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8/27/2017
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Texas Gulf HFMA
Medicare Updates
October 20, 2017
Disclaimer
All Current Procedural Terminology (CPT) only are copyright 2016 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable Federal Acquisition Regulation/ Defense Federal Acquisition Regulation (FARS/DFARS) Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
The information enclosed was current at the time it was presented. Medicare policy changes frequently; links to the source documents have been provided within the document for your reference. This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations.
Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services.
Novitas Solutions employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this guide.
This presentation is a general summary that explains certain aspects of the Medicare program, but is not a legal document. The official Medicare program provisions are contained in the relevant laws, regulations, and rulings.
Novitas Solutions does not permit videotaping or audio recording of training events.
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Novitas Solutions Education
This education contains specific contractor guidance for providers in
Medicare Administrative Contractor (MAC):
• Jurisdiction H (JH) includes: Arkansas, Colorado, Louisiana, Mississippi,
New Mexico, Oklahoma, and Texas
Acronym List
Acronym Definition
CERT Comprehensive Error Rate Testing
CMS Centers for Medicare & Medicaid Services
EDI Electronic Data Interchange
HIPAA Health Insurance Portability and Accountability Act
ICD-10 International Classification of Diseases, Tenth Revision,
Clinical Modification
MBI Medicare Beneficiary Identifier
MLN Medicare Learning Network
NCD National Coverage Determination
NPI National Provider Identifier
PHI Personal Health Information
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Today’s Presentation
Agenda:
• Quarterly Updates
• Preventative Services
• Novitas Initiatives
• Comprehensive Error Rate Testing (CERT) Program
Objectives:
• Identify and understand the current Medicare changes
• Understand how to avoid common documentation errors based on the
Comprehensive Error Rate Testing program findings
• Identify and utilize the educational resources and information
Medicare Updates
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Medicare Part A Skilled Nursing
Facility (SNF) Prospective Payment
System (PPS) Pricer Update FY 2018
Change Request # 10118:
• Effective: October, 1, 2017
• Implementation: October 2, 2017
Key Point:
Updates to the payment rates used under the PPS for SNFs for FY 2018, as
required by statute:
SNF payment increase factor is 1.0 percent
Reference:
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-
Network-MLN/MLNMattersArticles/downloads/MM10118.pdf
Medicare Annual Update
Annual October Update to the International Classification of
Diseases, Tenth Revision, Clinical Modification (ICD-10-CM):
• https://www.cms.gov/Regulations-and-
Guidance/Guidance/Transmittals/2017Downloads/R3799CP.pdf
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ICD-10 Coding Revisions to NCDs
Change Request # 10086:
• Effective: October 1, 2017
• Implementation: July 14, 2017 local edits, October 2, 2017 shared
system edits
Key Points:
• Maintenance update to NCDs:
20.29 – Hyperbaric Oxygen (HBO)
40.7 – Outpatient Intravenous Insulin Therapy
80.2 – Photodynamic Therapy
80.2.1 – Ocular Photodynamic Therapy
80.3 - Verteporfin
Reference:
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-
Network-MLN/MLNMattersArticles/Downloads/MM10086.pdf
Modify CWF Provider Queries to
Only Accept NPI as Valid Provider
Number
Change Request # 10098:
• Effective: January 1, 2018
• Implementation: January 2, 2018
Key Points:
• Modify Common Working File (CWF) provider queries to only accept
NPI as a valid provider number:
ELGA, ELGH, HIQA, HIQH and HUQA
Reference:
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-
Network-MLN/MLNMattersArticles/downloads/MM10098.pdf
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Quarterly ESRD PPS Updates
Change Request # 10193:
• Effective: October 1, 2017
• Implementation: October 2, 2017
Key Points:
• Updated to the consolidated billing list under the ESRD PPS with two
laboratory services:
G0499 - Hepb screen high risk indiv
87341 - Hepatitis b surface ag eia
Reference:
• https://www.cms.gov/Regulations-and-
Guidance/Guidance/Transmittals/2017Downloads/R3833CP.pdf
Current Procedural Terminology (CPT) only copyright 2016 American Medical Association. All rights reserved.
