Palmetto GBA E-mail Update: Tuesday, September 12, 2017

October 2017 Release ‘Dark Days’ for the Common Working File (CWF) Hosts
In anticipation of the October 2017 Release, the CWF Hosts will not process claims beginning Friday, September 29, 2017 through Sunday, October 1, 2017. During this period, which is commonly referred to as ‘dark days,’ the CWF Hosts will install the October 2017 Release, complete weekly/monthly/quarterly processing activities, and perform scheduled data center maintenance. This means Medicare Administrative Contractors (MACs) will not have access to the Health Insurance Master Record (HIMR) and Beneficiary Data Streamlining (BDS) transactions. Eligibility information in HIQA and HIQH will also not be available to providers.

Applies to:

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

Influenza And Pneumococcal Vaccines And Administration Reimbursement
These immunizations are paid at 100 percent of the established fee schedule amount. Coinsurance and the annual deductible do not apply. Please share with appropriate staff.

Applies to:

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

Palmetto GBA E-mail Update: Monday, September 11, 2017

Email and Faxed Inquiries
CMS requires all providers to utilize the Provider Contact Center (PCC) (855-696-0705) as their point of contact with their Medicare Administrative Contractors. If you submit an unsolicited fax or email inquiry directly to a specific department or individual your inquiry will be routed to the written correspondence area within the PCC for proper logging, tracking, research and response. An escalation process is used for complex issues. Submitting inquires directly to the PCC will assure CMS compliance and allow for the most timely response.

Applies to:

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

Provider Contact Center (PCC) To Close For Training On September 15
The Provider Contact Center (PCC) will be closed for training on September 15, 2017, from 8 a.m. to 12 p.m. ET. The PCC will reopen at 12 p.m. ET.

Applies to:

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

2018 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update
CR10262 provides the 2018 annual update of HCPCS Codes for SNF Consolidated Billing (SNF CB) and explains how the updates affect edits in Medicare claims processing systems. By the first week in December 2017, new code files will be posted at http://www.cms.gov/SNFConsolidatedBilling/. Make sure your staff is aware.

Applies to:

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

Medicare Secondary Payer Inquiry Form
As a reminder, A Medicare Secondary Payer Inquiry Form is available in the Medicare Secondary Payer forms section of our website. To ensure timely processing of your request, this form should be used for any Medicare Secondary Payer (MSP) request pertaining to Primary or Secondary payment of claims. Please share with appropriate staff.

Applies to:

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

A/B MACs Team Up with DME MACs for External Breast Prostheses and Related Mastectomy Supplies Webinar: October 18
Local A/B MACs and the DME MACs are excited to announce two collaboration webinars coming October 18, 2017. The event will be offered twice in the same day to accommodate national attendees. This webinar will focus on Medicare’s coverage of External Breast Prostheses and related supplies following surgical intervention. The educational representatives hosting the webinar will also spend time reviewing documentation requirements (such as detailed written orders and medical records). There will be plenty of time for questions after the presentation portion of the webinar. Please plan to attend.

Applies to:

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

MACtoberfest Workshop Conference: Innovation Today for Success Tomorrow
Palmetto GBA, the JM A/B MAC, is presenting an informative workshop in Columbia, South Carolina that will provide information related to the most common errors identified through a variety of data analysis and tips to avoid them. This workshop is intended to keep providers apprised of Medicare guidelines as well as using technology for better results. The recommended participants are administrators, billers, nurses and other healthcare professionals that submit claims to Medicare. Topics include: Electronic Data Interchange (EDI), Medicare Updates, Appeals, Medical Affairs, Medical Review, eServices portal, and Provider Enrollment and Revalidations. This is a free event! Please plan to attend.

Applies to:

  • JM Part B//General

September 2017 Medicare Part B Updates, Changes and Reminders: September 20
Palmetto GBA will host the Medicare Administrative Contract Part B September 2017 Quarterly Updates, Changes and Reminders Webcast on September 20, 2017, at 10 am. ET. These updates, changes and reminders include any new billing regulations, hot topics that impact provider billing, and a Q & A segment for questions on covered material. Note: An NPI and PTAN are required to register. You should only enter ‘n/a’ if you do not have an NPI or PTAN. Please share with your staff, and register today.

Applies to:

  • JM Part B//General

Did you know you can view your latest electronic Comparative Billing Report (eCBR) in eServices?
Did you know you can view your latest electronic Comparative Billing Report (eCBR) in eServices? Be sure to check them out today!

Applies to:

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

eServices makes it easy to monitor the use of your NPI!
eUtilization reports provide rendering providers and ordering and referring providers access to their personal data. Check them out today.

Applies to:

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

Palmetto GBA E-mail Update: Friday, August 25, 2017

Email and Faxed Inquiries
CMS requires all providers to utilize the Provider Contact Center (PCC) (855-696-0705) as their point of contact with their Medicare Administrative Contractors. If you submit an unsolicited fax or email inquiry directly to a specific department or individual your inquiry will be routed to the written correspondence area within the PCC for proper logging, tracking, research and response. An escalation process is used for complex issues. Submitting inquires directly to the PCC will assure CMS compliance and allow for the most timely response.

Applies to:

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

September 2017 Medicare Advisory
The September 2017 Medicare Advisory is now available. Please review this issue for Medicare policy and coverage updates as well as announcements for upcoming provider education opportunities. Please remember to share this information with your staff.

