Palmetto GBA E-mail Update: Friday, July 21, 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

August 2017 Medicare Advisory
The August 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

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

Palmetto GBA E-mail Update: Monday, July 17, 2017

Claims Payment/Processing Issues Log Webcast: July 26
Palmetto GBA will host a Part B Claims Payment/Processing Issues Log (CPIL) webcast on July 26, 2017 at 10 am, ET. This 60-minute Webcast is designed to provide an overview of the CPIL available on the Part B Palmetto GBA website and will include a question and answer period for questions related to accessing and using the CPIL. This webcast will include: how to access the CPIL, types of issues included on the log, and how to sign up for email notification of an individual CPIL updates. Please plan to attend.

Applies to:

  • JM Part B//General

North Carolina Part B Providers: Quality Payment Program (QPP) Webcast: July 25
North Carolina Part B providers, do you need help in being successful under the Quality Payment Program? Please join Alliant as we partner with Palmetto GBA on Tuesday, July 25th at 1:00 pm ET, for information concerning the Quality Payment Program. This webcast is intended for North Carolina Part B providers. The Quality Payment Program improves Medicare by helping practices focus on care quality and the one thing that matters most – making patients healthier. If you participate in Medicare Part B, the Quality Payment Program will provide new tools and resources to help you give your patients the best possible care. Please plan to attend.

Applies to:

  • JM Part B//General

Part B Top 10 Medical Review Denials Webcast: July 31
Please join Palmetto GBA on July 31, 2017, at 10:30 a.m. ET as we share the Top 10 Medical Review Denials and provide a better understanding of medical review denial reasons. During this 45 minute webcast, providers can expect to learn about: top medical review denials; edit effectiveness letter; denial documentation examples; medical necessity; and documentation tips. Please plan to attend.

Applies to:

  • JM Part B//General

Signature Log Can Be the Key
Do you have questions regarding the signature log? A signature log is a typed listing of the provider(s) identifying their name with a corresponding handwritten signature. This may be an individual log or a group log. A signature log may be used to establish signature identity as needed throughout the medical record documentation.

Applies to:

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

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

E/M Weekly Tip

E/M Weekly Tip: History Component ‘Unable to Obtain’
If you are unable to obtain the review of systems (ROS) and past, family and social history from the patient/source, the documentation must clearly describe the patient’s condition or other circumstance. Please share with appropriate staff.

Applies to:

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

Palmetto GBA E-mail Update: Friday, June 16, 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

Reminder of Advance Beneficiary Notice of Noncoverage (ABN) Renewal
The Centers for Medicare & Medicaid have renewed the Advance Beneficiary Notice of Noncoverage (ABN) Form CMS-R-131. Please note no changes have been made to the form itself; however, the newly incorporated expiration date is March 2020. Please share with appropriate staff.

Applies to:

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

E/M Weekly Tip: General Documentation
You may only use one set of evaluation and management (E/M) guidelines when selecting the appropriate CPT code. Mixing or combining of the two sets of guidelines is not acceptable. Please share with appropriate staff.

Applies to:

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

Signatures, Credentials and Dates: They Are Important
Each entry in the patient’s medical record requires the acceptable signature of the person writing the note along with the date. Palmetto GBA also recommends the inclusion of the applicable credentials (e.g. P.A., D.O. or M.D.), especially when the services being billed are only coverable when performed by certain credentialed professionals. Please share with appropriate staff.

Applies to:

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

Palmetto GBA E-mail Update: Monday, May 22, 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 Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Comprehensive Error Rate Testing (CERT) Question and Answer Fact Sheet
This article includes updates to questions and responses about the Comprehensive Error Rate Testing (CERT) program. Please review this information and share it with your staff.

Applies to:

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

Provider Contact Center (PCC) To Close May 29 For Memorial Day
The Provider Contact Center (PCC) will be closed on Monday, May 29, 2017, in observance of Memorial Day. The Call Center will reopen on Tuesday, May 30. Please review and share with your staff.

Applies to:

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

Ask the Contractor Part B Teleconference May 11, 2017: eServices Auditing and Reports Topic Discussion and Questions and Answers
The Ask the Contractor Part B Teleconference May 11, 2017: eServices Auditing and Reports Topic Discussion and Questions and Answers are now available. Please share with appropriate staff.

Applies to:

  • JM Part B//General

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, 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. Please share with appropriate staff.

Applies to:

  • JM Part B//General

June 2017 Medicare Part B Updates, Changes and Reminders: June 8
Palmetto GBA will host the Medicare Administrative Contract Part B June 2017 Quarterly Updates, Changes and Reminders Webcast on June 8, 2017, at 10 am. ET. These updates, changes and re minders 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

Medicare Basics for Part B Providers Webcast: June 26
On June 26, 2017 at 10 am ET, Palmetto GBA will host a webcast for new Part B providers and billers with a beginner level experience. If you are new to Medicare or have new billing staff, this webcast is for you. This learning tool gives a general overview of the following topics: The four parts of Medicare; Billing provider enrollment requirements; Mandatory claim submission regulations; Completion of the CMS 1500 claim form and Resources for new providers. Please plan to attend.

Applies to:

  • JM Part B//General

There is Still Time to Evaluate Our Services!
There is still time to share your experiences about the services we provide. Please complete the MAC Satisfaction Indicator (MSI) survey. These survey results will help us find ways to better serve you.

Applies to:

  • JM Part B//General

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