Medicare Part B Updates

Transcription

1 Medicare Part B Updates AAHAM January 23, 2015 Add doc ctrl no. Today s Presenter Gail O Leary Provider Outreach & Education Representative 2 1

2 Disclaimer National Government Services, Inc. has produced this material as an informational reference for providers furnishing services in our contract jurisdiction. National Government Services 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 material. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of publication, the Medicare Program is constantly changing, and it is the responsibility of each provider to remain abreast of the Medicare Program requirements. Any regulations, policies and/or guidelines cited in this publication are subject to change without further notice. Current Medicare regulations can be found on the CMS website at 3 No Recording Attendees/providers are never permitted to record (tape record or any other method) our educational events This applies to our webinars, teleconferences, live events and any other type of a National Government Services educational event 4 2

3 Updates 5 New Corporate Name - Branding WellPoint has changed its corporate name to Anthem, Inc. Effective December 3,

4 Add Provider Enrollment Addresses to List of Safe Senders correspondence sent from the NGS Provider Enrollment department will now display as: or correspondence sent from PECOS will continue to display as All individuals listed as enrollment application contacts should routinely verify their spam or junk folder and add the and addresses to their safe senders list to prevent these s from going into spam or junk folders Revised CMS 855R Application Reassignment of Benefits SE 1432 Beginning June 1, 2015 Physicians, Non-Physician Practitioners, Providers, and Suppliers must use the revised application (version 11/12) Available for use on the CMS.gov website 12/29/14 After 5/31/15, NGS will return any newly submitted CMS 855R applications on the previous version (07/11) to the provider 4

5 New Timeframe for Response to Additional Documentation Requests (ADR) Effective Date: April 1, 2015 MACs and ZPICs Prepayment Review Time Frames Requested documentation must be submitted within 45 calendar days No extensions will be granted MACs, CERT and RAs Post payment Review Time Frames Requested documentation must be submitted within 45 calendar days No extensions will be granted ZPICs Requested documentation must be submitted within 30 days MACs, CERT and ZPICs have the discretion to grant an extension Responding to ADRs National Government Services Jurisdiction K (CT, MA, ME, NH, NY, RI, VT) Fax: Mail: P.O. Box 7108 Indianapolis, IN Connex: through the My Claims tab 5

6 Part B Premiums/Deductibles Monthly Part B Premium for Beneficiary - $ Higher part B Premium Monthly Part B Premium for Beneficiary - $ Income above $85,000 up to $107,000 pay higher part B Premium $ Part B Deductible - $147 Part B Deductible - $147 Part B Coinsurance - 20% Part B Coinsurance - 20% Mental Health Services - 80% Mental Health Services 80 % 2015 Medicare Physician Fee Schedules The 2015 Medicare Physician Fee Schedule is now available on our website To access the fee schedule, go to and click on the Fee Schedule Lookup tool 12 6

7 2015 Medicare Physician Fee Schedule (MPFS) Update Sustainable Growth Rate SGR calls for a 21.2% cut, effective April 1, 2015 CMS supports legislation to permanently address the SGR physician pay cuts through March 2015 Awaiting Congressional action 13 Sequestration Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013 March 31, 2015 will incur a two percent reduction in Medicare payment The claims payment adjustment shall be applied to all claims after determining coinsurance, applicable deductible, and any applicable Medicare Secondary Payment adjustments Beneficiaries are not liable for this payment adjustment There are no exemptions provided in the law for drugs or any item or service provided under the fee-for-service program These adjustments also apply to bonus payments 14 7

8 2015 Therapy Caps $1940 Physical Therapy and Speech Language Combined $1940 Occupational Therapy Exceptions Process extended until March 31, 2015 Caps apply to outpatient hospital and Critical Access Hospitals 15 Therapy Threshold of $3,700 Extended through March 31,2015 $3,700 Therapy Threshold applies to current 2015 calendar year services Subject to Manual Review Functional Reporting is in place On-going education is in place for the G codes which relate to functional status and % of disability 16 8

9 2015 Annual Update to Therapy Code List New Codes effective January 1, (Negative pressure wound treatment) Replaces G (Negative pressure wound treatment > 50cm) Replaces G0457 The therapy code listing can be found at Annual Therapy Update - Centers for Medicare & Medicaid Services 17 Telehealth Services Criteria outlined for telehealth reimbursement includes: An interactive telecommunications system must be used to provide service Practitioner providing the service must meet telehealth requirements and the usual Medicare requirements Service must be provided to an eligible telehealth individual and must be in an eligible origination site 18 9

10 Telehealth Services Effective January 1, 2015 the definition of Originating Sites to include more rural locations Proposed further expansions on telehealth reimbursable services beginning in 2016 Family Psychotherapy Services - CPT codes and and Psychoanalysis CPT code Prolonged E&M Services - CPT codes and Annual Wellness Visit -HCPCS G0438 and G New Redetermination and Reopening Forms NGS encourages providers to use NGSConnex to submit redetermination and reopening requests For Providers not utilizing Connex tool for requests Revised Appeals Redetermination Request form New Reopening Clerical Claim Correction form NGS will continue to accept the old appeals request form as well as the new forms - effective 1/1/2015, old forms will no longer be available on our website Part B Appeals Request Form: Redetermination: First Level of Appeal Part B Reopening Form: Clerical Claim Corrections 20 10

