9/10/2015. Supplier Website Tutorial

Transcription

1 Supplier Website Tutorial Presented by Noridian Provider Outreach and Education Jurisdiction D DME MAC September

2 Disclaimer This information release is the property of Noridian Healthcare Solutions, LLC. It may be freely distributed in its entirety, but may not be modified, sold for profit or used in commercial documents. The information is provided as is without any expressed or implied warranty. While all information in this document is believed to be correct at the time of writing, this document is for educational purposes only and does not purport to provide legal advice. All models, methodologies and guidelines are undergoing continuous improvement and modification by Noridian and the Centers for Medicare & Medicaid Services (CMS). The most current edition of the information contained in this release can be found on the Noridian website at med.noridianmedicare.com/web/jddme and the CMS website at The identification of an organization or product in this information does not imply any form of endorsement. CPT codes, descriptors, and other data only are copyright 2015 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. September 2015 Noridian Jurisdiction D DME MAC 2 2

3 Workshop Protocol Entering Workshop Attendee lines are muted upon entry Throughout Workshop Written questions in Q & A section Conclusion of Workshop: Q & A Session Use Raise Hand feature to ask questions aloud When question finished, select Lower Hand button Certificate of Completion CEUs are NOT offered for this course Presentation was sent via and can also be found at: med.noridianmedicare.com/web/jddme/education/event-materials September 2015 Noridian Jurisdiction D DME MAC 3 3

4 How to Ask a Written Question Click on Q&A Tab Address All Panelists Type your question into box September 2015 Noridian Jurisdiction D DME MAC 4 4

5 ABN: Advance Beneficiary Notice of Noncoverage CERT: Comprehensive Error Rate Testing DMEPOS: Durable Medical Equipment, Prosthetics, Orthotics and Supplies DOS: Dates of Service DWO: Detailed Written Order Acronyms F2F: Face-to-Face LCD: Local Coverage Determination MLN: Medicare Learning Network PA: Policy Article PAP: Positive Airway Pressure POD: Proof of Delivery POS: Place of Service RAD: Respiratory Assist Device med.noridianmedicare.com/web/jddme/help/acronyms-glossary September 2015 Noridian Jurisdiction D DME MAC 5 5

6 Web tour Home Pages Enrollment DMEPOS Category Fees & News Policies i CERT & Reviews Education & Outreach Claims & Appeals Forms Contacts Agenda Tools/External Resources/Keeping Current Resources & Reminders September 2015 Noridian Jurisdiction D DME MAC 6 6

7 Noridian Home Page September 2015 Noridian Jurisdiction D DME MAC 7 7

8 Noridian DME Home Page September 2015 Noridian Jurisdiction D DME MAC 8 8

9 Search Feature & Guide September 2015 Noridian Jurisdiction D DME MAC 9 9

10 Browse by Topic - Enrollment September 2015 Noridian Jurisdiction D DME MAC 10 10

11 Browse by DMEPOS Category Therapeutic Shoes September 2015 Noridian Jurisdiction D DME MAC 11 11

12 Fees & News September 2015 Noridian Jurisdiction D DME MAC 12 12

13 Policies September 2015 Noridian Jurisdiction D DME MAC 13 13

14 CERT & Reviews September 2015 Noridian Jurisdiction D DME MAC 14 14

15 Education & Outreach September 2015 Noridian Jurisdiction D DME MAC 15 15

16 Claims & Appeals September 2015 Noridian Jurisdiction D DME MAC 16 16

17 Forms September 2015 Noridian Jurisdiction D DME MAC 17 17

18 Contacts September 2015 Noridian Jurisdiction D DME MAC 18 18

19 Tools/External Resources/ Keeping Current September 2015 Noridian Jurisdiction D DME MAC 19 19

20 Comprehensive Error Rate Testing (CERT) 20

21 CERT 2014 Improper Payment Rates Published 12/15/ Compliance-Programs/CERT/index.html September 2015 Noridian Jurisdiction D DME MAC 21 21

22 CERT Letter September 2015 Noridian Jurisdiction D DME MAC 22 22

23 CERT Randomly select submitted claims Request medical records from provider/supplier that submitted claim Review claims and medical record for compliance with Medicare to include: Coverage Coding Billing rules September 2015 Noridian Jurisdiction D DME MAC 23 23

24 Reasons for CERT Errors Insufficient documentation No documentation Service incorrectly coded Medically unnecessary service September 2015 Noridian Jurisdiction D DME MAC 24 24

25 Decrease CERT Errors Educate staff Train coders/billers Submit correct information Beneficiary name, social security number, Medicare number, date of service Submit legible and complete records Dates, required signatures, etc. September 2015 Noridian Jurisdiction D DME MAC 25 25

