Medicare Updates

MD AAHAM

November 20, 2015

Disclaimer

All Current Procedural Terminology (CPT) only are copyright 2014 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable Federal Acquisition Regulation/ Defense Federal Acquisition Regulation (FARS/DFARS) Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

The information enclosed was current at the time it was presented. Medicare policy changes frequently; links to the source documents have been provided within the document for your reference. This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations.

Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services.

Novitas Solutions employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this guide.

This presentation is a general summary that explains certain aspects of the Medicare program, but is not a legal document. The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings.

Novitas Solutions does not permit videotaping or audio recording of training events.

Novitas Solutions

Education specific to providers in Medicare Administrative Contractor Jurisdiction H (JH) include: Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas

Education specific to providers in Medicare Administrative Contractor (MAC) Jurisdiction L (JL) include: Delaware, District of Columbia, Maryland, New Jersey, and Pennsylvania

This education contains specific contractor guidance

If you are not a provider in JL or JH, please contact your Medicare contractor for specific guidance

Agenda

ICD-10 Assistance and Advice

Part A/B Updates

Preventive Services

Novitas Initiatives

Comprehensive Error Rate Testing (CERT) Program

Self-Service Options

Objectives

Identify and understand the current Medicare changes Learn how to apply the new guidelines Identify and utilize the educational resources and information

Acronym List

Acronym Definition

CERT Comprehensive Error Rate Testing

CMS Centers of Medicare & Medicaid Services

EDI Electronic Data Interchange

ICD-10 International Classification of Diseases, 10th Edition

IPPS Inpatient Prospective Payment System

LCD Local Coverage Determination

MLN Medicare Learning Network

NCD National Coverage Determination

OPPS Outpatient Prospective Payment System

ICD-10 Assistance and Advice

ICD-10 Tips

ICD-10 billing tips:• Use ICD-10 codes with dates of service on and after October 1, 2015• Use proper qualifiers on the proper codes- ICD-10 qualifiers (ABK/ABF) • May not use ICD-9 codes with dates after 10/1/15• Bill separate claims for September and October dates of service

CMS ICD-10 Implementation Page: • http://www.cms.gov/Medicare/Coding/ICD10/index.html

Flexibility to Coding Accuracy for Physician

No medical review denials the first year related to coding errors as long as the code is in the “appropriate family” of ICD-10 codes

• Applicable for services paid under the Medicare Fee-for-Service Part B physician fee schedule

No grace period, codes must be valid, carried out to the highest level of specificity

Claims subject to LCD/NCD guidelines may deny if not carried out to the highest level of specificity

No penalties on 2015 quality reports Reference:

• http://www.cms.gov/Medicare/Coding/ICD10/Downloads/MedicareProviderICD-10.pdf

• https://www.cms.gov/Medicare/Coding/ICD10/Clarifying-Questions-and-Answers-Related-to-the-July-6-2015-CMS-AMA-Joint-Announcement.pdf

Part A Appeal/Clerical Error and Claim Process

No changes with the appeals/clerical error or claim process:• Denied claims continue to follow appeal/CER process• Rejected claims can be adjusted (if applicable via the TPE-to-TPE field)

i.e. incorrect diagnosis code billed, incorrect units billed, wrong date of service, incorrect PT STATUS, etc.

Resubmitted claims will reject as duplicates

• RTP claims can be corrected and restored (F9) or rebilled

Part B Appeal/Clerical Error and Claim Process

No changes with the appeals/clerical error or claim process:• Denied claims continue to follow appeal process:

Providers will continue to use the claims corrections line or the Novitasphere portal to correct clerical errors

i.e. incorrect diagnosis code billed, incorrect units billed, wrong date of service, incorrect modifier, etc.

