Top Ten Things TrailBlazer Wishes You Knew
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- Garry Cummings
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1 Top Ten Things TrailBlazer Wishes You Knew Steven Mildward Published July /TrailBlazer. All rights reserved. TrailBlazer Wishes You Knew Your practice/facility. Your Medicare Administrative Contractor (MAC). Your patients. Your payers. Keep it simple. Communication is key. You have tools. You have a voice. You are not alone. MACs are messengers. Slide 2 Your Practice/Facility 1
2 What Type of Practice/Facility Are You? What did your enrollment application indicate about you? Where is a copy of that document? Does your staff know how special you really are? Does Medicare know? Slide 4 Your Medicare Administrative Contractor (MAC) MACs The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) enables the Centers for Medicare & Medicaid Services (CMS) to make significant changes to the Medicare Fee-for- Service (FFS) program s administrative structure that will make contracting dynamic, competitive and performance-based. Through implementation of Medicare contracting reform, CMS will integrate the administration of Medicare Parts A and B for the FFS benefit to entities called MACs. Slide 6 2
3 CMS MAC Web Page A source for all information concerning the MAC workloads and reporting. Contracting/MedicareContractingReform/index.html Slide 7 MAC Jurisdictions Consolidated A/B MAC Jurisdictions Slide 8 JH Listserv Slide 9 3
4 Your Patients Obtain Essential Patient Information During intake you should ask your patient coverage questions pertaining to his visit. Make a copy of the patient s Medicare card. Ask for a photo ID. Ask about any additional coverage or options they have elected. Slide 11 Your Payers 4
5 Who Is on First? For the purposes of Medicare billing, you are required to screen for any other payer who might be responsible for paying the claim as primary. TrailBlazer offers an interactive decision tree to assist in this determination. Service/Self-Service Tools/MSPdocumentationIDT.aspx Slide 13 Keep It Simple Know What Is Needed Providers often overcode on their bills, providing elements that are not required for the payment of the claim. For example: A Rural Health Clinic (RHC) that bills with HCPCS codes. Or, Filling in every diagnosis form locator when many were not related to the visit. Remember, if you provide it, then the elements can be evaluated. Keep it simple. Slide 15 5
6 Communication Is Key Change Happens Change may be the only constant. If your practice address or delegated officials change, let us know. It is important that this information is kept up to date. If Medicare receives mail returned as undeliverable, then your ability to bill Medicare could be in jeopardy. Slide 17 You Have Tools 6
7 EDI, ERA and EFT Electronic Data Interchange (EDI) enables you to submit claims electronically, which allows faster claims processing and quicker reimbursement. Part A providers use Direct Data Entry (DDE), also known as GPNet. Part B providers use the Professional Provider Telecommunication Network (PPTN). Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) are becoming the national standard. All providers submitting a validation or revalidation must have an EFT agreement on file. Slide 19 Internet Resources The CMS and TrailBlazer Web sites are both good places to start with any question you may have about Medicare. Professional associations also provide information and resources for their members. General searches may also be helpful. Slide 20 You Have a Voice 7
8 Speak Up CMS encourages discussion on Medicare changes in its Open Door Forums. Respond to CMS when they request feedback in writing. MACs also offer Ask-the-Contractor Teleconference (ACT) calls. Associations and elected officials are also important resources. Slide 22 You Are Not Alone The Power of Partnering Network with your peers. Joining associations can provide added support. Local and state offices that serve the provider community are also a great source of information and an avenue to express concerns. Slide 24 8
9 MACs Are Messengers Don t Shoot the Messenger MACs answer to and receive guidance from CMS, which is part of the Department of Health and Human Services. Congress makes the laws. Medicare reform begins with your locally elected federal officials. Do they know you and your needs? Slide 26 Top Ten Things TrailBlazer Wishes You Knew Thank you for attending. 9
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