April Quarterly Release Training
Contents
1. Healthcare Solutions April Quarterly Release Training Presented by Noridian Part A Provider Outreach and Education POE April 2014 Noridian Healthcare Solutions LLC 00 AMTMAIT idian Healthcare Solutions 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 CMS The most current edition of the information contained in this release can be found on the Noridian website at http www noridianmedicare com and the CMS website at http www cms gov 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 2014 American Medical Association All rights reserved Applicable FARS DFARS apply April 2014 2 noridian Before We Start Help Us Help You CHAT area Enter attendee name facility name and state do not enter in Q amp A section 77 Chak gt Send ko Al2. Healthcare Solutions Special Editions SE SSH SE0801 Clarification of Patient Discharge Status Codes amp Hospital Transfer Policies e Article Revised March 3 2014 Provides Clarification on Correct Patient Status Codes CMS requires patient status codes on Hospital Inpatient Claims type of bills TOBs 11X and 12X e Skilled Nursing Claims TOBs 18X 21X 22X and 23X Outpatient Hospital Services TOBs 13X 14X 71X 73X 74X 75X 76X and 85 All Hospice and Home Health Claims TOBs 32X 33X 34X 81X and 82 Healthcare Solutions Questions noridian Obtaining CEU Certificate Browse Browse Fees amp News Policies Audit amp CERT amp Enrollment Forms by Topic by Reimbursement Reviews Provider Fee Schedules Cost CERT Recovery Enroll Changes Downioadabie Forms 4 A Artes Bulletins LCDs NCDs IDEs Credit Balance Maxstor Revalidabon and Links JE Part A Education Outreach Workshop Materials Tutorials and Prior Events EDUCATION amp Workshop Materials Tutorials and Prior Events OUTREACH The Noridian Provider Outreach and Education POE team offers the following educational material to assist Schedule of Events providers and their team members access Medicare training material Attendance at events is encouraged to obtain Workshop Materials the most current information Sn Tutorials and Prior Even
3. 2013 Links Healthcare Provider Taxonomy Codes HPTC Update October 2013 PDF CR8417 9 30 2013 Help Integrated Outpatient Code Editor Specifications Version 14 3 October 2013 CR8419 9 30 2013 Holding Claims for Pricing Based on October 2013 FISS Release 9 27 2013 mm oleam o Cila LAID Mined Pinus April 2014 WHAT S NEW Medicare Learning Network MLN Connects Provider e News http www cms gov Outreach and Education Medicare Learning Network MLN MLNGenInfo index html redirect MLNGenInfo e SE and CRs listed from the last 90 days Every six weeks they are included in a Bulletin e Subscribe to Tuesday and Friday emails Latest news from Noridian and CMS Workshop and educational event notices Medical policy updates and more April 2014 46 _ 5i idian Healthcare Solutions Hospital Inpatient Admission Order and Certification Inpatient Hospital Admissions Effective with admissions 10 01 13 and after Expectation that patient will remain in hospital for at least 2 midnights Can consider time spent in outpatient setting clock starts running when patient begins receiving services Inpatient portion begins with formal admission e 2 midnight expectation doesn t apply to inpatient procedures April 2014 48 iE noridian Inpatient Hospital Admissions e Applies to PPS hospitals
4. Group CMS Open Door Forums Open Door Coverage Meetings Education Request Noridian Home Medicare Part A Site Map Search Guide Advanced Search Quick Search You are here Horidan Home gt Medicare Part gt Educafion Center gt In Person Seminars Select B for expanded navigation SEMINARS Medicare Part A News and Publications Date Time Fee Schedules ALASKA amp LCDs Coverage MR 05014 amp Appeals Enrollment New Provider Biller amp Claims Endeavor Online Claims Audit Reimbursement CERT RA ARIZONA 8 ICD 10 05 05 14 Forms to Success Contact amp Links Help Seminar Title Location Registration Medicare Climbing the Ladder Homewood Suites to