Resubmitted claims will deny as duplicates

• Rejected claims need to be rebilled

CMS Communication and Collaboration Center

Drawing from best practices of other technology implementation:• Monitor the implementation• Quickly identify issues• Initiate fixes

Check the validity of ICD-10 codes:• 2016 ICD-10 and GEMs (zip file titled “icd10cm_codes_2016.txt”)

https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2016-Code-Descriptions-in-Tabular-Order.zip

Ombudsman

Ombudsman for physicians and other providers:• Located at the ICD-10 Coordination Center• Triage and answer questions about claim submissions• Ask coding questions• Dr. William Rogers

ICD10_Ombudsman@cms.hhs.gov

AHA Central Office Coding Questions

Free assistance and advice• Providing ICD-10 and ICD-10-PCS coding advice• Does not replace learning how to code

Questions should be submitted via http://www.codingclinicadvisor.com/:

• Not limited to AHA members, but registration required• Review FAQ section for details on how to submit questions

Formulate coding question, not just “what is the code for XYZ” Provide documentation Specify whether inquiry refers to a certain setting Cannot answer questions on payment/coverage

CMS Teleconferences and Videos

CMS sponsored ICD-10 teleconferences: • http://www.cms.gov/Medicare/Coding/ICD10/CMS-Sponsored-ICD-10-Te

leconferences.html

MedScape modules:• http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html

CMS has created “Road to 10” to help jump start the transition to ICD-10:

• http://www.roadto10.org/

CMS Tools and Fact Sheets

CMS ICD-10 Fact Sheets:• Intro Guide to ICD-10• The ICD-10 Transition: An Introduction• ICD-10 Basics for Medical Practices• Talking to Your Vendors About ICD-10: Tips for Medical Practices• ICD-10 and CMS eHealth: What’s the Connection?• ICD-10 Basics for Small and Rural Practices• Online ICD-10 Implementation Guide

ICD-10-CM/PCS Billing and Payment FAQs:• http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-ML

N/MLNProducts/Downloads/ICD-10BillingandPaymentFAQs.pdf

ICD-10 Quick Start Guide ICD-10 Infographic ICD-10 Website Wheel Educational Tool Reference:

• http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html

CMS Resources

The CMS International Classification of Disease, Tenth Revision (ICD-10) website:

• http://www.cms.gov/icd10 Sign up for Centers and Medicare & Medicare Services (CMS) ICD-10

Industry Email Updates:• http://www.cms.gov/Medicare/Coding/ICD10/CMS_ICD-10_Industry_Email

_Updates.html

Subscribe to Latest New Page Watch:• https://public.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=

USCMS_609

Part A/B Updates

Sequestration Update

Mandatory Payment Reduction of 2% continues through March 31, 2016, for the Medicare Fee For Service Program

For more information:• http://

www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Downloads/2015-03-19-eNews.pdf

Frequently Asked Questions: http://

www.novitas-solutions.com/webcenter/spaces/MedicareJL/page/pagebyid?contentId=00007998

New and Revised Place of Service Codes (POS) for Outpatient Hospitals

Change Request # 9231• Effective: January 1, 2016• Implementation: January 4, 2016

Key Points:• POS 19 Off Campus-Outpatient Hospital • POS 22 On Campus-Outpatient Hospital • POS 17 Walk-in Retail Health Clinic• POS 26 Military Treatment Facility

Reference:• https://

www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9231.pdf

Claims Processing Instructions for Diagnostic Digital Breast Tomosynthesis Change Request # 9191

• Effective: January 1, 2015• Implementation: January 4, 2016

Key Points:• Payment for code G0279 will be permitted only when billed in

conjunction with codes G0204 or G0206• Deductible and coinsurance will be applied to claim lines with code

G0279• Institutional claims for code G0279 will be paid for type of bills 12X,

13X, 22X, 23X, and 85X when submitted with revenue code 0401• Professional claims for code G0279 will be paid for TOB 85X when

submitted with revenue code 096X, 097X, or 098X Reference:

• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9191.pdf

Current Procedural Terminology (CPT) only copyright 2014 American Medical Association. All rights reserved.