26 CERT Inquiries should include: CERT Claim Identification (CID) In Subject Line Supplier name and address Telephone number Explanation of the issues, concern or question DO NOT send Protected Health Information (PHI) Response within 2 business days September 2015 Noridian Jurisdiction D DME MAC 26 26

27 Quick Look CERT Documentation Chart med.noridianmedicare.com/web/jddme/cert-reviews/cert/documentation-chart September 2015 Noridian Jurisdiction D DME MAC 27 27

28 ICD-10 28

29 ICD-10 Transition October 1, 2015, timeframe for ICD-10 Transition Sign up for list serve to get ICD-10 news Noridian CMS Dedicated ICD-10 web page on Noridian website September 2015 Noridian Jurisdiction D DME MAC 29 29

30 Testing Opportunities Front-end (acknowledgement testing) Pass EDI front-end edits Are ICD-10 codes valid? Acknowledgement Testing Registration is not required Can do this testing at any time Noridian/CEDI-CMS will be monitoring activity during the designated testing weeks Make sure the claims you submit for testing are clean claims September 2015 Noridian Jurisdiction D DME MAC 30 30

31 ICD-10 Updated LCDs & PAs All Local Coverage Determinations and Policy Articles have been updated ICD-9 and ICD-10 LCDs and PAs are assigned new ID numbers to keep them separate Not considered new policies Coding revisions do not change the intent of the coverage/non-coverage licies/lcd/future September 2015 Noridian Jurisdiction D DME MAC 31 31

32 Road to 10 Small Physician s Practice Route to ICD-10 No-cost tool that will help you: Get an overview of ICD-10 Explore Specialty References Create your personal action plan Resources: ICD-10 Overview Webcasts FAQ Quick References Template Library Events Coding Scenarios (NEW!) September 2015 Noridian Jurisdiction D DME MAC 32 32

33 ICD-10: 5 Steps for a Quick Start nloads/icd10quickstartguide pdf 1. Make a plan Get ICD-10 Codes 2. Train Your Staff Identify 25 top codes 3. Update Your Processes Update your Forms Identify Gaps in Documentation September 2015 Noridian Jurisdiction D DME MAC 33 33

34 ICD-10: 5 Steps for a Quick Start [2] 4. Talk to Your Vendor and Health Plans Is your system ready? 5. Test Your Systems and Processes Front-end testing with Medicare Test with other Payers September 2015 Noridian Jurisdiction D DME MAC 34 34

35 ICD-10 Transition CM-Tabular-List-of-Diseases-and-Injuries.pdf GEMs.html September 2015 Noridian Jurisdiction D DME MAC 35 35

36 Resources and Reminders 36

37 Have a Verbal Question? Be sure that you have entered the Attendee ID # on this screen to ensure you are correctly connected to the phone lines, which will allow you to ask verbal questions September 2015 Noridian Jurisdiction D DME MAC 37 37

38 Click on Participants tab at top right Asking a Verbal Question Must have a phone or headset by your name Click on Hand on bottom right September 2015 Noridian Jurisdiction D DME MAC 38 38

39 LCD/Policy Article Resources med.noridianmedicare.com/web/jddme/policies/lcd/active Supplier Manual med.noridianmedicare.com/web/jddme/education/supplie r-manual Dear Physician letters med.noridianmedicare.com/web/jddme/policies/physician -resources Documentation Checklist med.noridianmedicare.com/web/jddme/policies/documen tation-checklists September 2015 Noridian Jurisdiction D DME MAC 39 39

40 New Supplier Curriculum General and policy specific Short presentations grouped by relevance Quiz at conclusion with certificate Great for new and existing suppliers Suppliers encouraged to view both general and policy specific curriculum September 2015 Noridian Jurisdiction D DME MAC 40 40

41 We ve Moved Improved Content Access & Navigation To A New Website! Tuesday, April 21 Browse By DMEPOS Category Browse By Topic September 2015 Noridian Jurisdiction D DME MAC 41 41

42 New Web Site Home Page med.noridianmedicare.com/web/jddme September 2015 Noridian Jurisdiction D DME MAC 42 42

43 Functions Eligibility Claim Status CMR and DCR claim processing comments prepayment review Same or Similar Same or Same (Includes A, L, & V codes.) Claim-Specific Remittance Advices Overpayments Reopening/Redetermination Submission Status Inquiry PMD Prior Auth Request Status ADR Requests Endeavor Availability Eligibility 24 hours/day, 7 days/week All other functions 6 a.m. 8 p.m. CT, Mon. Fri. 7 a.m. 3 p.m. CT, Sat. User Manual med.noridianmedicare.com/web/ com/web/ jddme/topics/portal/user-manual med.noridianmedicare.com/web/jddme/topics/portal September 2015 Noridian Jurisdiction D DME MAC 43 43