11 Adjudicated Claims Appeal, Do Not Resubmit To change previously-adjudicated claim, submit reopening request or appeal claim decision MA01 remark code on remittance advice indicating claim can be appealed Seeing increase in incorrect billing practice Duplicate claim with comment of corrected claim on electronic notepad Amount in Controversy Changes - Appeals Administrative Law Judge Hearing - Requests filed on or after 01/01/2015, at least $150 must remain in controversy. Federal Court Review - Requests filed on or after 01/01/2015, at least $1,460 remains in controversy 22 11

12 News Article - PA Services Posted 11/14/14 NGS has identified a system error resulting in claims being incorrectly denied for services performed by a PA as: The provider not being eligible to perform the service outside the scope of practice All affected claims will be adjusted and no action is necessary by the physician/provider 23 News Article - PA Services Posted 11/14/14 For 2014, these are all new allowed services: Image guided fluid collection drainage by catheter, ; visceral, percutaneous Image guided fluid collection drainage by catheter..; peritoneal or retroperitoneal, percutaneous Image guided fluid collection drainage by catheter, ;peritoneal or retroperitoneal, transvaginal or transrectal Image guided fluid collection drainage by catheter soft tissue, percutaneous Additionally, Change of percutaneous biliary drainage catheter, will be allowed when performed by a PA 24 12

13 News Article - Certified Registered Nurse Anesthetists Billing Posted 10/16/14 It has been brought to NGS s attention CRNA s are not being reimbursed for services they may be allowed to perform NGS has determined that CRNA s may be allowed to bill for E&M services and pain procedures, if allowed by state scope of practice law Claims will be adjusted if you have had E&M services or pain procedures denied for a CRNA, based on provider specialty, and if your state scope of practice law allows CRNAs to perform these services No action is required by providers 25 Update to Clarify Claims Processing for Laboratory Services CR8883 This update clarifies that: The location where the independent laboratory performed the test determines the appropriate billing jurisdiction for specimen collection fees and travel allowance 26 13

14 Health Professional Shortage Area (HPSA) CR 8942 The annual HPSA bonus payment file for 2015 will be used for HPSA bonus payments on applicable claims with dates of service on or after 01/01/2015 through 12/31/ 2015 Review Physician Bonuses webpage on CMS s website annually to determine if modifier AQ is needed on your claim in order to receive the bonus payment, or, to see if the ZIP code in which you rendered services will automatically receive the HPSA bonus payment Be sure your billing staffs are aware of any changes Payment /HPSAPSAPhysicianBonuses 27 Local Coverage Determinations and Article Revisions for December 2014 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy (L35336) Lumbar Epidural Injections (L35338) Pain Management (L28529) 28 14

15 ICD ICD-10 Implementation Allows Health Care Industry Ample Time to Prepare For Change U.S. Department of Health and Human Services (HHS) issued a rule finalizing Oct. 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD

16 Transition Road Map ICD-10-CM Implementation: 6 Phases 1. Planning 2. Communication and awareness 3. Assessment 4. Operational implementation 5. Testing 6. Transition 31 ICD-10 Acknowledgement Testing Weeks CMS encourages this opportunity for trading partners, software vendors, clearinghouses, and billing services to come together and test their ICD-10 compliance efforts already underway with Electronic Data Interchange (EDI) with the added benefit of real time Help Desk support Testing Week Support Hours: March 2, 2015 through March 6, 2015 June 1, 2015 through June 5, :00 a.m. - 5:00 p.m. Eastern Standard Time (ET) JK: EDI Inquiry Form 32 16

17 FAQs ICD-10 End-to-End Testing SE1435 Acknowledgment Testing Submit claims with ICD-10 codes to Medicare Fee-For-Service claims systems Receive acknowledgements to confirm that claims were accepted/rejected End to End Testing Processing claims through all Medicare system edits to produce and return an accurate Electronic Remittance Advice (ERA). 33 NGSConnex 34 17

18 What is NGSConnex? Need Internet access and address No cost Provides: Claim status Beneficiary eligibility Financial data/provider demographics Ability to order/download duplicate remittances Initiate a redetermination request Reopening request for Part B claim corrections Inquiries 35 Connex Redetermination/Reopening Requests Reminder Redeterminations /Reopenings can be accepted via Connex Rules for reopenings has not changed Only claims that have processed through our system are eligible Claims rejected MA-130 must be corrected and resubmitted 18

19 NGS Connex Feature - Electronic Claims Submission Allows Part B providers to submit claims on our secure portal It is faster than paper - 14-day turnaround! It is free to submit a claim You can edit errors immediately Receive confirmation of claim submission Recent Enhancements Preventive Services Verify when a beneficiary has last received a preventive service and next eligibility date Downloadable Remittance Advice Remittance advices are not available for claims with a paid date greater than 60 days. (RAs are purged 60 days after paid date. User must select Order Duplicate Remittance option.) Must have an EDI enrollment agreement on file 38 19

20 Our Contact Information IVR: Provider Contact Center: Fax on Demand: EDI Helpdesk: Correspondence National Government Services Part B Provider General Written Inquiries P.O. Box 6189 Indianapolis, IN New Direct Telephone line for Provider Enrollment (JK): Updates Subscribe to receive the latest Medicare information

21 Website Survey This is your chance to have your voice heard Say yes when you see this pop-up so National Government Services can make your job easier! 41 Medicare University Interactive online system available 24/7 Educational opportunities available Computer-based training courses Teleconferences, webinars, live seminars/ face-to-face training Self-report attendance 21

22 Thank You! Questions? 43 22