Supplemental Security Income (SSI)/Medicare
Beneficiary Data for Fiscal Year 2015 for IPPS
Hospitals, IRFs, and LTCH
Change Request # 10026: • Effective: July 31, 2017
• Implementation: July 31, 2017
Key Points: • Updated data for determining the disproportionate share adjustment for
Inpatient Prospective Payment System (IPPS) hospitals and the low income patient (LIP) adjustment for IRFs as well as payments as applicable for Long Term Care Hospitals (LTCH) discharges
• Files are available at the following: IPPS Hospitals:
https://www.cms.gov/Medicare/Medicare-Fee-For-Service-Payment/AcuteInpatientPPS/dsh.html
IRFs: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-
Payment/InpatientRehabFacPPS/SSIData.html
LTCH: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-
Payment/LongTermCareHospitalPPS/download.html
Reference: • https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-
MLN/MLNMattersArticles/Downloads/MM10026.pdf
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Modifications to the National
Coordination of Benefits
Agreement Crossover Process
Change Request # 10155:
• Effective: January 1, 2018
• Implementation: January 2, 2018
Key Points:
• Modify the Part A shared system maintainer’s Direct Data Entry screen
entry process to allow for the reporting of a provider taxonomy code at
the attending physician level
Reference:
• https://www.cms.gov/Regulations-and-
Guidance/Guidance/Transmittals/2017Downloads/R1876OTN.pdf
October 2017 Update of the Hospital
Outpatient Prospective Payment
System (OPPS)
Change Request # 10236:
• Effective: October 1, 2017
• Implementation: October 2, 2017
Key Points:
• Describes changes to and billing instructions for various payment
policies implemented in the October 2017 OPPS update:
Proprietary Laboratory Analyses (PLA) CPT Codes 0006U through 0017U
Effective August 1, 2017
Billing for Peripheral Artery Disease (PAD) Rehabilitation
New Procedures Requiring the Insertion of a Device
Drugs, Biologicals and Radiopharmaceuticals
Upper Eyelid Blepharoplasty and Blepharoptosis Repair
Reference:
• https://www.cms.gov/Regulations-and-
Guidance/Guidance/Transmittals/2017Downloads/R3853CP.pdf Current Procedural Terminology (CPT) only copyright 2016 American Medical Association. All rights reserved.
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Implementing the RA Messaging for the
20 Hour Weekly Minimum for Partial
Hospitalization Program (PHP) Services
Change Request # 9880:
• Effective: October 1, 2017
• Implementation: October 2, 2017
Key Points:
• PHPs are intended for patients who require a minimum of 20 hours per week of therapeutic services as evidenced in their plan of care
• Effective for PHP claims processed on and after October 1, 2017, with line item dates of service (LIDOS) on and after October 1, 2017, Novitas shall return the following Remittance Advice Remark Code (RARC) when any PHP claims receive FISS reason code W7095:
RARC N787- “Alert: An eligible PHP beneficiary requires a minimum of 20 hours of PHP services per week, as evidenced in the plan of care. PHP services must be furnished in accordance with the plan of care”
Reference:
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM9880.pdf
Current Procedural Terminology (CPT) only copyright 2016 American Medical Association. All rights reserved.
Signature Requirements for Scribes
Change Request # 10076:
• Effective: June 6, 2017
• Implementation: June 6, 2017
Key Points:
• Scribes are not providers of items or services
• Scribes are used by a provider in documenting medical records:
CMS does not require the scribe to sign/date the documentation
• Treating physician’s/non-physician practitioner’s signature affirms the
note adequately documents the care provided
Reference:
• https://www.cms.gov/Regulations-and-
Guidance/Guidance/Transmittals/2017Downloads/R713PI.pdf
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Qualified Medicare Beneficiary
(QMB) Indicator
Change Request # 9911:
• Effective: October 2, 2017
• Implementation: October 2, 2017
Key Points:
• Provider Remittance Advice will notify providers that the beneficiary is
enrolled in the QMB program and may not bill for Medicare deductibles,
coinsurance or copayments
• Beneficiaries will also be notified through their Medicare Summary
Notice there is no Medicare cost-sharing liability because they are
enrolled in the QMB program
• There will be Remittance Advice Remark Codes (RARC) that are
specific to those enrolled in QMB
Reference:
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-
Network-MLN/MLNMattersArticles/Downloads/MM9911.pdf
New Medicare Card
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
requires CMS to remove Social Security Numbers (SSNs) from all
