Medicare Part B - Current Updates October 2015

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1 Medicare Part B - Current Updates October 2015 Disclaimer Every reasonable effort has been made to ensure the accuracy of this information. However, the provider has the ultimate responsibility for compliance with Medicare rules and regulations. WPS Medicare bears no liability for the results or consequences of the misuse of this information. The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings. ICD-10 Compliance Date is October 1, 2015 Providers are required to continue to use ICD-9-CM for dates of service through September 30, Providers must submit valid ICD-10-CM codes for dates of service October 1, 2015 and after. ICD-10 Resources The CMS ICD-10 web page has information and educational resources for providers to implement and transition to ICD-10 medical coding at: Resources.html You can also find ICD-10 information on the ICD-10 page of the WPS Medicare website at: Iowa, Kansas, Missouri, and Nebraska CMS Secure Net Access Portal (C-SNAP) Enhancements The following features have been added to C-SNAP: J8 Michigan Part A providers can submit electronic prior authorization requests for Hyperbaric Oxygen (HBO) services. Our Medical Review staff will respond with a decision letter to these requests via C-SNAP. Medical Review will also be sending notifications to providers via on their probe and additional development response (ADR) review. C-SNAP has been enhanced to electronically to accept appeals attachments from Part B providers. Refer to the C-SNAP User Manual for detailed instructions and specifications on size limitations and system requirements. Need Help Using C-SNAP? Updated 09/28/15 1

2 On Demand Training can be found at: Iowa, Kansas, Missouri, and Nebraska If you have questions that cannot be resolved after reviewing this training, please call Medicare Customer Service at Iowa, Kansas, Missouri, and Nebraska (866) (866) More help is available on our Help Center on the C-SNAP Home page at: C-SNAP User Manual is available on the C-SNAP Home page at: Sign up for Medicare Learning Network CMS national provider educational products, named The Medicare Learning Network (MLN), share up-to-date educational information and accompany the release of new or revised Medicare program policies. Available educational tools include National Educational Articles, Brochures, Fact Sheets, Web-Based Training Courses, Videos and Podcasts. For more details, please visit: MLN/MLNGenInfo/index.html Comprehensive Error Rate Testing (CERT) Program CMS uses the CERT program to measure and improve the quality and accuracy of Medicare claims submission, processing, and payment. WPS Medicare uses the error rate information to ensure education will address and prevent the most common billing errors and claim denials. CMS Comprehensive Error Rate Testing (CERT) Program web page: Programs/CERT/index.html Iowa, Kansas, Missouri, and Nebraska WPS Medicare web page: WPS Medicare web page: Internet-based Provider Enrollment, Chain and Ownership System (PECOS) Submit your Medicare Enrollment Application using Internet-based PECOS, the fastest, easiest way to enroll in the Medicare program or update your Medicare program enrollment record. You can access Internet-based PECOS at: Certification/MedicareProviderSupEnroll/InternetbasedPECOS.html 2

3 The CMS publication (ICN ), titled "The Basics of Internet-based Provider Enrollment, Chain and Ownership System (PECOS) for Provider and Supplier Organizations helps you use internet-based PECOS. You can download it here: MLN/MLNProducts/downloads/MedEnroll_PECOS_ProviderSup_FactSheet_ICN pdf The CMS publication (ICN ), titled "The Basics of Internet-based PECOS for Physicians and Non-Physician Practitioners helps you use internet-based PECOS. You can download it here: MLN/MLNProducts/downloads/MedEnroll_Pecos_PhysNonPhys_FactSheet_ICN pdf Customer Satisfaction Survey WPS Medicare strives to continue to improve our website to meet our providers needs. We use the ForeSee Customer Satisfaction Survey as a primary means to gather your feedback and input and gauge your satisfaction with our website. Please take time to complete the Website Satisfaction Survey that pops up when visiting the WPS Medicare website. Medicare Quarterly Provider Compliance Newsletter The Medicare Learning Network (MLN) Products Provider Compliance page contains educational products informing Medicare Fee-For-Service (FFS) providers about how to avoid common billing errors and other improper activities when dealing with the Medicare Program. Since 1996, CMS has implemented several initiatives to prevent improper payments before a claim is processed and to identify and recoup improper payments after the claim is processed. The overall goal of CMS' claim review programs is to reduce payment errors by identifying and addressing billing errors concerning coverage and coding made by providers. To learn more, visit the CMS Provider Compliance page: MLN/MLNProducts/ProviderCompliance.html enews WPS Medicare sends out a weekly enews on Monday with the most current and vital information Medicare providers need to know. The weekly enews contains current news from CMS and WPS Medicare, policy updates, information about upcoming changes, and more. A second enews is sent on Wednesday containing announcements about educational opportunities. Additional enews messages will be sent when we have time-sensitive or urgent information to share with the provider community. We encourage all individuals at a provider's office to subscribe, as there are no restrictions on how many individuals can subscribe. Select the "enews" link in the top right corner of any wpsmedicare.com web page or you can sign-up on the WPS Medicare website at: WPS Medicare Resources Web Page WPS Medicare offers a wide range of resources to assist providers. We regularly develop and improve our online resources to decrease providers costs and time spent contacting WPS Medicare. Easy access to the following information can be found under the Resources tab: Acronyms Lookup, CMS/External Links, Modifiers, New Providers and Provider 3

