Georgia HFMA. Top 5 Claim Submission Errors

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1 Georgia HFMA March 15, 2012 Top 5 Claim Submission Errors Claim Submission Errors Jan - Feb 2012 Claims in Thousands Claims in Thousands U C

2 Tips to Prevent CSE s Ensure claims are being submitted correctly Ensure staff is familiar with Medicare s coverage and billing guidelines Check for RTP or rejection patterns Post claim payments timely and accurately Use this presentation as an internal training tool HIPAA 5010 Transition Are You Compliant? Electronic transactions transitioned to Version 5010 on December 31, Day Discretionary Enforcement Period for noncompliant entities Enforcement will not be exercised until April 1, 2012 Electronic Data Interchange (EDI): 1(866)

3 HIPAA 5010 Transition Are You Compliant? ICD-10 HHS will initiate a process to postpone the date by which certain health care entities have to comply with ICD-10 A new compliance date will be announced 3

4 Revalidation Providers enrolled in Medicare prior to March 25, 2011 must revalidate by March 2015March 2015 Do not revalidate until you receive notification Providers have 60 days from date of letter PECOS Web Application The Preferred Method Advantages of using Internet-based Provider Enrollment Chain Ownership System More control over enrollment information Easiest way to update enrollment information Less staff time and administrative costs New Enhancements are here! Electronic Signature Access to More Information Multiple Views of Your Information Overall Usability 4

5 Comprehensive Error Rate Testing The CERT Program - Measures improper payments in the Medicare fee-forservice (FFS) program. - Designed to comply with the Improper Payments Elimination and Recovery Act of 2010 (IPERA). The CERT Documentation Contractor - Responsible for requesting and receiving the medical record documentation from providers. The CERT Review Contractor - Review selected claims and associated medical record documentation. CMS New Look 5

6 Cahaba Website Coming Soon! New Cahaba Website Design Self Service Tools Cahaba University Online learning management system New and updated educational courses available Available 24 hours a day Notification (Listserv) Stay update with the latest news and information from Cahaba GBA and CMS Upcoming events Visit: 6

7 Reimbursement Department Part A Presented by Hiala Elridge, MBA Demand Letter Updates October 29, 2011, CMS issued a mandatory direction to eliminate 2 nd Demand Letters. January 3, 2012, CMS issued CR 7436, which directed d that t the responsibility for mailing Demand letters shift to the MAC. 7

8 Demand Letter Updates (cont.) The demand letters are generated based on an automated system setup by CMS. The automated system generates letters to the physical address of your facility which was obtained from your provider enrollment data. Demand Letter Address Updates The address for the demand letters is defined as: Practice Location Information in Section 4A on your Provider/Supplier Enrollment application, CMS Form-855A. Providers may choose to update their address information via CMS Form-855A to include a specific contact at your facility. This could be done by including an Attn. line so the correspondence can be directed to a specific individual. 8

9 Demand Letter Address Updates Note: This change would impact other demand letter correspondences (non-rac) that are also generated from the Practice Location Information. Demand Letter Updates (cont.) Under Tolerance (CR2292): The automated system does not generate demand letters for ARs less than $25. The system aggregates AR s until there is a total of $25 then demand letters are generated to include each AR. Note: No penalty is assessed until a demand letter is sent and the clock begins ticking. 9

10 Remittance Advice Updates Reporting of recoupment for overpayment on the Remittance Advice (RA) (CR7499): CMS will implement the CR 7499, April 2, This will change the remittance reporting by providing the Patient Control Number rather than the HIC number (Medicare Health Insurance Claim Number) Note: Please make sure that your remittance vendor is aware of this change. Remittance Advice Updates (cont.) Reporting of recoupment for overpayment on the Remittance Advice (RA) CR6870: In an effort to enable providers to reconcile records and payments easier, CMS implemented CR6870, July 5, CR6870 instructed that multiple PLB lines appear on the remits, however, this process did not work as CMS directed. Oct 20, 2011, CMS put a corrected change of action into place. The new process allows providers to reconcile their remits easier by listing all of the adjustment information in one location. 10

11 Tips for Timely Processing Submit only one check for the total amount of the Claim ARs being refunded, a copy of the 1 st page of the demand letter and the list of all applicable claims. When you become aware of a claim overpayment, you are encouraged to initiate adjustments electronically or via hardcopy for outstanding credit balances. If unable to do so, submit a hardcopy UB form containing all claim modifications along with any credit balance report for which adjustments are required. Tips for Timely Processing (cont.) Submit a request for a Part A immediate offset h b / /f / h Include: Demand letter date NPI, DOS, Provider Number Type overpayment (Example: 935 claims AR, cost report Final Settlement, etc.) Cost report period (for cost report settlements and lump sum adjustments) Claim AR number (for claims 935 claims AR). 11

12 CMS MLN Matters article: Thank you Cahaba Government Benefit Administrators, LLC J10 A/B Medicare Administrative Contractor 12