Medicare cards by April 2019
Medicare Beneficiary Identifier (MBI) will replace the SSN-based
Health Insurance Claim Number (HICN) on the new Medicare cards:
• 11-characters in length
• Made up only of numbers and uppercase letters (no special characters)
Transition period:
• Will begin no earlier than April 1, 2018 and run through December 31,
2019:
Either the HICN or the MBI can be used
Use the MBI or the HICN to check Medicare eligibility, after transition period
ends use only the MBI
Use the beneficiary identifier (MBI or HICN) you used to submit the claim
that’s under appeal, even after the transition period
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Medicare Beneficiary Identifier
(MBI) Characteristics
The Medicare Beneficiary Identifier will have the following
characteristics:
• The same number of characters as the current Health Insurance Claim
Number (HICN) (11), but will be visibly distinguishable from the HICN
• Contain uppercase alphabetic and numeric characters throughout the
11 digit identifier
• Occupy the same field as the HICN on transactions
• Be unique to each beneficiary (e.g. husband and wife will have their
own MBI)
• Be easy to read and limit the possibility of letters being interpreted as
numbers (e.g. Alphabetic characters are upper case only and will
exclude S, L, O, I, B, Z)
• Not contain any embedded intelligence or special characters
• Not contain inappropriate combinations of numbers or strings that may
be offensive
HICN and MBI Number
Health Insurance Claim Number (HICN):
• Primary Beneficiary Account Holder Social Security Number (SSN) plus
Beneficiary Identification Code (BIC)
• 9-byte SSN plus 1 or 2-byte BIC
• Key positions 1-9 are numeric
Medicare Beneficiary Identifier (MBI):
• New Non-Intelligent Unique Identifier
• 11 bytes
• Key positions 2, 5, 8, and 9 will always be alphabetic
https://www.cms.gov/Medicare/SSNRI/SSNRI-ODF-slides-11-1-
16.pptx
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What Providers Need to Know on
the New Medicare Card
How will providers get the MBI?:
• During the transition period, the MBI will be on the remittance advice
when you submit a claim using your patient’s HICN
• In the message field on the eligibility transaction responses it will let you
know when a new Medicare card has been mailed to each person with
Medicare
• Your systems must be ready to accept the MBI by April 2018:
No earlier than April 2018 Medicare cards will be sent, people new to
Medicare will only be assigned an MBI
Claim forms:
• Not changing:
During the transition period, you can use either the HICN or the MBI
Once the transition period ends, you must use the MBI
Get more information about the SSNRI:
• https://www.cms.gov/Medicare/SSNRI/Index.html
“5 Ways for Healthcare Providers to
Get Ready for New Medicare Cards
Here are 5 steps you can take today to help your office or healthcare
facility get ready:
• Go to CMS provider website and sign-up for the weekly MLN
Connects® newsletter
• Attend CMS quarterly calls to get more information
• Verify all of your Medicare patients’ addresses
• Work with us to help your Medicare patients adjust to their new
Medicare card
• Test your system changes and work with your billing office staff to be
sure your office is ready to use the new MBI format
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Resources
New Medicare Cards:
• https://www.cms.gov/medicare/new-medicare-card/nmc-home.html
Provider web page:
• https://www.cms.gov/Medicare/New-Medicare-
Card/Providers/Providers.html
New Medicare Card Open Door Forums:
• https://www.cms.gov/Medicare/New-Medicare-Card/Open-Door-
Forums.html
Subscribe to get the latest news and information about the new
Medicare cards:
https://public.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=U
SCMS_12325
MOON Overview
Federal Notice of Observation Treatment and Implication for Care
Eligibility ACT (NOTICE Act) passed August 6, 2015:
• NOTICE Act requires all hospitals and CAHs to provide written and oral
notification to individuals receiving observation services as outpatients
for more than 24 hours
MOON is a standardized notice to inform beneficiaries they are:
• An outpatient receiving observation services
• Not an inpatient of the hospital or CAH
• No Part A benefits paid for observation care:
Self-administered drugs not covered under Medicare Part B
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Hospital Delivery of the MOON
Provide both standardized written as well as oral notification
Must include the reason the individual is receiving observation services
Hospitals or CAHs must obtain the signature of the individual or an authorized individual acting on behalf of the patient:
• Electronic issuance is permitted