Success 101 West 48th Avenue Anchorage AK 99503 907 762 7000 Medicare Climbing the Ladder Westmark Hotel and Convention to Success Center 813 Noble St Fairbanks AK 99701 907 456 7722 Medicare Climbing the Ladder Hilton Garden Inn Phoenix Aiport 3422 E Elwood At University Phoenix AZ 85040 602 470 0500 Medicare Climbing the Ladder Hilton Garden Inn to Success 6575 S Country Club Rd Tucson A7 85756 520 741 0505 Medicare Climbing the Ladder Hampton Inn to Success 2400 Reulah Flagstaff AZ 86001 808 912 0900 Register Now Be the first to receive Medicare news and information In Person Seminars Climbing the Ladder to Success Session will include the follo
5. MLNProducts MLN Web Guides http Awww cms gov MLNEdWebGuide MLN Connects Provider eNews hiip Awww cms gov Outreach and Education Outreach FFSProvPartProg index html redirectz FFSProvP artProg April 2014 CMS Provider Compliance Resources http www cms gov Outreach and Education Medicare Learning Network MLN MLNProducts index html MLN Catalog of Products http www cms gov Outreach and Education Medicare Learning Network MLN MLNProducts Downloads MLNCatalog pdf MLN Product Ordering Page http cms meridianksi com kc pfs pfs Inkfrm fl asp lgnfrm regprod amp fu nction pfs MLN Publications List http www cms gov Outreach and Education Medicare Learning Network MLN MLNProducts MLN Publications html MLN Provider Compliance Products http www cms gov Outreach and Education Medicare Learning Network MLN MLNProducts Downloads ProvCmpl Products paf April 2014 12 Medicare Quarterly Provider Compliance Newsletter e Includes Comprehensive Error Medicare Quarterly Provider Rate Testing CERT Compliance Newsletter Findings Guidance to Address Billing Errors Recovery Auditor Findings r k gt n Volume 4 huuu 5 2514 A dee http www cms gov Outreach and Education Medicare Learning Network MLN MLNProducts Downloads ProvCmpl Products pdf April 2014 13 SH Green Sign up for ERAs Electron
6. recommended to make clear e CERT Reviewer will request added evidence from NPI or UPIN on claim to support service billed and coverage of LCD NCDs April 2014 37 CHEN CERT Post Audit Checklists JE https med noridianmedicare com web jea cert reviews cert checklists JF https www noridianmedicare com parta claims cert cert med doc html Ambulance Documentation Checklist Chemotherapy Documentation Checklist Dialysis Documentation Checklist Evaluation and Management E M Documentation Checklist Laboratory Documentation Checklist Physical Occupational and Speech Therapies Documentation Checklist Psychiatric Mental Health Documentation Checklist Radiology Documentation Checklist April 2014 38 i Ii Noridian CERT Education e CERT Coordinator Christine Burnside Phone Number 701 277 6789 Elisha Jemison Phone Number 701 715 9339 e Send letters or make calls on types of services and providers with frequent errors Provider specific error rate statistics Call when providers do not reply to Documentation Requests from CERT Discusses corrective action plans Updates facility Point of Contact Noridian CERT Fax 701 277 7860 April 2014 39 MAC CERT Contacts Who can contact at Noridian regarding CERT reviewed claims e Part Provider Contact Center e 1 877 908 8431 JF 1 855 609
7. 13 12 00 pm Open Payments Sunshine Rule Webinar for CMS Register Regions 5 6 7 amp 8 Now 11 20 13 1 00pm Avoiding Common Return to Provider RTP Errors Register Download Jurisdiction F Now Documents 11 26 13 1 00pm influenza and Pneumonia Roster Billing Register Available Available Now 11 19 13 11 19 13 12 03 13 1 00pm SNF Swing Bed PPS amp Consolidated Billing Part One Register Available Available Now 11 26 13 11 26 13 12 0443 1 00 935 Process Limitation on Recoupments Register Available Available Now 11 27 13 11 27 13 12 05 13 1 00 SNF Swing Bed PPS amp Consolidated Billing Part Two Register Available Available Now 11 28 13 11 28 13 WebEx Registration cannot be completed using a mobile device The registration process can be completed using desktop or laptop computer www noridianmedicare com pa rta train workshops Click on CEU enter password and print 86 Healthcare Solutions Thank You Noridian Healthcare Solutions LLC
