmetto GBA will assume the photography was performed on only one eye when the modifier is used bull HCPCS modifiers RT and LT are invalid for CPT code 92250 bull Documentation reflecting the reason the service was reduced should be retained in the patientrsquos medical

record

Local Coverage Determination bull Refer to the Ophthalmology Extended Ophthalmoscopy and Fundus Photography LCD for medical

necessity requirements

36 32017

Updated Editing of Professional Therapy Services MLN Mattersreg Number MM9933 Related Change Request (CR) CR 9933 Related CR Release Date January 27 2017 Effective Date January 1 2017 Related CR Transmittal R1775OTN Implementation Date July 3 2017

Provider Types Affected This MLN Mattersreg is intended for physicians therapists and other practitioners who submit professional claims to Medicare Administrative Contractors (MACs) for therapy services provided to Medicare beneficiaries

Provider Action Needed Change request (CR) 9933 instructs the MACs to apply certain coding edits to the new Current Procedural Terminology (CPT) codes that are used to report physical therapy (PT) and occupational therapy (OT) evaluations and re-evaluations effective January 1 2017 Make sure your billing staffs are aware of these coding changes

Background Original Medicare claims processing systems contain edits to ensure claims for the evaluative procedures furnished by rehabilitative therapy clinicians ndash including physical therapists occupational therapists and speech-language pathologists ndash are coded correctly These edits ensure that when the codes for evaluative services are submitted the therapy modifi er (GP GO or GN) that reports the type of therapy plan of care is consistent with the discipline described by the evaluation or re-evaluation code The edits also ensure that Functional Reporting occurs which is to say that functi onal G-codes along with severity modifi ers always accompany codes for therapy evaluative services These edits were applied to institutional claims in CR9698 A related article is available at httpswwwcmsgovOutreach-and-EducationMedicare-Learning-NetworkshyMLNMLNMattersArticlesDownloadsMM9698pdf CR9933 applies these edits to professional claims

For Calendar Year (CY) 2017 eight new CPT codes (97161-97168) were created to replace existing codes (97001-97004) to report PT and OT evaluations and reevaluations The new CPT code descriptors include specific components that are required for reporting as well as the typical face-to-face times In CR9782 the Centers for Medicare amp Medicaid Services (CMS) described the new PT and OT code sets each comprised of three new codes for evaluation ndash stratified by low moderate and high complexity ndash and one code for reshyevaluation CR9782 designated all eight new codes as ldquoalways therapyrdquo (always require a therapy modifier) and added them to the 2017 therapy code list located at httpwwwcmsgovMedicareBillingTherapyServices indexhtml For a complete listing of the new codes their CPT long descriptors and related policies see the related article for CR9782 at httpswwwcmsgovOutreach-and-EducationMedicare-Learning-Network-MLN MLNMattersArticlesDownloadsMM9782pdf

CR9933 applies the coding requirements for certain evaluative procedures that are currently outlined in the ldquoMedicare Claims Processing Manual (MCPM)rdquo Chapter 5 to the new codes for PT and OT evaluative procedures These new PT and OT codes 97161 ndash 97168 were added to the applicable code lists in MCPM Chapter 5 by CR9698

37 32017

Key Points CR9933 implements the following payment policies related to professional claims for therapy services for the new CPT codes for PT and OT evaluative procedures ndash claims without the required information will be returnedrejected

Therapy modifiers The new PT and OT codes are added to the current list of evaluative procedures that require a specifi c therapy modifier to identify the plan of care under which the services are delivered to be on the claim for therapy services Therapy modifiers GP GO or GN are required to report the type of therapy plan of care ndash PT OT or speech-language pathology respectively This payment policy requires that each new PT evaluative procedure code ndash 97161 97162 97163 or 97164 ndash to be accompanied by the GP modifier and (b) each new code for an OT evaluative procedure ndash 97165 97166 97167 or 97168 ndash be reported with the GO modifi er

Functional Reporting In addition to other Functional Reporting requirements Medicare payment policy requires Functional Reporting using G-codes and severity modifiers when an evaluative procedure is furnished and billed This notification adds the eight new codes for PT and OT evaluations and re-evaluations ndash 97161 97162 97163 97164 97165 97166 97167 and 97168 ndash to the procedure code list of evaluative procedures that necessitate Functional Reporting A severity modifier (CH ndash CN) is required to accompany each functional G-code (G8978-G8999 G9158-9176 and G9186) on the same line of service

For each evaluative procedure code Functional Reporting requires either two or three functional G-codes and related severity modifi ers be on the same claim Two G-codes are typically reported on specified claims throughout the therapy episode However when an evaluative service is furnished that represents a one-time therapy visit the therapy clinician reports all three G-codes in the functional limitation set ndash G-codes for Current Status Goal Status and Discharge Status

CMS coding requirements for Functional Reporting applied through CR9933 ensure that at least two G-codes in a functional set and their corresponding severity modifiers are present on the same claim with any one of the codes on this evaluative procedure code list The required reporting of G-codes includes (a) G-codes for Current Status and Goal Status or (b) G-codes for Discharge Status and Goal Status

For the documentation requirements related to Functional Reporting please refer to the ldquoMedicare Benefits Policy Manualrdquo Chapter 15 Section 2204 which is available at httpswwwcmsgovRegulations-andshyGuidanceGuidanceManualsdownloadsbp102c15pdf

Claims Coding Requirements Therapy Modifiers Your MAC will returnreject professional claims when bull Reporting codes 97161 97162 97163 or 97164 without the GP modifi er bull Reporting codes 97165 97166 97167 or 97168 without the GO modifi er bull Reporting an ldquoalways therapyrdquo code without a therapy modifier

