Approved 2017 MIPS registry list released

Originally published in the April 19th issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

In response to MGMA advocacy calling for an expedited release of crucial program information, the Centers for Medicare & Medicaid Services (CMS) released the 2017 list of approved qualified registries. Physician practices may utilize these third-party vendors to report individual or group data for the Quality, Advancing Care Information, and Improvement Activities categories of the Merit-Based Incentive Payment System (MIPS) in order to avoid a -4% penalty and potentially earn a small bonus in 2019. Registry is one of several MIPS reporting options. For more information and resources to help your group succeed in MIPS, visit MGMA’s MACRA Resource Center.

Palmetto GBA E-mail Update: Tuesday, April 11, 2017

Provider Enrollment Revalidation – Cycle 2
Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers/suppliers to revalidate their Medicare enrollment information under new enrollment screening criteria. In an effort to streamline the revalidation process and reduce provider/supplier burden, CMS has implemented several revalidation processing improvements that are captured within this article. Make sure your staff is aware.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General

Local Coverage Determination (LCD) Update: Part A and Part B
The Minimally Invasive Treatment for Benign Prostatic Hyperplasia Involving Prostatic Urethral Lift (Urolift) L36109 for JM A/B MAC LCDs was revised. Please share with appropriate staff.

Applies to:

  • JM Part A//General
  • JM Part B//General

July 2017 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
Change Request (CR) 10016 provides the July 2017 ASP drug pricing files and quarterly updates, and if released by the Centers for Medicare & Medicaid Services (CMS), the revised April 2017, January 2017, October 2016, and July 2016 Average Sales Price (ASP) drug pricing files for Medicare Part B drugs. Medicare will use these files to determine the payment limit for claims for separately payable Medicare Part B drugs processed or reprocessed on or after July 3, 2017, with dates of service July 1, 2017, through September 30, 2017. MACs will not search and adjust claims previously processed unless brought to their attention.

Applies to:

  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare
  • JM Home Health and Hospice//General

Local Coverage Determination (LCD) Updates Part B
The Hyaluronate Polymers L33432 LCD for JM Part B LCD, was revised. Please share with appropriate staff.

Applies to:

  • JM Part B//General

Palmetto GBA E-mail Update: Thursday, April 06, 2017

Change to Check Mailing Addresses
Palmetto GBA has reduced the number of addresses used for submitting provider checks to satisfy Medicare debts. Please immediately begin using the addresses in this article to submit payment for any Medicare Debts. All other PO Boxes will be closed. Please share with appropriate staff.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General

Gain Insight Into Your Billing Patterns and Utilization Services: Use Electronic Comparative Billing Reports (eCBRs)
Palmetto GBA uses electronic Comparative Billing Reports (eCBRs) as an educational tool for providers to use in order to provide insight into your billing patterns and utilization of services in comparison to your peers. eCBR will provide you with the ability to view and download your individual CBR online.

Applies to:

  • JM Part B//General
  • JM Part B//Chiropractic
  • JM Part B//Physician
  • JM Part B//Primary Care

eUtilization: See Who Has Been Using Your NPI
Electronic Utilization (eUtilization) reports are now available in the eServices 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.

Applies to:

  • JM Part B//General
  • JM Part B//Physician
  • JM Part B//Primary Care

Palmetto GBA E-mail Update: Tuesday, April 04, 2017

eServices Makes Asking a Medicare Question Easier
Palmetto GBA has Secure eChat to make asking Medicare questions easier. 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 specific inquires or address questions that require the sharing of PHI information! Using Secure eChat is simple! Please share with appropriate staff.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General

What Can You Expect to Receive from the CERT Contractor?
You can expect to receive the following from the CERT Contractor: Information on the CERT process; Health Insurance Portability Accountability Act (HIPAA) compliance information; What documentation to submit; Timeframe for responding to the request; and Claim information.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Inquiries for Unprocessable/Rejected Claims
Did you know the top two reasons for Palmetto GBA Provider Contact Center inquiries in February all had to do with claims that were unprocessable or rejected? When a claim is rejected (also referred to as unprocessable) the claim is not afforded appeal rights. You must correct and refile the claim correcting the missing, invalid or incomplete information. Reason code MA-130 will appear on your remittance advice (RA) along with one or more remark codes that outline the error causing a claim to be considered unprocessable. If your clearinghouse is not providing you with associated remarks code to explain why a claim was rejected, speak with your clearinghouse to receive that information. Please share with appropriate staff.

Applies to:

  • JM Part B//General

Unprocessable/Rejected Claims Webcast: April 13
Jurisdiction M will hold a Part B Unprocessable/Rejected Claims Webcast on April 13, 2017, at 10 am, ET. This webcast will include identifying, correcting, and reviewing examples and resources to resolve and prevent rejected claims. Please plan to attend.

Applies to:

  • JM Part B//General

E/M Weekly Tip: History Component – Status of Three Chronic/Inactive Conditions
An extended History of Present Illness (HPI) ma y consist of the status of three chronic/inactive conditions for either set of guidelines (1995 or 1997) for services performed on or after on or after September 10, 2013. Please share with appropriate staff.

Applies to:

  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

New Waived Tests
Change Request (CR) 9956 informs MACs of new Clinical Laboratory Improvement Amendments of 1988 (CLIA) waived tests approved by the Food and Drug Administration (FDA). Since these tests are marketed immediately after approval, the Centers for Medicare & Medicaid Services (CMS) must notify MACs of the new tests so that they can accurately process claims. Make sure that your billing staffs are aware of these CLIA-related changes.

Applies to:

  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Palmetto GBA E-mail Update: Tuesday, March 28, 2017

Action Needed: Due to Increased CMS Security Requirements, eServices Portal Users Must Sign Up for Multi-Factor Authentication (MFA) by July 1, 2017
This article informs providers who use the eServices Portal that they must sign up for MFA by July 1, 2017. Instructions on how to register for MFA are also included in this article. Please review this information and share it with your staff who uses eServices.

Applies to:

  • JM Part A//General
  • JM Part B//General
  • JM Home Health and Hospice//General
  • Railroad Medicare (RRB)//General – Railroad Medicare
  • eServices//General Information

Palmetto GBA E-mail Update: Wednesday, March 22, 2017

Release of Beneficiary Information to Ambulance Providers of Repetitive Scheduled Non-Emergent Transports
Ambulance providers requesting documentation for prior authorization are reminded to ensure that the dialysis center or physician being asked for documentation has the authorization to release this information. This article includes a statement that may be considered as an addition to the release and a reference article.

Applies to:

  • JM Part B//Ambulance
  • JM Part B//General

EDI Enrollment Instructions Guide Module
Do you need help completing your EDI Enrollment packet? This guide will give you all the information you need to get started. Please share with appropriate staff.

Applies to:

  • JM Part B//General

Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI); LCD L34431
Palmetto GBA has added a new Jurisdiction M Part B CPIL regarding Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI); LCD L34431.

Applies to:

  • JM Part B//General

Unclassified or Not Otherwise Classified (NOC) Drug Codes: Rejected if Not Submitted Correctly
As a reminder, please do not file unlisted codes for procedures (i.e., surgical) without indicating a description of the service being provided for payment. Please share with appropriate staff.

Applies to:

  • JM Part B// General

Two New Articles Posted to MLN Matters

New Articles

MM10000
Billing for Advance Care Planning (ACP) Claims
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10000.pdf

MM10036
Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2017
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10036.pdf