• A paper copy of the MOON must be given regardless if paper or electronic issuance
Beneficiary refusal to sign:
• Staff member who presented the written notification will sign and give the date and time of refusal (date of notice receipt)
Must use the OMB-approved MOON CMS-10611 Form:
• https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-10611.html
When To Issue the MOON
Medicare beneficiaries receiving observation services for more than
24 hours
Delivery of the MOON before an individual has received 24 hours of
observation services is allowed:
• Sooner if beneficiary is transferred, discharged or admitted inpatient
• Allows consistency with any applicable State laws
Must be delivered no later than 36 hours after observation services
are initiated
Beneficiaries who do not have Part B coverage
Beneficiaries who are subsequently admitted as an inpatient prior to
the required delivery of the MOON
Hospitals are still required to deliver the MOON regardless if:
• Medicare is the primary or secondary payer
• Beneficiary has a Medicare Advantage plan
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MOON References
CMS IOM, Pub 100-04, Chapter 30 – Financial Liability Protection,
Section 400 – Part A Medicare Outpatient Observation Notice:
• https://www.cms.gov/Regulations-and-
Guidance/Guidance/Manuals/Downloads/clm104c30.pdf
MOON Instructions:
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-
Network-MLN/MLNMattersArticles/Downloads/MM9935.pdf
MOON FAQs:
• https://www.cms.gov/Medicare/Medicare-General-
Information/BNI/Downloads/MOON-FAQs.docx
MOON Inquiries:
• Send emails to:
Beneficiary Notice Initiative (BNI)
Notifications given by providers to beneficiaries to communicate financial liability, appeal rights and protections:
• FFS Advance Beneficiary Notice of Noncoverage (FFS ABN)
• FFS Home Health Change of Care Notice (FFS HHCCN)
• FFS Skilled Nursing Facility Advance Beneficiary Notice (FFS SNFABN) and SNF Denial Letters
• FFS Hospital-Issued Notices of Noncoverage (FFS HINNs)
• FFS Expedited Determination Notices for Home Health Agencies, Skilled Nursing Facility, Hospice and Comprehensive Outpatient Rehabilitation Facility (FFS Expedited Determination Notices)
• MA Denial Notices (MA Denial Notices)
• MA Expedited Determination Notices (MA Expedited Determination Notices)
• Important Message from Medicare (IM) and Detailed Notice of Discharge (DND) (Hospital Discharge Appeal Notices)
• FFS Notice of Exclusion from Medicare Benefits - Skilled Nursing Facility (FFS NEMB SNF)
https://www.cms.gov/Medicare/Medicare-General-Information/BNI/index.html
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New ABN Form Updates
ABN form (CMS-R-131) has been approved by the Office of Management and Budget (OMB) for renewal:
• Effective: June 21, 2017
• New expiration date on the form:
Be sure to use the form with the date 3/20/20 at the bottom
• Rehabilitation Act of 1973 (Section 504) revises the form to include language informing beneficiaries of rights to CMS nondiscrimination practices and how to request alternative format if needed
• No other changes to the form
ABN form (CMS-R-131):
• https://www.cms.gov/Medicare/Medicare-General-Information/BNI/Downloads/ABN-Forms-English-and-Spanish.zip
ABN form instructions:
• https://www.cms.gov/Medicare/Medicare-General-Information/BNI/Downloads/ABN-Form-Instructions.pdf
Questions regarding the ABN can be emailed to:
New ABN Form
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Hospital Discharge Appeal Notices
Updates
Newly incorporated expiration dates have been added to each form:
• Important Message from Medicare (IM) Form CMS-R-193:
https://www.cms.gov/Medicare/Medicare-General-
Information/BNI/Downloads/Important-Message-English-and-Spanish.zip
• Detailed Notice of Discharge (DND) Form CMS-10066:
https://www.cms.gov/Medicare/Medicare-General-
Information/BNI/Downloads/Detailed-Notice-English-and-Spanish.zip
Part A Quarterly/Annual Updates
Update-Inpatient Psychiatric Facilities Prospective Payment System
(IPF PPS) Fiscal Year (FY) 2018:
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-
Network-MLN/MLNMattersArticles/Downloads/MM10214.pdf
October 2017 Integrated Outpatient Code Editor (I/OCE)
Specifications Version 18.3:
• https://www.cms.gov/Regulations-and-
Guidance/Guidance/Transmittals/2017Downloads/R3852CP.pdf
October Quarterly Update to 2017 Annual Update of HCPCS Codes
Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB)
Enforcement:
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-
Network-MLN/MLNMattersArticles/Downloads/MM10163.pdf
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More Part A Quarterly/Annual
Updates
Quarterly Update to the Correct Coding Initiative (CCI) Edits, Version 23.2, Effective October 1, 2017:
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10183.pdf
Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2017:
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10156.pdf
Claim Status Category and Claim Status Codes Update:
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10043.pdf
October 2017- Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files:
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10187.pdf
Influenza Vaccine Payment Allowances - Annual Update for 2017-2018 Season:
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10224.pdf
Additional Part A Quarterly/Annual
Updates
Fiscal Year (FY) 2017 Inpatient Prospective Payment System (IPPS) and
Long-Term Care Hospital (LTCH) PPS Changes:
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-
MLN/MLNMattersArticles/Downloads/MM9723.pdf
Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment
System (PPS) Pricer Changes for FY 2018:
https://www.cms.gov/Regulations-and-
Guidance/Guidance/Transmittals/2017Downloads/R3849CP.pdf
Remittance Advice Remark and Claims Adjustment Reason Code,
Medicare Remit Easy Print and PC Print Update:
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-
MLN/MLNMattersArticles/downloads/MM10040.pdf
Notice of New Interest Rate for Medicare Overpayments and
Underpayments -4th Qtr Notification for FY 2017:
https://www.cms.gov/Regulations-and-
Guidance/Guidance/Transmittals/2017Downloads/R280FM.pdf
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Novitas Initiatives
Novitas Medicare Learning Center
Features:
• Create an individualized education account
• Register for webinars, teleconferences, and workshops
• Download your Continuing Education Unit (CEU) Certificates
• Be placed on a waitlist if the educational event you register for is closed
Benefits:
• Centralized location for all educational materials
• Track all of the educational events you’ve attended
• Access Medicare education 24 hours a day, 7 days a week with web-
based training modules
JH Providers:
• http://www.novitas-
solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00081
812
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Novitasphere
Free Web-based portal
Part A – Access to Eligibility, Medical Review Record Submission, ,
Claim Submission with File Status, and Audit and Reimbursement
Cost Reports Submission
Part B - Access to Eligibility, Claim Information and Remittance
Advice, Claim Submission with File Status, Electronic Remittance
Advice (ERA), Claim Correction, Secure Messaging and a MailBox
Live Chat feature
Dedicated Help Desk- 1-855-880-8424
For demonstrations and more information:
• JH Providers:
http://www.novitas-solutions.com/webcenter/portal/Novitasphere_JH/
Website Satisfaction Surveys
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Join Our Email List Today
Stay current with Medicare by receiving emails twice a week
Available email lists (not all-inclusive):
• Jurisdiction L
• Jurisdiction H
• Part B Electronic Billing
• Novitasphere Portal
• ABILITY| PC-ACE
• Medicare Remit Easy Print (MREP) Users
JH Providers join using:
• http://www.novitas-
solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00007
968
Part A Publications
Latest Part A News & Website Updates
News Bulletins & Articles
Monthly Medicare Part A Newsletters
Novitas Solutions e-News
Novitas Educational Tips and Tools (NETTs)
Reference Manual
JH Providers:
• http://www.novitas-
solutions.com/webcenter/portal/Bulletins_JH/Publications
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On-Demand Education
Frequently Asked Questions
Novitas Educational Tips and Tools (NETTs)
Podcasts
Educational Videos and Tutorials:
• Watch and learn about the Medicare program and our website's
features
• JH Providers:
http://www.novitas-
solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00082787
Centers for Medicare & Medicaid
Services (CMS)
CMS Internet Only Manuals (IOMs): • Offers day-to-day operating instructions, policies, and procedures
based on statutes and regulations, guidelines, models, and directives
Medicare Learning Network (MLN) Matters Articles: • Your destination for health care professional education products
Open Door Forums: • Provides an opportunity for live dialogue between CMS and the
stakeholder community at large
Quarterly Provider Updates: • Published quarterly for providers, suppliers, and the general public
http://www.cms.gov/
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Provider Specialties / Services
One stop shop to direct access to consolidate information for certain
provider specialties and other specific services:
• Ambulance
• End Stage Renal Disease
• Federally Qualified Health Centers
• Medicare Secondary Payer
