SD MGMAThird Party Payer Day

Medicare Hot Topics 2018 Part A/B Provider Outreach and Education

November 2018

Disclaimer

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This information release is the property of Noridian Healthcare Solutions, LLC. It may be freely distributed in its entirety but may not be modified, sold for profit or used in commercial documents.

The information is provided “as is” without any expressed or implied warranty. While all information in this document is believed to be correct at the time of writing, this document is for educational purposes only and does not purport to provide legal advice.

All models, methodologies and guidelines are undergoing continuous improvement and modification by Noridian and CMS. The most current edition of the information contained in this release can be found on the Noridian website at https://med.noridianmedicare.com and the CMS website at https://www.cms.gov.

The identification of an organization or product in this information does not imply any form of endorsement.

CPT codes, descriptors, and other data only are copyright 2018 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.

November 2018

Agenda

• Hot topics – Medicare updates

• Part A/B– Noridian updates

• Educational corner– Resources and tools

3November 2018

Medicare Updates

CMS Patients Over Paperwork• Reduce administrative burden to improve customer

experience– https://www.cms.gov/About-CMS/story-page/patients-over-

paperwork.html• CMS efforts

– Proposed rule to lift unnecessary regulations, ease burden on providers

– Requests for information process, including progress in addressing comments

– Engaging customers through customer centered workgroups– Proposed and final rules to save money/reduce burden hours– Documentation simplification efforts– Other initiatives, Meaningful Measures initiative and

MyHealthEdata

Medicare Beneficiary Identifier (MBI)New Medicare Card

• April 1, 2018– SSN replaced by new MBI– Cards issued by geographic

location

• Allowing new MBI?– Noridian will accept HICN or

MBI until December 31, 2019

• Learn more:– https://www.cms.gov/Medica

re/New-Medicare-Card/index.html

November 2018 6

Obtaining the MBI

• Ask beneficiary to bring in new insurance card• New secure web interface MBI look up tool• New remittance advice (RA) updates• Learn more:

– https://www.cms.gov/Medicare/New-Medicare-Card/Providers/Getting-MBIs.html

November 2018 7

MBI Beneficiary Promotional Materials for Providers

• CMS promotional materials • Tear-off pads/posters

– You’re Getting a New MedicareStill Waiting for Your New Card– Card– "10 Things to Know About Your New Medicare Card" handout

• CMS MBI Materials– https://www.cms.gov/Medicare/New-Medicare-Card/Outreach-

and-Education/Outreach-and-education.html– https://www.cms.gov/Medicare/New-Medicare-Card/Outreach-

and-Education/Products-to-share-with-beneficiaries.html

November 2018 8

Promotional Materials

November 2018 9

MBI Resources for Beneficiaries

• 1-800-Medicare– (1-800-633-4227)

• MyMedicare.gov– https://www.mymedicare.gov

– Card mailing status– View or print card

• Card must be mailed

November 2018 10

MBI Lookup Tool• Noridian Medicare Portal

(NMP)• Input values

– Select TIN, NPI, PTAN, Program

– Legal First/Last name– Date of Birth (DOB) – Social Security Number

(SSN)• No two beneficiaries will

have same MBI

November 2018 11

MBI Lookup Results

November 2018 12

Part A Remittance Advice (RA)

• October 1, 2018 RA provides MBI

• FISS– MID field/line 32 =

Medicare ID (HICN submitted)

– MBI field/line 66 = MBI• PC Print

– MID field = Medicare ID (HICN submitted)

– CORR MID= MBI

November 2018 13

Part B Remittance Advice (RA) • October 1, 2018 RA

provides MBI• MCS

– MID field = Medicare ID (HICN submitted)

– MBI field = MBI• MREP

– First line MID field = Medicare ID (HICN submitted)

– Second line MID field = MBI

November 2018 14

Noridian MBI Webpage

• Noridian Website– https://med.noridianmedicare.com

• Jurisdiction F• Medicare Part A/B• Browse by Topic

– Medicare BeneficiaryIdentifier (MBI)

November 2018 15

New 2019 Influenza Virus Vaccine Code

• Effective January 1, 2019– CR 10871

• 2019 influenza virus vaccine code – CPT 90689 – Not retroactive to August 1, 2018

• No claim will be accepted for CPT 90689 between DOS August 1, 2018 and December 31, 2018

• Payment allowance information CR 10914

November 2018 16

Provider Enrollment PECOS Process Change

• Effective October 1, 2018– CR 10845

• Provider enrollment certification statements may be uploaded into Provider Enrollment Chain and Ownership System (PECOS)

• Check the CR for signature requirement changes

November 2018 17

Supplemental Medical Review Contractor (SMRC)

• Noridian – New Contractor– Review claims to lower improper payment rates and

claim errors– Conduct nationwide medical review

• Part A• Part B• Durable Medical Equipment (DME)

– Notify CMS of improper payments and noncompliance of documentation requests

– May result in claim adjustments completed by MACs

November 2018 18

Unified Program Integrity Contractor (UPIC)

• Effective May 1, 2018• CMS selects “Qlarant Integrity Solution”• UPIC West

– Replaces Zone 1 and 2 for Zone Program Integrity Contractor (ZPIC)

• Purpose is to detect, prevent, deter, reduce and make referrals to recover fraud, waste and abuse

November 2018 19

Noridian Updates

Noridian Call Center Triage Process

• POE does not accept claim inquiry calls or emails– Contact Provider Contact Center customer service

