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

8 Ways to Know if You Should Participate in the Quality Payment Program

You may have heard that the Centers for Medicare & Medicaid Services (CMS) is reviewing claims and letting practices know which clinicians should take part in the Merit-based Incentive Payment System (MIPS). MIPS is an important part of the new Quality Payment Program.

The Quality Payment Program works to make Medicare better by keeping patients at the center of healthcare while paying clinicians based on their performance. It replaces the Sustainable Growth Rate formula, which threatened clinicians participating in Medicare with potential payment cuts for 13 years. This program combines and streamlines many existing Medicare quality programs. It also gives new ways to improve care delivery by supporting and rewarding clinicians who:

  • Find new ways to engage patients, families, and caregivers.
  • Improve care coordination and population health management.

During this first year as we move to the Quality Payment Program, CMS is committed to working hard with clinicians to make the reporting and participation process easier. It’s CMS’ priority to further reduce burdensome requirements so that clinicians can deliver the best possible care to patients.

Here are 8 ways to know if you’re included in the Quality Payment Program:

  1. You visit qpp.cms.gov, click on the MIPS Participation Look-up Tool, and use your National Provider Identifier (NPI) to check your status. Also, you may have recently gotten a letter from your Medicare Administrative Contractor (MAC) that tells if you’re included in MIPS. Your practice should have received a letter that includes the MIPS participation status of each clinician associated with the practice’s Taxpayer Identification Number (TIN).
  2. You’re a:
    • Physician (includes doctors of medicine, doctors of osteopathy (including osteopathic practitioners), doctors of dental surgery, doctors of dental medicine, doctors of podiatric medicine, doctors of optometry, and chiropractors)
    • Physician assistant
    • Nurse practitioner
    • Clinical nurse specialist
    • Certified registered nurse anesthetist
    • A group including such clinicians
  3. You’re a MIPS eligible clinician that bills $30,000 or more in Medicare Part B allowed charges a year AND provides care to more than 100 Part B-enrolled Medicare beneficiaries a year. If you did both and you’re part of MIPS for the 2017 transition year. In other words, you go beyond the “low-volume threshold.” CMS determined billing and patient volume by using claims data from September 1, 2015 through August 31, 2016. CMS will identify additional low-volume clinicians using claims data from September 1, 2016 through August 31, 2017.
  4. You’re not new to Medicare in 2017. If you’re new in 2017, you’re not part of MIPS.
  5. Your practice tells you the group you’re a part of is participating. Each practice should let its clinicians know their MIPS status. If you practice under more than one TIN, you’ll hear about your status for each TIN. Your status can be different across TINs. For example, you might be part of two practices with different TINs. Your Medicare billing and patient count might be more than the low-volume threshold at one practice, but not at the other practice.
  6. Your practice chooses to participate in MIPS as a group. If your group does choose to participate, you’ll be assessed and scored as a group.
  7. You didn’t participate sufficiently in Advanced Alternative Payment Models (APMs) and become a Qualifying APM Participant (QP). If you did, you’re exempt from participating in MIPS. If you’re in an Advanced APM and become a Partial QP, you may choose whether to report on MIPS measures and activities, be scored using the APM scoring standard, and be subject to a MIPS payment adjustment. Partial QPs can choose not to participate in MIPS, but they still have to meet the participation requirements of their APMs.
  8. You want to participate. Even if you don’t have to participate in the MIPS program you can still choose to participate. If you do, you won’t be subject to MIPS payment adjustments.

The Quality Payment Program has free resources to help.

  • Visit the official CMS website at qpp.cms.gov.
  • Email qpp@cms.hhs.gov, or
  • Call 1-866-288-8292 (toll-free)
  • TTY 1-877-715-6222

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: Monday, January 09, 2017

We’d love your feedback!
Palmetto GBA is committed to continuously improve your customer experience. We welcome your feedback on your experiences with the PalmettoGBA.com website and the eServices portal. As a visitor to the Palmetto GBA’s website, you may be presented with an opportunity to take the website satisfaction survey. The next time the survey is offered to you, please agree to participate and provide us with your feedback.