• Observation
• Rural Health Centers
• Skilled Nursing Facilities
• Therapy
• Inpatient Perspective Payment System
• And many more
JH provider specialty search:
• http://www.novitas-
solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00134579
Comprehensive Error Rate Testing
(CERT) Program
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CERT Program
Program developed by CMS to monitor the accuracy of claims
processing
Designed to protect the Medicare trust fund and determine error
rates nationally and regionally
Random audits conducted on a monthly basis:
• AdvanceMed request medical records for claims selected as part of the
monthly random sample
• Medical record documentation supporting claim must be returned in
designated time frame
JH CERT page:
• http://www.novitas-solutions.com/webcenter/portal/CERT_JH/CERT
CERT Program New Processes
Documentation Requests:
• All FIRST Additional Documentation Request (ADR) letters for CERT
are sent to the address on file with the National Supplier Clearinghouse
(NSC) for the Medicare Administrative Contractor (MAC) for the
provider/supplier that billed/submit the claim
• All SUBSEQUENT ADR letters can be sent to a specific
correspondence address:
This can be provided to the CERT Customer Service Representative (CSR)
by calling 888-779-7477
• More information:
JH Providers:
http://www.novitas-
solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00156103
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New CERT Documentation
Contractor
AdvanceMed, the current Comprehensive Error Rate Testing
(CERT) Review Contactor, will also be operating the CERT
Documentation Center
All CERT inquires and medical records should be sent to
AdvanceMed
More Information:
• https://www.cms.gov/Outreach-and-
Education/Outreach/FFSProvPartProg/Provider-Partnership-Email-
Archive-Items/2016-09-29-eNews.html
CERT Identification Online Tool
Provides status information for sampled claims using the Claim
Identification Number (CID) where a decision has been made by the
CERT contractor:
• Claim in Error- CERT error was assessed or not
• Status Date- last date that CERT updated/reviewed the case
• Status Decision- where the claim is with the CERT Review Contractor
• Appealed- if an appeal was initiated and the appeal status
• Error Code- errors assessed
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CERT Appeals vs. Claim
Adjustments
Part A providers may not cancel or adjust claims selected in the CERT review process
Notify CERT if an error has been made on a claim, do not cancel or adjust claims
Novitas initiates adjustments for necessary denials
CERT adjustments in FISS appear as XXH bill type
Appeal denials on XXH bill type as a means of submitting corrections to claims using the Medicare Part A Redetermination Request form
JH Article:
• http://www.novitas-solutions.com/webcenter/spaces/MedicareJH/page/pagebyid?contentId=00003498
JL Article:
• http://www.novitas-solutions.com/webcenter/spaces/MedicareJL/page/pagebyid?contentId=00003498
Medical Record Signature
Reminders
Categorized as “Insufficient Documentation” errors:
• Missing signatures
• Illegible handwritten signatures
• Electronic signatures not dated
• Attestation statements do not match the date of service
Records must be signed and dated
Include signature logs to determine handwritten signatures
Complete attestation statements when records are not signed
Do not add late signatures
CMS Complying with Medicare Signature Requirements:
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-
Network-
MLN/MLNProducts/downloads/Signature_Requirements_Fact_Sheet_I
CN905364.pdf
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Summary
Gave key points and references to the latest quarterly updates
Stay up to date with the latest Medicare changes by visiting the
Novitas Solutions website
Be aware of CERT documentation request and respond
appropriately
Complete the Credit Balance Report accurately and timely
Take advantage of the various self service options available to the
provider community
JH Customer Contact Information
Providers are required to use the IVR unit to obtain:
• Claim Status
• Patient Eligibility
• Check/Earning
• Remittance inquiries
Customer Contact Center- 1-855-252-8782
Provider Teletypewriter- 1-855-498-2447
JH Self-Service Tools:
• http://www.novitas-
solutions.com/webcenter/portal/CustomerServiceCenter_JH/Self-
Service+Tools
Patient / Medicare Beneficiary:
• 1-800-MEDICARE (1-800-633-4227)
• http://www.medicare.gov/index.html
8/27/2017
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Important Contacts
Janice Mumma
Supervisor Provider Outreach and Education
717-526-6406
Teresa Tatum
Education Specialist, Provider Outreach and Education
Thank you