8. 9960 JE e Noridian Medicare Part A send an e mail to CERTPartAQuestion noridian com Update your Point of Contact POC form found on the CERT webpage April 2014 40 5i idian Healthcare Solutions Change Requests CR and Medicare Learning Network Matters MLN CRs MLNs and SEs Two options to access information Noridian website https www noridianmedicare com Select JE Fees amp News home page top ribbon or Left hand navigation click Read Latest Updates Select JF News and Publications left hand navigation Or use The Top Links What s New Latest Updates from the home page CMS website http www cms gov Regulations and Guidance Guidance Transmittals index html April 2014 42 CMS Web Page a ee Home gt Regulstions and Guidance gt Transmittals gt 2014 Transmittals 2014 Transmittals 2013 Transmittals 2012 Transmittals 2011 Transmittals 2010 Transmittals Transmittal a 2009 Transmittals 2008 Transmittals 2007 Transmittals 2006 Transmittals 2005 Transmittals 2004 Transmittals R100MSP CMS Program Memoranda R100SOMA R101SOMA April 2014 2014 Transmittals Implementation Date The Medicare Contractors and the Shared Systems Shall Send the Correct Cost Avoided Indicator and Special Project Type to the Common Working File CVVF so the Correct Savings is applied both to the Medicare Secondary Pa
9. CAHs Long Term Care Hospitals and Inpatient Psychiatric Hospitals e Final Rule http www cms gov Medicare Medicare Fee for Service Payment AcutelnpatientPPS FY2014 IPPS Final Rule Home Page html April 2014 49 Inpatient Hospital Admissions CMS is handling all education and questions related to the 2 midnight rule Questions can be sent to IPPSAdmissions cms hhs gov e 2 midnight benchmark clock starts When hospital care begins i e Observation care Emergency department operating room other treatment area The start of care after registration and initial triaging activities such as vital signs Excludes excessive wait times April 2014 poridian Inpatient Hospital Admissions Probe and Educate Probe and Educate patient status reviews apply to PPS hospitals Long Term Care Hospitals LTCH and Inpatient Psychiatric Hospitals IPF Exempt from review process CAH and IRF April 2014 EEUU Inpatient Hospital Admissions Probe and Educate Probe and Educate between 10 1 13 oeptember 2014 Pre payment reviews selected will receive Additional Development Request ADR 504 Submit medical records by using Endeavor Fax or Mail to PO Box for your state https www noridianmedicare com parta coverage mr adr_submission html April 2014 Inpatient Hospital Admissions Probe a
10. F hospital units Critical Access Hospitals CAHs Children s Hospitals Cancer Hospitals UE ane Waiver Hospitals and other facilities as provided by CR8666 Part Inpatient Payment Policies CMS 1599 F Beneficiaries liable for usual Part B financial Liability Dependent on what the Beneficiaries liability is for the Part A claim they may owe more or receive a refund off of the Part B claim Timely filing applies to the 12X claims One year from date of service April 2014 78 Healthcare Solutions Outpatient noiidian CR8548 January 2014 Integrated Outpatient Code Editor Updates otatus indicators updated Edits modified HCPCS added or deleted Version 20 0 of the NCCI edits implemented Updates to procedure device and add on primary procedure codes for specific services Full list of OCE specifications is available at http www cms gov Medicare Coding Outpati entCodeEdit index htm l April 2014 80 Healthcare Solutions Recurring Updates noiidian Ee CR8539 Home Health Consolidated Billing CB Quarterly Update e Non routine supply code and speech therapy HCPCS effective 1 1 2014 was not added to previous CR 8539 7047 Oral Interface Used With Respiratory suction Pump each 92521 92524 these four codes replace 92506 Review HHCB IOM 100 04 Chapter 10 Section 20 April 2014