Applies to:

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

eServices Administrators: Assign Unique User IDs
When assigning user names for individuals at your practice, facility or agency, make sure each user ID is unique. It is recommended to use an employee’s first and last name instead of something generic or related to their position. 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

Lack of Documentation Affects Provider Reimbursement
Here are some guidelines for documenting medical records. All information about services performed must be documented. If it isn’t documented, then no one knows what was performed.

Applies to:

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

Provider Contact Center (PCC) To Close For Training On January 13 and Closed on January 16 for Martin Luther King Jr. Day
The Provider Contact Center (PCC) will be closed for training on January 13, 2017, from 8 a.m. to 12 p.m. ET. The PCC will reopen at 12 p.m. ET. The PCC will also be closed on January 16, 2017 for Martin Luther King Jr. day.

Applies to:

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

North Carolina Healthcare Finance Management Association (NCHFMA) Annual Medicare Update Conference: February 7
Palmetto GBA will be speaking at the North Carolina Healthcare Finance Management Association (NCHFMA) Annual Medicare Update Conference on Tuesday, February 7, 2017 8:30 a.m. – 4:30 p.m. ET at the Novant Health Conference Center 3333 Silas Creek Parkway, Winston-Salem, NC 27103. This workshop is tailored for Medicare providers who bill on both a Part A UB04 and Part B 1500 claim format. Please plan to attend.

Applies to:

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

E/M Weekly Tip

E/M Weekly Tip: Cloning (Chief Complaint (CC), History of Present Illness (HPI), Review of Systems (ROS) and Examination)
Always document the Chief Complaint (CC) and History of Present Illness (HPI) based on the patient’s description on that day. Never copy it from a previous visit. Only use the Review of Systems (ROS) and examination that is relevant to that day’s visit.

Applies to:

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

Palmetto GBA E-mail Update: Monday, October 03, 2016

Managing Multiple eService Accounts Just Got Easier with Account Linking!
Palmetto GBA is excited to announce the highly anticipated eService enhancement- Account Linking! No longer will providers need a separate login for each PTAN and NPI combination. Palmetto GBA now gives users the ability to link their previously assigned eServices user IDs under one default ID. Getting started is simple! Users should log into eServices with the user ID that they wish to designate as their default login ID. This is the user ID that will be used to access the linked accounts. Once the user has successfully logged into eServices, they will select the My Account Tab and then access the Account Linking sub-tab. This will allow the provider to choose the accounts they wish to link.

Applies to:

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

Billing for Influenza: New CPT Code 90674
The American Medical Association issued a new Current Procedural Terminology (CPT) code for influenza vaccine Flucelvax, CPT 90674, effective August 1, 2016 for Medicare claims. However, Medicare claims processing systems will not be able to accept the new code until January 1, 2017. If you bill institutional claims, note that code CPT 90674 will be implemented on February 20, 2 017. Claims may either be held or you can check with your MAC for this information and other interim billing instructions.

Applies to:

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

Palmetto GBA E-mail Update: Tuesday, March 29, 2016

Entering Beneficiary Information: eServices Eligibility Inquiry vs. Claim Submission
This article explains how to enter beneficiary information for each task: obtaining beneficiary eligibility from eServices and submitting a claim. eServices uses CMS’s HETS 270/271 system, as required by CMS, for all eligibility inquiries. To protect the privacy of beneficiary data, all fields entered, including optional fields, must match the beneficiary’s data as it is maintained by CMS’ HIPAA Eligibility Transaction System (HETS); otherwise, eligibility data will not be returned. Please share with appropriate staff.

Applies to:

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

eServices: Claim Status
To check on a particular claim status, please enter the HICN and other required beneficiary information, as well as the date(s) of service. Should you not know the exact date of service, you are able to enter a span or range of up to 45 days.