National Coverage Determination for Single Chamber and Dual Chamber Permanent Cardiac Pacemakers

Change Request # 9078• Effective: August 13, 2013• Implementation: July 6, 2015

Key Points:• Implanted permanent cardiac pacemakers, single chamber or dual chamber, are

reasonable and necessary for the treatment of non-reversible symptomatic bradycardia due to sinus node dysfunction and second and/or third degree atrioventricular block

• Covered indications Documented non-reversible symptomatic bradycardia due to sinus node dysfunction Documented non-reversible symptomatic bradycardia due to second degree and/or third

degree atrioventricular block

• Contractors shall accept the inclusion of the -KX modifier on the claim line(s) as an attestation by the practitioner and/or provider of the service that documentation is on file verifying the patient has non-reversible symptomatic bradycardia

Reference:• http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/

R3204CP.pdf

Deactivation of Associated Shared System Edits

CMS released Change Request (CR) 9078 implementing national coverage determination (NCD) 20.8.3 on 7/6/15 for beneficiaries that meet specific coverage criteria

Temporary delay in implementing NCD 20.8.3 All editing and coverage relative to CR 9078 will be made at the

local Medicare Administrator level until notified by CMS This information was included in the MLN Connects Provider eNews

article:• https://

www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Downloads/2015-09-10-eNews.pdf

Updates on the Therapy Cap

Exceptions to the therapy cap will remain in effect for claims with dates of service through December 31, 2017

Hospital outpatient therapy claims will continue to apply to the therapy cap through December 31, 2017

Suspension for therapy services that exceed $3,700 will remain in effect for therapy services through December 31, 2017

https://www.cms.gov/Medicare/Billing/TherapyServices/index.html?r

edirect=/TherapyServices

Applying Therapy Caps to Maryland Hospitals

Change Request # 9223 • Effective: January 1, 2016• Implementation: January 4, 2016

Key Points:• Revises Original Medicare systems to ensure therapy services provided in

Maryland hospitals are subject to the outpatient therapy per-beneficiary caps

• The therapy caps and related provisions apply to hospitals paid under the Maryland All-Payer Model

• Medicare will use the rates established under the All-Payer Model to count the therapy services of Maryland hospitals toward the therapy caps and threshold total of beneficiaries

Reference:• https://

www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9223.pdf

Instructions for Submitting Requests to Reopen Claims that are Beyond the Claim Filing Timeframes

SE1426 Revised, Related CR 8581• Effective: Claims received on or after January 1, 2016• Implementation: January 1, 2016

Key Points:• Due to ICD-10 implementation, currently scheduled for October

2015, the NUBC is going to delay implementation of the new bill type and condition codes until January 1, 2016

• Provide additional information, coding instructions and scenarios for requesting a reopening of a claim that is beyond the filing timeframe

• Institutional reopenings must be submitted with a “Q” frequency code to identify them as a Reopening

Reference:• http://

www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1426.pdf

Special Edition Articles (SE)/Fact Sheets

Updates to ICD-10 Local Coverage Determinations: • http://

www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1421.pdf

Fact Sheet: Two-Midnight Rule:• http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/20

15-Fact-sheets-items/2015-07-01-2.html

Preventive Services

Medicare Learning Network (MLN) Products for Preventive Services Help Keep Your Medicare Patients Healthy In 2015! Ensure your patients take advantage of Medicare-covered

preventive services Medicare covers a wide array of preventive services for eligible

beneficiaries, including cancer screenings, certain immunizations, among others

The Medicare Learning Network (MLN) Preventive Services Educational Products Web Page provides descriptions and ordering information for MLN preventive services educational products and resources for health care professionals and their staff:

• http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/PreventiveServices.html

Preventive Services and Screenings Covered by Medicare

Abdominal Aortic Aneurysm Screening Alcohol Misuse Screening and Behavioral

counseling Intervention in Primary Care Annual Wellness Visit (Including

Personalized Prevention Plan Services) Bone Mass Measurements Cancer Screenings

o Breast Cancer (mammograms and clinical breast exam)

o Cervical and Vaginal Cancer (pap test and pelvic exam [includes the clinical breast exam])

o Colorectal Cancer Fecal Occult Blood Test Flexible Sigmoidoscopy Colonoscopy Barium Enema

o Prostate (Prostate Specific Antigen blood test and Digital Rectal Exam)

Cardiovascular Disease Screening Depression Screening in Adults

Diabetes Screening Diabetes Self-Management Training Glaucoma Screening Hepatitis C Screening Human Immunodeficiency Virus (HIV)