Applies to:

  • JM Part B//General

When using the Clock Draw test (CDT) to assess the patient’s cognitive function as part of the Annual Wellness Visit, do we need to scan the actual paper CDT into the patient’s medical record?
The provider may scan the patient’s Clock Draw test (CDT) but it is not required. At a minimum the interpretation and scoring of the drawing must be documented. Please share with appropriate staff.

Applies to:

  • JM Part B//General

A Physician’s Guide to Medicare Part D Medication Therapy Management (MTM) Programs
Medication Therapy Management providers work with physicians to deliver the best medication therapy to patients and to coordinate their medication therapy across multiple practitioners. The latest clinical information is used by MTM providers when reviewing patients’ medication therapy, such as updates to the Beers criteria for high-risk medications and revised monographs for old and new medications. MTM providers also listen to patients’ concerns about their medications and may offer recommendations to physicians and patients to help achieve their goals of therapy. As always, physicians make the final decisions about changes in drug therapy.

Applies to:

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

Palmetto GBA E-mail Update : Thursday, August 24, 2017

Email and Faxed Inquiries
CMS requires all providers to utilize the Provider Contact Center (PCC) (855-696-0705) as their point of contact with their Medicare Administrative Contractors. If you submit an unsolicited fax or email inquiry directly to a specific department or individual your inquiry will be routed to the written correspondence area within the PCC for proper logging, tracking, research and response. An escalation process is used for complex issues. Submitting inquires directly to the PCC will assure CMS compliance and allow for the most timely response.

Applies to:

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

CMS Launches Jimmo Settlement Agreement Webpage
The Centers for Medicare & Medicaid Services (CMS) reminds the Medicare community of the Jimmo Settlement Agreement (January 2013), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met). Specifically, the Jimmo Settlement required manual revisions to restate a “maintenance coverage standard” for both skilled nursing and therapy services.

Applies to:

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

Medicare Secondary Payer Inquiry Form
As a reminder, A Medicare Secondary Payer Inquiry Form is available in the Medicare Secondary Payer forms section of our website. To ensure timely processing of your request, this form should be used for any Medicare Secondary Payer (MSP) request pertaining to Primary or Secondary payment of claims. Please share with appropriate staff.

Applies to:

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

Prohibition on Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program
Medicare providers may not bill QMB individuals for Medicare cost-sharing, regardless of whether the State reimburses providers for the full Medicare cost-sharing amounts. Further, all original Medicare and MA providers–not only those that accept Medicaid–must refrain from charging QMB individuals for Medicare cost-sharing. Providers who inappropriately bill QMB individuals are subject to sanctions.

Applies to:

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

Palmetto GBA E-mail Update: Wednesday, August 09, 2017

Create a Signature Log
If a provider does not have a signature log currently in place, the provider may create a signature log at any time. Medicare contractors will accept all submitted signature logs regardless of the date on which they were created. Please share with appropriate staff.

Applies to:

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

Quarterly Influenza Virus Vaccine Code Update – January 2018
Change Request (CR) 10196, from which this article was developed, provides instructions for payment and edits for the Common Working File (CWF) and the Fiscal Intermediary Shared System (FISS) to include and update new or existing influenza virus vaccine codes. The influenza virus vaccine code set is updated on a quarterly basis. This update will include one new influenza virus vaccine code. Please make sure your billing staffs are aware of this update.

Applies to:

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

Part B Billing for Certain New Biosimilar Biological Products before the Modifier is Implemented
Modifiers that identify the manufacturer of a biosimilar biological product are required on Part B claims. CMS updates assignment of modifiers to specific HCPCS codes quarterly. In situations where a HCPCS code is already associated with one or more modifiers and a new biosimilar biological product becomes available before its corresponding manufacturer’s modifier becomes effective, a Not Otherwise Classified (NOC) code without a modifier may be used to bill for the new biosimilar product. Check out the website for more details.

Applies to:

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

Palmetto GBA E-mail Update: Tuesday, August 01, 2017

CMS National Provider Enrollment Conference: September 6 and 7, 2017
The Centers for Medicare & Medicaid Services (CMS) will hold a National Provider Enrollment Conference on Wednesday, September 6, 2017 from 8 a.m. to 5 p.m. EDT and Thursday, September 7, 2017 from 8 a.m. to 3 p.m. EDT. This session will be held at the Charleston Area Convention Center located at 5000 Coliseum Dr., North Charleston, SC 29418. Don’t miss this opportunity to interact directly with CMS and Medicare Administrative Contractor provider enrollment experts. Registration for this free conference ends August 29, 2017. Please plan to attend.

Applies to:

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

Rendering Physicians Can Now Review Their Individual Medicare Billing Activities!
Palmetto GBA is excited to announce that rendering physicians now have access to eReview functions via the eServices portal to review and analyze their Medicare billing activity. JM Part B rendering physicians who are currently listed in PECOS may register for a rendering physician account in eServices.

Applies to:

  • JM Part B//General

Palmetto GBA E-mail Update: Monday, July 31, 2017

Correct Date of Service for Specific Services
This article is applicable to physicians, non-physician practitioners, and others submitting claims on a CMS-1500 form for reimbursement for Medicare Part B services. Physicians and non-physician practitioners need to identify the correct date of service for the services they provide to a Medicare patient.Please review and share it with your staff.

Applies to:

  • JM Part B//General

Opt Out Listing
This article includes a listing of those providers who have elected to opt out of the Medicare program. If you’ve recently opted out of the Medicare Program it’s possible that your name will not appear on the website until the next quarterly update. Please share with appropriate staff.

Applies to:

  • JM Part B//General

New Waived Tests
Change Request (CR) 10198 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