44 Change in Endeavor Registration CEDI Requirement Effective July 1, 2015, National Provider Identifier (NPI) registered as electronic submitter with Common Electronic Data Interchange (CEDI) Established Endeavor users still have access NPI additions must be registered with CEDI Enroll or questions, refer CEDI website Questions on Endeavor September 2015 Noridian Jurisdiction D DME MAC 44 44

45 Common Electronic Data Interchange (CEDI) Single front end electronic solution Free software Front end error report manual CEDI works with: DME MAC software vendors Billing services Clearinghouses Trading partners Contact: Scroll down for information on home page Phone: CEDI 5010A1 Manual: September 2015 Noridian Jurisdiction D DME MAC 45 45

46 Denial Code Guidance Each denial code webpage includes: Claim adjustment reason code and description Why did my claim li deny? Claim adjustment remark code and description Common reason why Noridian uses that reason/remark code Next step (re-file, redetermination, reopening, etc.) How to avoid these types of denials Applicable resources More pages to come! Why was my claim processed this way? med.noridianmedicare.com/web/jddme/topics/ra/denial-guidance September 2015 Noridian Jurisdiction D DME MAC 46 46

47 Claims may be denied if: PECOS Requirement The ordering/referring physician is NOT in PECOS and eligible to order and refer The ordering/referring physician is not of the specialty to order/refer If the physician's name submitted on the claim does not match their name in PECOS med.noridianmedicare.com/web/jddme/claims-appeals/claimsubmission/pecos-edits See how to avoid these claim denials by properly submitting the ordering physician name from the CMS PECOS Report Implemented January 6, 2014 View the PECOS DME on Demand on our website! September 2015 Noridian Jurisdiction D DME MAC 47 47

48 ALJ Appeal Status Info System (AASIS) Check the status of an ALJ appeal September 2015 Noridian Jurisdiction D DME MAC 48 48

49 Updates Tuesday and Friday Latest updates and announcements Customizable Sign-up in the lower right corner of our new website! September 2015 Noridian Jurisdiction D DME MAC 49 49

50 Website Survey September 2015 Noridian Jurisdiction D DME MAC 50 50

51 esmd (Electronic Submission of Medical Documentation) esmd is the ability to transmit documentation electronically for review Who accepts documentation via esmd? DME MAC (Noridian) CERT Recovery Auditor ZPIC What types of requests can be sent via esmd? Complex Medical Review & PMD PAR Find out more: Systems/ESMD/index.html?redirect=/esmd September 2015 Noridian Jurisdiction D DME MAC 51 51

52 MREP Medicare Remit Easy Print Free software! View, search and print remits Print and export reports CMS Brochure mit_0408.pdf MREP Software RemitEasyPrint.asp September 2015 Noridian Jurisdiction D DME MAC 52 52

53 Medicare Learning Network (MLN) Guides Training Articles Presentations Educational Tools Web-Based Training Booklets Brochures Special Initiatives Fact Sheets Web Resources MLN/MLNGenInfo/index.html September 2015 Noridian Jurisdiction D DME MAC 53 53

54 We Are Coming To You!! If you are going to be in the following cities, please come and visit us for Adjust Your Sails for Medicare Success September September 15, Las Vegas, NV September 17, Phoenix, AZ September 29, Los Angeles, CA October October 1, Riverside, CA October 13, Seattle, WA October 15, Portland, OR Now offering 30 minute 1 on 1 sessions during our fall in person seminars. Register today to reserve your spot! med.noridianmedicare.com/web/jddme/education September 2015 Noridian Jurisdiction D DME MAC 54 54

55 Education Opportunities Web-Based Workshops Q & A Sessions 2 nd Monday of each 3 p.m. CT DME On Demand Education Request (Free one on one) ACT med.noridianmedicare.com/web/jddme/education September 2015 Noridian Jurisdiction D DME MAC 55 55

56 Single Toll Free Line IVR Supplier Contact Center Telephone Reopenings Monday Friday 8 a.m. 6 p.m. Central Time Effective March 1, 2015 September 2015 Noridian Jurisdiction D DME MAC 56 56

57 Beneficiary Contact Information Suppliers please use Noridian Contact Center number for supplier inquiries only Beneficiaries who need assistance can be directed to: Medicare ( ) Question on claims and coverage of equipment Social Security Administration ( ) Update name/address, questions on premiums, Medicare entitlement Benefits Coordination Recovery Center ( ) Primary insurance information update September 2015 Noridian Jurisdiction D DME MAC 57 57

58 Questions 58

59 Thank you for attending! 59