Screening Immunizations (Seasonal Influenza,

Pneumococcal, and Hepatitis B) Initial Preventive Physical Examination (IPPE)

(also commonly referred to as the “Welcome to Medicare” Preventive Visit)

Intensive Behavioral Therapy for Cardiovascular Disease

Intensive Behavioral Therapy for Obesity Medical Nutrition Therapy (for beneficiaries with

diabetes or renal disease) Sexually Transmitted Infections (STIs)

Screening and High-Intensity Behavioral Counseling (HIBC) to prevent STIs

Tobacco-Use Cessation Counseling

Influenza Vaccine Payment Allowances - Annual Update for 2015-2016 Season Change Request #9299

• Effective Date: August 1, 2015• Implementation : No later than November 24, 2015

Key Points:• These payment allowances are updated on an annual basis• The pending payment allowances will be updated in the influenza

vaccine pricing webpage• Providers may visit the webpage for the updated prices

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/VaccinesPricing.html

Reference:• https://

www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9299.pdf

Screening for Colorectal Cancer Using Cologuard™ - A Multitarget Stool DNA Test Change Request # 9115

• Effective: October 9, 2014• Implementation: September 8, 2015

Key Points:• Effective for claims with dates of service on or after October 9, 2014, contractors shall recognize

new HCPCS code G0464 (colorectal cancer screening; stool-based DNA and fecal occult hemoglobin) as a covered service.

• The Cologuard™ test will be covered once every three years for beneficiaries who meet all of the following criteria: • Age 50 to 85 years, • Asymptomatic• At average risk of developing colorectal cancer

• All other screening stool DNA tests not otherwise specified above remain nationally non-covered• There is no coinsurance or deductible for tests paid under the Clinical Laboratory Fee Schedule

(CLFS), including HCPCS code G0464 (Colorectal cancer screening; stool-based DNA and fecal occult hemoglobin (e.g., KRAS, NDRG4 and BMP3))

• Only laboratories that are authorized by the manufacturer to perform the Cologuard™ test may bill for this test

Reference:• https://

www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9115.pdf

Current Procedural Terminology (CPT) only copyright 2014 American Medical Association. All rights reserved.

Preventive Services Resources

Quick Reference Chart for Medicare Preventive Services:o https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads

/MPS_QuickReferenceChart_1.pdf

Improve Your Patients’ Health with the Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV):

• http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1338.pdf

Novitas Initiatives

Website Satisfaction Surveys

Policy Search Application

Updated customized “Policy Search Application” Search:

• Current, retired or draft policies• ICD-9 LCDs and Articles• ICD-10 LCDs and Articles• National Coverage Determinations

Gives more search power, more accurate results, the new options allows for search by date of service

Policy Search:• http://

www.novitas-solutions.com/webcenter/spaces/MedicareJL/page/LcdSearch

JL Local Coverage Determinations and Articles Updated

October 29, 2015• The following JL ICD-10 Local Coverage Determinations have been

revised: Cardiac Rhythm Device Evaluation (L34833) Cardiovascular Nuclear Medicine (L35085) Diagnostic Abdominal Aortography and Renal Angiography (L35092) Lower Extremity Major Joint Replacement (Hip and Knee) (L36007) Monitored Anesthesia Care (L35049) Non-Vascular Extremity Ultrasound (L35409) Qualitative Drug Testing (L35006) Scanning Computerized Ophthalmic Diagnostic Imaging (L35038) Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography

(L35035) Vitamin D Assay Testing (L34888)

Introducing Our New Novitas Solutions eNews Mailing Schedule

In response to your feedback, we are implementing a new delivery schedule for our “Novitas Solutions eNews” e-mail

Our emails will arrive in your inbox just twice a week – Every Tuesday and Thursday

These emails will still contain all the important Medicare news and updates you need

We will continue to send any urgent Medicare news or alerts to your inbox instantly

Increasing Your Bottom Line: How Much Does Rework Cost?