• Per CMS, specific rules for inquiries must follow triage process

• IOM 100-09, Chapter 6, Sections 30.1– http://www.cms.gov/Regulations-and-Guidance/

Guidance/ Manuals/ Downloads/com109c06.pdf• Insures proper tracking/monitoring of inquiries

November 2018 21

EDISS Ended Supportof Dial-up Modem Technology

• Noridian no longer supports dial-up modem functionally – Effective October 1, 2018

• Providers need to find alternative methods for connectivity– Network Service Vendors (NSVs)

• http://www.edissweb.com/cgp/news/modem.html

• Noridian and EDISS cannot assist with making decisions for your organization – Research within your facility to determine which NSV

will fit your needs

November 2018 22

Improved Noridian Websitehttps://med.noridianmedicare.com

Part A Part B

November 2018 23

Like What We’re Doing?

• Let us know what you like andwhat we can improve on– Jurisdiction F:

https://survey.foreseeresults.com/survey/display?cid=wtsU0tp0khBZxlUgcpcMxA==&sid=link-noridian-jf

November 2018 24

Noridian Site Tour

• High-level overview • Information• Part A site tour

– JF: https://med.noridianmedicare.com/web/jfa/help/site-tour

• Part B site tour– JF:

https://med.noridianmedicare.com/web/jfb/help/site-tour

November 2018 25

Provider Based Billing

• Poster available– Add facility logo

• Noridian website• Educational resources

– https://med.noridianmedicare.com/documents/10538/18067468/Provider-Based+Billing+Poster

November 2018 26

Medicare Eligibility/Entitlement Webpage

• Eligibility/entitlement information– Different patient eligibility – Entitlement types– Points of contact to request additional details and

status updates• Noridian Website

– Jurisdiction F– Part A/B– Browse By Topic– Claims

• Eligibility and Entitlement for Persons with Medicare

November 2018 27

Medically Unlikely Edit (MUE) Tool

• Part A/B providers aid in billing processes

• Enter CPT/HCPCS • MUE tool returns

frequency limitation as established by CMS

• Education & Outreach– Tools

November 2018 28

Global Surgery Date Calculator

• New Part A/B resource tool

• Providers enter surgery date – Receive 10-day and 90-

day post-operative period

• Learn More– Part B Global surgery

webpage– Education & Outreach

• Tools

October 2018 29

Noridian Medicare Portal (NMP)

• Quick link• Keep up to date • Notifications & updates

– https://www.noridianmedicareportal.com– Have new users?

• Get registered

• Functionality– Verify eligibility– Check claim status– Reopening– Submit an appeal

November 2018 30

Additional Documentation Inquiry

• ADR Information: https://www.brainshark.com/noridian/vu?pi=zH8zvFC7ezYOHfz0

November 2018 31

NMP Eligibility Denial Details

• Claim status - Related Inquiries– Medicare Secondary Payer (MSP)– Medicare Advantage/Health Maintenance Organization (HMO)– Hospice– Home Health– Entitlement (No Medicare coverage)– Date of Death

November 2018 32

Medicare Diabetes Prevention Program (MDPP) NMP Enhancement

• Part B only• NMP eligibility inquiry feature offers MDPP

details – Active, inactive, deductible and coinsurance

period• Provider registered as an MDPP ‘D1'

specialty type• Learn More

• https://med.noridianmedicare.com/web/jfb/topics/preventive-services/mdpp

November 2018 33

MDPP

• Part B Webpage• Core sessions,

beneficiary eligibility, provider requirements, HCPCS codes, documentation, reimbursement and more – https://med.noridianmedi

care.com/web/jfb/topics/preventive-services/mdpp

November 2018 34

Educational Corner

Noridian Websitehttps://med.noridianmedicare.com

• Free site• Resources

– Jurisdiction F– Medicare Part A/B

• Browse By Topic• Browse By Specialty• Fees &News• Policies• Medical Review• Education & Outreach• Enrollment • Forms

November 2018 36

Part A/B Upcoming Webinars

• Earn CEUs• Webinars

– Part A• https://med.noridianmedicare.com/web/jfa/education/

training-events– Part B

• https://med.noridianmedicare.com/web/jfb/education/training-events

– After Hours Part A/B webinars• 7:00 PM CT

November 2018 37

Online Provider Education

• Education on Demand– View self-paced tutorials

at your convenience– Keep up to date/refresher

• Certificate emailed upon completion

• Learn more– Education & Outreach

November 2018 38

Social Media Growth

• Facebook– Noridian Jurisdiction F

• Give us a ‘Like' and ‘Follow' us to stay connected

• YouTube– https://www.youtube.com/channel/U

CcmjLoqW4RyRVjOYDxQCNtA

November 2018 39

Sign Up - Medicare News!

• Receive most recent Noridian/CMS news – MLNs are posted under Latest Updates– Tuesday/Friday – Simple/quick signup

November 2018 40

Located at the bottom of every page

Ask the Contractor Teleconference

• ACT – Call in to ask question on any topic• Noridian staff available to answer• Part B Next call: November 14, 2018• No registration required• Call information

– Part B • https://med.noridianmedicare.com/web/jeb/education/act

November 2018 41

Collaboration with External Entities Form

• Form for Associations• Send to:

mac@noridian.com– Subject line:

Collaboration Request

November 2018 42

Questions?

Thank you!