4 Specialties/Services, Tips for First Time Visitors and Website Updates. Information is available 24 hours a day, 7 days a week, at a time most suitable to providers schedules. Visit the WPS Medicare Resource Web Page: Iowa, Kansas, Missouri, and Nebraska Electronic Remit Advice Electronic Remittance Advice (ERA) is an electronic version of your Explanation of Payment (EOP) and allows you to automatically post your accounts. Online ERA Enrollment: Online enrollment eliminates the need to submit a paper ERA Agreement. ERA Agreement: To be submitted to WPS if enrolling via paper. Medicare Remit Easy Print (MREP) and PC-Print Software MREP for Part B; PC-Print for Part A will enable physicians and suppliers to view and locally print a Medicare / DMERC HIPAA compliant 835 file in a format that mirrors the Medicare Standard Paper Remittance Advice (SPR). Get easy Access to MREP and PC-Print by visiting the WPS Medicare website below: For assistance, please call Medicare MAC J5 A & B, J5 National Part A (Iowa, Kansas, Missouri, Nebraska and J5 National) J5 (866) opt 1 MAC J8 A & B, (Indiana, Michigan) J8 (866) opt 1 PC-ACE PRO32 Billing Software Upgrade Version 2.70 Now Available Online Attention: PC-ACE Pro32 and Windows 10 Beginning on July 29, 2015, Microsoft will make Windows 10 available to current users of Windows 7 and Windows 8.1. Because the product will be distributed via download, and at no cost for many existing Windows users, there may be a high number of early adopters. While WPS EDI is committed to supporting PC-ACE Pro32 on Windows 10, Microsoft s release date of July 29th did not allow our vendor adequate compatibility testing prior to the July 2015 (2.7) release. Compatibility testing will instead be completed as part of the October 2015 (2.8) release. As such, we strongly recommend that PC-ACE Pro32 users delay installation of Windows 10 until October, after the 2.8 release of PC-ACE Pro32 has taken place, as we will be unable to support PC-ACE on Windows 10 (**Note that Microsoft will allow users to upgrade for free for up to a year). 4

5 Download PC-ACE Pro32 Version 2.70 If you are currently using the PC-ACE Pro32 billing software, you can now download the latest upgrade online ( Now available online is: The upgrade to the latest version of PC-ACE Pro32, version 2.70 Instructions related to the upgrade Users Guides/Manuals Change Summary for the version 2.70 upgrade If you are not using the version listed above, it is very important that you update your software immediately. As software upgrades are received each quarter (January, April, July, and October), please download/install the upgrades to update your program, so as to avoid the software expiring. If you are not currently using this program but you are interested in using this HIPAA compliant software, please contact our EDI Hotline at (866) You can also reach our help desk at the following address: Medicare Incentive Programs Incentive payments are available to eligible professionals who meet the eligibility and reporting requirements for each program. In 2015, eligible professionals may choose to participate in the following payment incentive programs. 1. While there are no incentive payments for 2015, compliance will prevent a negative payment adjustment in future years. Physician Quality Reporting System Medicare eligible professionals who satisfactory report data on quality measures for covered professional services furnished to Medicare beneficiaries. Find more information on the Physician Quality Reporting System program on the CMS website: Instruments/PQRS/index.html 2. Electronic Health Records (EHR) Medicare eligible professionals, hospitals, and critical access hospitals for the meaningful use of certified EHR technology. Medicare eligible professionals may not earn incentives under the erx and Electronic Health Records incentive programs at the same time. Find more information on the EHR Incentive Program on the CMS website: Appeals- Are you following the Appeals Process including meeting the timeframes for submitting your Appeal request? WPS Medicare has seen an increase in the number of appeal request dismissals for various reasons. In an effort to avoid future dismissals of appeal requests, we have published an article reminding providers of the steps to submitting an appeal including the timeframes and which contractor will be processing that appeal request. Please see the article Medicare Appeals - The Importance of Getting It to the Right Place at the Right Time! found on the WPS Medicare website on the Appeals page. 5

6 Iowa, Kansas, Missouri, and Nebraska Appeals MLN Matters SE Limiting the Scope of Review on Redeterminations and Reconsiderations of Certain Claims Post-payment Appeals: This article provides CMS clarification regarding redeterminations and reconsiderations of claims denied following a post-payment review or audit. Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) are to limit their review to the reason(s) the claim or line at issue was initially denied. Post-payment review or audit refers to claims that were initially paid by Medicare and subsequently reopened and reviewed by, for example, a Zone Program Integrity Contractor (ZPIC), Recovery Auditor, MAC, or Comprehensive Error Rate Testing (CERT) contractor, and revised to deny coverage, change coding, or reduce payment. Effective for requests received by a MAC or QIC on or after August 1, 2015; not applied retroactively. Pre-payment Appeals: If an appeal involves a claim or line item denied on a pre-payment basis, MACs and QICs may continue to develop new issues and evidence at their discretion and may issue unfavorable decisions for reasons other than those specified in the initial determination. Contractors will continue to follow existing procedures regarding claim adjustments resulting from favorable appeal decisions. You can access the MLN article at: MLN/MLNMattersArticles/Downloads/SE1521.pdf 6