Cost savings for providers by reducing the need for Clerical Error Reopening requests:

• Correct minor errors• Omissions of claim specific information

Education Initiatives:• Articles published to assist with proper use of specific modifiers

New Web page dedicated to help you reduce rework and increase your bottom line:

• http://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00092539

Using Internet-based PECOS is Easy

Advantages of Internet-based Provider Enrollment Chain and Ownership System (PECOS):

• Completely paperless process• Electronic signature and digital document features available• Faster processing than paper-based enrollment

JL Provider Enrollment Status Inquiry Tool:• http://www.novitas-solutions.com/webcenter/spaces/MedicareJL/page/p

agebyid?contentId=00004864

Novitas is Now Accepting Part A Appeal Request Forms by Fax

Faxing Part A Redeterminations/Clerical Reopening requests:• Available 24 hours, 7 days a week , fax 1-888-541-3829• On-line form available- Part A Redetermination and Clerical Error

Reopening (Form 1000)• Submit one form for each claim in question• Do not copy the form  • Do not submit more than 1,500 pages per fax

JL online tutorial available:• http://www.novitas-solutions.com/webcenter/spaces/MedicareJL/page/p

agebyid?contentId=00002684

Novitas Medicare Learning Center

Features• Create an individualized education account• Register for webinars, teleconferences, and workshops• Download your Continuing Education Unit (CEU) Certificates• Be placed on a waitlist if the educational event you register for is closed

Benefits• Centralized location for all educational materials• Track all of the educational events you’ve attended• Access Medicare education 24 hours a day, 7 days a week with web-

based training modules http://

www.novitas-solutions.com/webcenter/spaces/MedicareJL/page/pagebyid?contentId=00081806

What is Novitasphere?

Free web-based Portal which allow enrolled users access to Eligibility, Claim Information and Remittance Advice, Claim Submission with File Status, Electronic Remittance Advice (ERA), Claim Correction, and a Mail Box

Available to JH and JL Part B providers, billing services and clearinghouses servicing Part B practitioners

For demonstrations and more information on Novitasphere visit:• http://www.novitas-solutions.com/webcenter/spaces/MedicareJL/page/p

agebyid?contentId=00024648

Novitasphere Claim Correction Feature

Common clerical errors can be corrected on finalized claims:• Number of services or units • Diagnosis code (Primary) • Eligible modifiers • Procedure code • Date of service • Place of service • Billed amount

JL Novitasphere Claims Correction Guide: • http://novitas-solutions.com/cs/idcplg?IdcService=GET_FILE&Revision

SelectionMethod=LatestReleased&dDocName=00086496&allowInterrupt=1

Novitasphere Help Desk

1-855-880-8424

Calendar of Events

Our Education and Training Center offers a wide variety of education

Join us for Workshops, Teleconferences, and Webinars

The most current calendar of events• http://www.novitas-solutions.com/webcenter/spaces/MedicareJL/page/p

agebyid?contentId=00008010

Stay Up-to-Date

Electronic Mailing List:• Daily E-mail of the latest Medicare Updates• Subscribe • http://www.novitas-solutions.com/webcenter/spaces/MedicareJL/page/p

agebyid?contentId=00007968

Podcast:• Podcast of the latest Medicare Updates and other informative topics

http://www.novitas-solutions.com/webcenter/spaces/MedicareJL/page/pagebyid?contentId=00008119

Educational Videos and Tutorials:• http://

www.novitas-solutions.com/webcenter/spaces/MedicareJL/page/pagebyid?contentId=00082787

Upcoming Part A Webinars

Part A How to Avoid Top Claim Errors - Fourth Quarter• December, 1, 2015 2:00pm-3:00pm ET

Proper Use of Modifiers• December 3, 2015 2:00pm-3:30pm ET

Part A Effectively Using International Classification of Disease, Tenth Revision (ICD-10)

• December 4, 2015 10:00am-11:30am ET

Credit Balance• December 10, 2015 11:00am-12:30pm ET

ABILITY|PC-ACE• December 30, 2015 10:00am-11:00am ET

For a complete list of webinars• http://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=000080

10

Upcoming Part B Webinars

Part B Evaluation and Management Score Sheet: Part 4: Scoring Medical Records Using the Score Sheet