Applies to:

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

eServices: How Often is Patient Eligibility Updated?
The eServices application is required to use CMS’ HETS 270/271 system for all eligibility inquiries. Although eServices pulls data from HETS in real time, the data available in the HETS 270/271 system is only updated at certain times. CMS currently pulls the updated data Tuesday through Saturday during the hours of 6 p.m. and 8 p.m. This data is then uploaded into HETS during the hours of 9 p.m. to 6 a.m. As soon as updated data is available in the HETS 270/271 system, p roviders will be able to view it in eServices.

Applies to:

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

I do not see the remittance that I am looking for, what should I do?
You will only be able to view remits for the one NPI associated with your eServices user ID. If you have additional NPIs, they will need to be registered separately. The remittance date range will default to the last 30 days. You may also select the option to search by a specific date range. The date range for remittances are listed in eServices by the remittance upload date and not the deposit date, so you may need to search a few days earlier or later in the remit list to find the specific remittance you are looking for. Only remittances for your NPI with a remittance upload date within your date range will display.

Applies to:

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

Is the eligibility information available through eServices real time?
While eServices pulls eligibility information from CMS’s HETS 270/271 system in real time, the information available in HETS is only updated at certain times. Please read this article to learn more.

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 (MSP) eServices Tab
eServices allows users to identify when a patient has coverage primary to Medicare under the Medicare Sec ondary Payer (MSP) tab. The MSP tab will display active MSP data based on the dates you request if they are within the past 12 months. 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

What should I do if I receive a message that the eligibility system is unavailable?
We are aware that eServices users may experience intermittent performance issues when attempting to use the eligibility look-up func tion. A high volume of transactions may cause processing delays and higher than normal timeouts within CMS’ HIPAA Eligibility Transaction System (HETS), that eServices is required to access for eligibility data. This issue affects all eligibility vendors, clearinghouses, contractors and other third parties that use HETS. CMS works to resolve these issues as soon as they happen. If you receive a message that the system is unavailable, please submit your request again.

Applies to:

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

When performing a claim status inquiry, why do I receive an error message that there is nothing found to display?
Claim status information is retrieved from CMS standard systems and is as current as the data maintained in those standard systems. You will only be able to view claim status information for the one PTAN/NPI combination associated with your eServices user ID. If you have additional PTANs or NPIs, they will need to be registered separately. 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

When performing an eligibility inquiry, why do I receive an error message that the beneficiary I requested cannot be found?
To protect the privacy of beneficiary data, CMS’ HIPAA Eligibility Transaction System (HETS) 270/271 system, that we are required to use for all eligibility transactions, will not return data when all fields entered do not match the beneficiary’s data as it is maintained in HETS. You may enter data into optional fields, but these fields are not required to receive a valid Medicare beneficiary eligibility benefit response. If data entered into an optional field does not match the beneficiary’s data maintained in CMS’ HETS system, eligibility data will not be returned on the eligibility response tabs. 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

Why am I missing eligibility information?
Palmetto GBA’s eServices uses the CMS HIPAA Eligibility Transaction System (HETS) 270/271 system, which is designed to give you general eligibility checks for claims submission. Only the information that is available through HETS will be displayed in eServices. You may not be seeing information in the eligibility tabs because you are not entering a date range on the inquiry sc reen. To make sure you see all of the information, enter a date range in the inquiry screen. 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

Provider Enrollment Open House: Available the First Tuesday of the Month
Palmetto GBA’s Provider Enrollment Department holds an open house at our Palmetto GBA office located at 17 Technology Circle Columbia, South Carolina 29203, the first Tuesday of each month. This open house is for any of Palmetto GBA’s Part B providers who would like to stop by and receive answers to th eir questions concerning their Medicare provider enrollment applications.

Applies to:

  • JM Part B//General

E/M Weekly Tip: Diagnosis/Management Options
The number of possible diagnoses and/or the number of management options that must be considered is based on the number and types of problems addressed during the encounter, the complexity of establishing a diagnosis and the management decisions that are made by the physician. Please share with appropriate staff.

Applies to:

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

A Legible Medical Record Matters
Signatures in the medical record must be clearly visible after each entry. Remember, if you can’t read it, Palmetto GBA can’t read it!

Applies to:

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