11. HE LAST 95 DAYS Medicare Part A Get the latest news and information in your e mail box Signup Now News and Publications Articles posted in the What s New Section are compiled and published approximately every six weeks in Bulletins Fee Schedules LCDs Coverage MR Posted Health Professional Shortage Area HPSA Bonus Payments 2014 Update PDF CR8463 10 21 2013 MEN Statement Covers Dates for Two Midnight Inpatient Admission Provisions 10 21 2013 Endeavor Appropriate Discharge Status Codes 10 21 2013 POE Advisory Group Non Coverage of Injectable Bulking Agents for the Treatment of Fecal Incontinence 10 17 2013 picts a IRF Documentation Requirements 10 16 2013 Education Requests Prepare to Document Conservative Measures Using ICD 10 Training 10 16 2013 Appeals New Direct Data Entry DDE Users Guide Available 10 14 2013 Enrollment Direct Data Entry DDE Workshops Question and Answers 10 9 2013 ae MSP Claims Update on Location SMFADJ 10 9 2013 Endeavor Online Claims Self Administered Drug Exclusion List R2 10 8 2013 Audit Reimbursement Register Now for the Quarterly Release Workshop on October 24 10 2 2013 CERT MAC Operations Continue During Shutdown 10 1 2013 RA Redaction of Health Insurance Claim Numbers HICNs in Medicare Redetermination CR8268 10 1 2013 ICD 10 Notices MRNs Revised PDF iid Mandatory Reporting of an 8 Digit Clinical Trial Number on Claims PDF CR8401 9 30
12. Obtains submitted CERT documentation from providers April 2014 o noiidian CERT Envelope CENTERS FON MEDICARE AND MEDICAID SER ICES 1 MH iT amp Medicare Record Request April 2014 33 SSH e CERT Documentation Contractor requests medical records Livanta Provider fails to send requested record Error counted for Provider and Noridian e CERT Review Contractor conducts a review AdvanceMed e Claim determined incorrectly paid Error counted for individual Provider and MAC April 2014 34 CERT Documentation Requests Reminders e Respond to the initial medical records request Send all documentation for the claim selected to avoid denial within 75 days When necessary all entities must work together to obtain records for patients April 2014 35 noiidian CERT Documentation Requests Reminders e CERT calls or sends another letter for added medical records Additional 15 calendar days given to providers to support medical necessity of billed services e Fax to 240 568 6222 Identify the CID on cover page or used the bar coded cover sheet April 2014 noi idian CERT Reviewer s Medical Record Request Update e CR8547 Third party Additional Documentation Request CERT Instructions will be added to the Program Integrity Manual IOM 100 08 in January 2014 this addition does not constitute new instructions
13. R IS PRESENT IN THE CROSSWALK FILE BUT THE NPI NUMBER CORRESPONDS TO MORE THAN ONE LEGACY OSCAR NUMBER KOK OK OK OK KOK KOK K ENTER THE OSCAR NUMBER ASSOCIATED WITH THE NPI NUMBER SUBMITTED KOK OK KOK KK K NPI REASON CODE 32105 IF REQUESTED DOCUMENTATION IS NOT RECEIVED WITHIN 14 DAYS THE CLAIM WILL BE REJECTED Non Medical ADR Requests e An example of what your provider file would like if you chose to set up different zip codes for each PTAN is listed below OSCAR ENTITY TAXO CD FAC ZIP NAME 1234567890 125345 Noridian 111YO0000X 12345 Health 1234567890 127345 Noridian 111YO0000X 123451111 Health 1234567890 120345 Noridian 111YO0000X 123451112 Health April 2014 9 ACRONYM DESCRIPTION ABN Advanced Beneficiary Notice of Non Coverage CCI Correct Coding Initiative CERT Comprehensive Error Rate Testing CR Change Request Electronic Data Interchange Support Services Internet Only Manual Medicare Learning Network Medicare Physician Fee Schedule Medicare Secondary Payer April 2014 Products available Web based Training medicare Brochures network e Fact Sheets Mben rroge 4 Quick Reference Charts e Most products come in downloadable hardcopy formats MLN products FREE of charge shipping e MLN dedicated web pages MLN General Information http www cms gov MLNGenlnfo MLN Matters Articles http Awww cms gov MLNMattersArticles MLN Products http www cms gov