38 32017

For these returnedrejected claims your MAC will supply the following messages bull Group code CO bull CARC ndash 4 The procedure code is inconsistent with the modifier used or a required modifier is missing

Functional Reporting Your MAC will returnreject claims when bull The professional claims you submit for the new therapy evaluative procedures codes 97161- 97168 without

including one of the following pairs of G-codesseverity modifiers required for Functional Reporting (a) A Current Status G-codeseverity modifier paired with a Goal Status G-codeseverity modifier or (b) A Goal Status G-codeseverity modifier paired with a Discharge Status G-codeseverity modifi er Your MAC will provide the following remittance messages when returning such submissions

bull Group code of CO (contractual obligation) bull Claim Adjustment Reason Code (CARC) ndash 16 Claimservice lacks information or has submissionbilling

error(s) which is needed for adjudication bull Remittance Advice Remarks Code (RARC) ndash N572 This procedure is not payable unless non-payable reporting codes and appropriate modifiers are submitted

39 32017

Review and Print Electronic Remittances ndash via eRemits

Palmetto GBA is pleased to offer eRemits through our eServices a free web-based provider self-service tool You can view or print remittances which are available for approximately one year In addition eServices will let you store remittances and utilize search features to fi nd specific information on the notices eRemits are available to be accessed every day between the hours of 8 am and 7 pm ET

To use eServices you must have an Electronic Data Interchange (EDI) Agreement on file with Palmetto GBA If you are already submitting claims electronically you do not have to submit a new EDI Enrollment Agreement For more information on EDI please visit our website at wwwPalmettoGBAcomEDI

eServices EligibilityeServices by Palmetto GBA allows you to search for patient eligibility which is a functionality of HETS HETS requires you to enter beneficiary last name and HICN in addition to either the birth date or first name See options below

bull HICN Last Name First Name Birth Date bull HICN Last Name Birth Date bull HICN Last Name First Name

For more information about eServices and the many services it offers please visit our website at httpwwwPalmettoGBAcomeServices CPT codes descriptors and other data only are copyright 2016 American Medical Association (or such other date of publication of CPT) All Rights Reserved Applicable FARSDFARS apply Current Dental Terminology fourth edition (CDT) (including procedure codes nomenclature descriptors and other data contained therein) is copyright by the American Dental Association copy2016 American Dental Association All rights reserved Applicable FARSDFARS apply

40 32017

Interactive Tools

These guides provide instruction on how to complete or interpret the following forms They are available on the home page under FormsTools

Remittance Advice

EDI Agreement

EDI Application

EDI Provider Authorization

CMS 1500 Claim Form

41 32017

_______________________________________

MLN ConnectsTM

MLN Connects contains a weekrsquos worth of Medicare-related messages instead of many different messages being sent to you throughout the week This notification process ensures planned coordinated messages are delivered timely about Medicare-related topics

MLN Connectstrade Provider eNews

MLN Connectstrade for February 2 2017 httpswwwcmsgovOutreach-and-EducationOutreachFFSProvPartProgDownloads2017-02-02-eNewspdf

Receive ADRs Electronically Go Green via eServices

Providers can now opt to receive Additional Documentation Requests (ADRs) through eServices If your claim is selected for review you can receive your request as it is generated ndash instead of by mail (which decreases the amount of time you have to respond)

This new process is free secure and easy to use Our messaging function in eServices will send an inbox message to let users know that an lsquoeLetterrsquo is now available This new process delivers the electronic document as a link within the secure message once you sign into eServices

For more information about eServices and the many services it offers please visit our website at wwwPalmettoGBAcomeServices

42 32017

CMS Offers FREE Medicare Training for Providers CMS Web Training The Centers for Medicare amp Medicaid Services (CMS) has launched a series of education and training programs designed to leverage emerging Internet and satellite technologies to offer just-in-time training to Medicare providers and suppliers throughout the United States Many of these programs include free downloadable computerWeb based training courses These courses are also available on CD-ROM

httpwwwcmsgovMLNGenInfo

Palmetto GBA Medicare Customer Information and Outreach

Training Available To request a Medicare Education meetingseminar at no cost to you complete and fax the form located on the httpwwwPalmettoGBAcomJMBforms

httpwwwPalmettoGBAcomMedicare

Important Sources For You bull httpwwwcmsgov bull httpwwwcmsgovMLNGenInfo bull httpwwwcmsgovCMSformsCMSformslistasp

Important Telephone Numbers Provider Contact Center (855) 696-0705 (Toll-Free)

Electronic Data Interchange (EDI) Technical Support

(855) 696-0705

Medicare Beneficiary Call Center

1-800-MEDICARE (1-800-633-4227)

TTY 1-877-486-2048

Attention Billing Manager

43 32017

Whatrsquos Inside

Going Beyond Diagnosis

eServices News

Get Your Medicare News Electronically

Medicare Participating Physicians Directory (MEDPARD)

Wersquod Love Your Feedback

Action Needed Due to Increased CMS Security Requirements eServices Portal Users Must Sign Up for Multi-Factor Authentication (MFA) by July 1 2017

Medicare Learning Networkreg (MLN)

Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) Edits Version 231 Effective April 1 2017

New Common Working File (CWF) Medicare Secondary Payer (MSP) Type for Liability Medicare Set-Aside Arrangements (LMSAs) and No-Fault Medicare Set-Aside Arrangements (NFMSAs)

Implementation of New Influenza Virus Vaccine Code

Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits

Updated Editing of Professional Therapy Services