• November 24, 2015 10:00am - 11:00am ET

Novitasphere Claim Correction Overview• November 25, 2015 2:00pm - 3:00pm ET

Novitasphere Portal Overview• December 1, 2015 10:00am - 11:00am ET

Part B Initial Inpatient Services• December 2, 2015 10:00am - 11:00am ET

Part B Top Claim Errors - Fourth Quarter 2015• December 3, 2015 10:00am - 11:00am ET

Proper Use of Modifiers• December 3, 2015 2:00pm-3:30pm ET

For a complete list of webinars• http://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00008044

Comprehensive Error Rate Testing (CERT) Program

Comprehensive Error Rate Testing (CERT)

Program developed by CMS to monitor the accuracy of claims processing

Designed to protect the Medicare trust fund and determine error rates nationally and regionally

Random audits conducted on a monthly basis AdvanceMed request medical records for claims selected as part of

the monthly random sample Medical record documentation supporting claim must be returned in

designated time frame JL CERT page:

• http://www.novitas-solutions.com/webcenter/spaces/CERT_JL

Part A Common Errors

Insufficient documentation:• Missing valid physician’s order• Missing documentation to

support minimum 15 hours per week of combined therapy

• Diagnosis insufficient to support procedure or service billed

• Missing Skilled Nursing Facility (SNF) 3 day qualifying stay  

• Missing or illegible documentation and/or physician signature

• No valid certification for therapy services

Medical necessity errors:• Documentation did not

support inpatient stay

Other errors:• Incorrect Diagnosis

Related Group (DRG) billed

• Discharge disposition code• Resource Utilization Group

(RUG)• Laboratory services billed

incorrectly• Debridement codes

CERT Appeals vs. Claim Adjustments

Providers may not cancel or adjust claims selected in the CERT review process

Notify CERT if an error has been made on a claim, do not cancel or adjust claims

Novitas initiate adjustments for necessary denials CERT adjustments in FISS appear as XXH Bill Type Appeal denials on XXH Bill Type as a means of submitting

corrections to claims using the Medicare Part A Redetermination Request Form

JL Article:• http://www.novitas-solutions.com/webcenter/spaces/MedicareJL/page/p

agebyid?contentId=00003498

Part B Common Errors

Insufficient documentation:• Procedure/service billed• Missing or illegible documentation and/or physician signature  • No valid physician’s order   • No physical therapy certified plan of care/treatment plan 

Incorrect coding errors:• Evaluation and Management (E/M) codes• Critical care, discharge day management, physical therapy   • Units of medication/infusion services   • Laboratory services

Self-Service Options

Customer Contact Information

Jurisdiction L Providers:• 1-877-235-8073 • JL Self-Service Tools:

http://www.novitas-solutions.com/webcenter/portal/CustomerServiceCenter_JL/Self-Service+Tools

Telecommunication Devices for the Deaf:• 1-877-235-8074

Patient / Medicare Beneficiary:• 1-800-MEDICARE (1-800-633-4227)

http://www.medicare.gov/index.html

Fiscal Intermediary Standard System (FISS) Hours

District of Columbia (DC), Maryland (MD), New Jersey (NJ), Pennsylvania (PA)

• Monday – Friday 6 am – 9 pm, Eastern Time (ET)

• Saturdays 6 am – 4 pm ET

Centers for Medicare & Medicaid Services (CMS)

The CMS website offers valuable resources such as • CMS Internet Only Manuals (IOMs)• Medicare Learning Network (MLN) Matters Articles• Open Door Forum• http://www.cms.gov/

Summary

Discussed the current change requests, giving key points and links

Reviewed the Novitas tools that are needed to keep providers updated

Gave valuable resources from the CMS and Novitas websites

Provider Outreach & Education Contact Information

Contact Information:

Denise Church

Provider Outreach and Education Manager

Denise.Church@novitas-solutions.com

412-802-1739

Janice Mumma

Jurisdiction JL Provider Outreach and Education Supervisor

Janice.mumma@novitas-solutions.com

717-526-3645

Thank You For Attending

Questions