14. aim includes outpatient services provided prior to the time of admission especially as this pertains to the two midnight inpatient admission provisions Positron Emission Tomography Audits Suspended Noridian edits the National Coverage Determination NCD on PET scans in order to prevent claims billing errors Moreover unless the Contractor specifically defines the coverage coding any reviewer may deny any claim the reviewer deems inconsistent with that coverage description in the NCD Health Professional Shortage Area HPSA Bonus Payments 2014 Update Change Request CR 8463 from which this article is taken alerts you that the annual HPSA bonus payment file for 2014 will be made available by the Centers for Medicare amp Medicaid Services CMS to your Medicare contractor and will be used for HPSA bonus mda claims with dates of service on or after January 1 2014 through December 31 2014 What s New Articles Medicare Administrative Contract MAC Jurisdiction F p n Alaska Arizona Idaho Montana North Dakota i i South Dakota Utah Washington Wyoming Healthcare Solutions Noridian Home Medicare Part A Site Map Search Guide Advanced Search Quick Search You are here Noridian Home gt Medicare Part A gt News and Publications gt Whats New Articles From the Last 95 days Select amp for expanded navigation WHAT S NEW ARTICLES FROM T
15. edback This survey is conducted by an independent company ForeSee on behalf of Noridian Medicare TRUSTe April 2014 19 Healthcare Solutions ENDEAVOR Endeavor Sign Up Today Free secure internet website Verify Eligibility Check claim and check status View and print Remittance Advice e Full Part B Only or single claim Reopening Redetermination requests Submit view and track April 2014 SSH Endeavor Sign Up Today EDI registration required Hours of operation nearly 24 7 Exception for maintenance and CMS required downtime Information tutorials and User manual noridianmedicare com website Endeavor April 2014 22 New Functionality Financial Information ESSE Most Recent 50 Checks Financial Inquiry Select a provider by clicking on the Select Provider button and complete all mandatory fields marked with an asterisk Select Provider Identifier Type x Identifier Enter the corresponding PTAN April 2014 24 Financial Results Financial Inquiry Results Provider Medicare Contract A Only the most recent 50 checks are offered through Endeavor The Contact Center can assist you if older information is required Check Number Check Amount Issue Date April 2014 Endeavor Reminders SSH Assistance e Accoun
16. fter October 1 2013 processed thru April 6 2014 April 2014 73 Healthcare Solutions Hospital Healt Rescinded CR8273 Informational Unsolicited Response IUR for Inpatient Claims Common Working File CWF adds for Part A Inpatient Claims in history e Effective April 2014 inpatient hospital claims with diagnosis codes matching hospice claims will be adjusted to non covered Group Code CO MSN 16 29 Payment is included in another service you have received B9 Patient is enrolled in a Hospice RARC MA63 Missing incomplete invalid principal diagnosis April 2014 noiidian CR8666 Part B Inpatient Payment Policies CMS 1599 F Effective October 1 2013 Implementation April 21 2014 Applies to claims determined to not be meeting inpatient criteria No Part A Entitlement in CWF Benefits Exhaust Review of claim by facility or external reviewer ex Recover Audit determines Inpatient claim not medically necessary April 2014 CR8666 Part Inpatient Payment Policies CMS 1599 F May bill 12X type of bill for ancillary Part B Services received during inpatient stay e Who May Bill Part B Claims April 2014 Short Term Acute Care Hospitals IPPS OPPS Hospitals Long Term Care Hospitals LTCHs Inpatient Psychiatric Facilities IPFs and IPF hospital units Inpatient Rehabilitation Facilities IRFs and IR
