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

Palmetto GBA E-mail Update: Wednesday, March 15, 2017

Revised CMS-855O Application: Enrollment Solely to Order, Certify or Prescribe
Physicians and non-physician practitioners must use the revised CMS-855O application (Eligible Ordering, Certifying, and Prescribing Physicians and Other Eligible Professionals) beginning January 1, 2018. The revised application will be posted on the CMS Forms List by early summer. Medicare Administrative Contractors will accept both the current and revised versions of the CMS-855O through December 31, 2017. Visit the Medicare Provider-Supplier Enrollment webpage for more information about Medicare enrollment.

Applies to:

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

Palmetto GBA E-mail Update: Wednesday, March 08, 2017

Are you an eServices user who has received an error message when trying to attach documents?
You may add attachments up to 40 megabytes (MB) each to a form. While there is no longer a limit to the number of files that can be attached to this form, the combined size of all attachments cannot exceed 150 MB. All attachments must be in PDF format unless otherwise noted in the eServices user manual. Files must be either PDF or Excel format for Credit Balance Reporting. For Cost Report forms, eServices users may submit attachments in one of the following formats: PDF, Excel (*.xls, *xlsx), or HSF (*.##a1).

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 no t 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

Part B Ask the Contractor Teleconference: Top Part B Medical Review Denials
The Jurisdiction M Part B Ask the Contractor Teleconference Q&A Document is now available.

Applies to:

  • JM Part B//General

RESOLVED 2017 Moderate Sedation CPT Codes
The JM and Railroad Resolved Moderate Sedation CPIL has been updated to include additional codes affected by this issue. See the CPIL for full details (Post Resolution Update) and share with appropriate staff.

Applies to:

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

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

New Common Working File (CWF) Medicare Secondary Payer (MSP) Type for Liability Medicare Set-Aside Arrangements (LMSAs) and No-Fault Medicare Set-Aside Arrangements (NFMSAs)
This article is based on Change Request (CR) 9893. To comply with the Government Accountability Office (GAO) final report entitled Medicare Secondary Payer (MSP): Additional Steps Are Needed to Improve Program Effectiveness for Non-Group Health Plans (GAO 12-333), the Centers for Medicare & Medicaid Services (CMS) will establish two (2) new set-aide processes: a Liability Insurance Medicare Set-Aside Arrangement (LMSA), and a No-Fault Insurance Medicare Set-Aside Arrangement (NFMSA). Please be sure your billing staffs are aware of these changes.

Applies to:

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

Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – April CY 2017 Update
Change Request (CR) 9977 informs MACs about changes to the MPFS payment files. While the changes will be implemented in Medicare systems on April 3, the changes are effective January 1, 2017. Note that MACs need not search their files to either retract payment for claims already paid or to retroactively pay claims already processed. However, the MACs will adjust such claims that you bring to their attention. Make sure that your billing staffs are aware of these changes.

Applies to:

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

Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens
Change Request (CR) 9960 revises the payment of travel allowances when billed on a per mileage basis using Health Care Common Procedure Coding System (HCPCS) code P9603 and when billed on a flat-rate basis using HCPCS code P9604 for Calendar Year (CY) 2017. Make sure that your billing staffs are aware of these changes.

Applies to:

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

ICD-10 Coding Revisions to National Coverage Determination (NCDs)
Change Request (CR) 9861 is the tenth maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs). The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CRs, specifically CR7818, CR8109, CR8197, CR8691, CR9087, CR9252, CR9540, CR9631, and CR 9751; while others are the result of revisions required to other NCD-related CRs released separately. Make sure your staff is aware.

Applies to:

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

Implementation of New Influenza Virus Vaccine Code
Change Request (CR) 9876 provides instructions for payment for a new influenza virus vaccine code for intramuscular use, for claims with dates of service on or after July 1, 2017. Make sure that your billing staffs are aware of these instructions.

Applies to:

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

March 2017 Medicare Part B Updates, Changes and Reminders: March 9
Palmetto GBA will host the Medicare Administrative Contract Part B March 2017 Quarterly Updates, Changes and Reminders Webcast on March 9, 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

Updated Editing of Professional Therapy Services
Change request (CR) 9933 instructs the MACs to apply certain coding edits to the new Current Procedural Terminology (CPT) codes that are used to report physical therapy (PT) and occupational therapy (OT) evaluations and re-evaluations, effective January 1, 2017. Make sure your billing staffs are aware of these coding changes.

Applies to:

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

Palmetto GBA E-mail Update: Tuesday, February 14, 2017

What is the Social Security Number Removal Initiative (SSNRI)?
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires that Social Security Numbers (SSNs) be removed from all Medicare cards by April 2019. A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards for Medicare transactions like billing, eligibility status, and claim status.

Applies to:

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

Social Security Number Removal Initiative (SSNRI)
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new randomly generated Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number on new Medicare cards for transactions like billing, eligibility status, and claim status.

Applies to:

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

Palmetto GBA E-mail Update: Friday, December 09, 2016

Smart Edits to Detect Electronic Comparative Billing Report (eCBR) Billing Patterns via the eServices Portal
Palmetto GBA is excited to announce that the Palmetto GBA Advanced Clinical Editing System (P-ACE) will soon use data driven pattern detection techniques communicated through ‘smart edits’ for Part B providers. P-ACE eCompare will return pre-adjudicated, informational only messaging through claim acknowledgement transaction reports sent to you or your clearinghouse if you currently use one based on the Medicare 277CA. These eCompare smart edits will assist you in monitoring your specific billing patterns and can serve as a training aide providing detailed provider education for self-auditing purposes.

Applies to:

  • JM Part B//General