17. ic Remittance Advice ERA is electronic version of paper remit Benefits of ERAs Faster payment notification Paper reduction helps save money and time Capability of automatically posting Expedite filing to secondary payers Simplify your office and save a tree Contact EDISS at www edissweb com JF 877 908 8431 JE 855 609 9960 April 2014 14 u idian Web Based Workshops 04 29 14 1PM Hospital Based Ambulance Coverage and Billing Healthcare Solutions Register Now JF https www noridianmedicare com parta train workshops index html JE https med noridianmedicare com web jea education training events April 2014 15 Noridian Home Medicare Part A noridian In Person Seminars Climbing the Ladder to Success Site Map Search Guide Advanced Searc You are Noridian Home gt Medicare Part gt Education Center Select for expanded navigation Medicare Part A News and Publications Fee Schedules LCDs Coverage MR Education Center Appeals Enrollment New Provider Biller Claims Endeavor Online Claims Audit Reimbursement CERT RA ICD 10 Forms Contact Links Help April 2014 EDUCATION CENTER Noridian offers providers a variety of avenues Web Based Workshops Webinars In Person Seminars gt Workshop Archive Educational Tools Calculators Tools Ask the Contractor Teleconferences ACT Provider Outreach and Education POE Advisory
18. l Panelists sena e Dial into teleconference using assigned Attendee ID number rather than just sign eCheck Event Info tab for ID April 2014 3 SSH Workshop Protocol Entering workshop Attendee lines are muted upon entry Enter additional attendee names provider city in Chat not Q amp A e Throughout workshop Questions pertinent to workshop slide addressed Address amp A to all panelists not to host directly All other questions call Part A Provider Contact Center Workshop conclusion Asking questions aloud Use raise lower hand feature MUTE phones never place on HOLD April 2014 4 SSH Continuing Education Units CEU Process e Attend entire workshop e Type only additional names in Chat e Take short survey after workshop closes Certificate of Attendance o last slide CEU password provided at the conclusion April 2014 5 SSH Agenda e Noridian Updates Endeavor CERT Reminders e Accessing Change Requests CRs and Medical Learning Network Matters MLNs e Quarterly Provider Updates e Recurring Updates e Special Editions April 2014 6 Healthcare Solutions Noridian Updates Healthcare Solutions SB6001 Edit 32105 Avoid claim rejections by setting up either 1 1 NPI to PTAN match or Set up the 5 or 9 digit Zip Codes with each PTAN for your Facility THE NPI NUMBE
19. m the DMEPOS fee schedule files as of January 1 2014 4611 4612 A4613 E0457 E0459 18685 L 8686 18687 18688 April 2014 57 CR8582 Claim Status Category and Claim Status Code Update Effective Implemented 4 1 2014 e Contractors must use approved codes that meet the Code Maintenance Committee regulations Code sets can be found at http Awww wpc edi com reference codelists healthcare claim status category codes http www WpCc edi com reference codelists healthcare claim status codes April 2014 CR8607 Quarterly Average Sales Price ASP Drug Pricing Updates Effective April 1 2014 Implementation April 7 2014 Medicare uses the April 2014 quarterly ASP Part B drug pricing files to determine the payment limit for claims relation to separately payable Medicare Part B drugs processed or reprocessed on or after April 1 2014 with dates of services from April 1 2014 through June 30 2014 April 2014 poridian CR8641 Medicare Travel Allowance F s for Collection of Specimens Effective for Dates of Service 1 1 2014 Implementation Date June 16 2014 P9603 travel allowance per mileage basis P9604 travel allowance flat rate basis Multiple collections during same trip will receive a prorated travel component payment April 2014 60 noiidian CR8658 April 2014 Integrated O
20. nd Educate e Reopenings and Appeals of Inpatient Probe and Educate Claims CMS requesting re review of probe and educate claims e Work with MACs to ensure claims have been re reviewed prior to submitting appeal CMS will waive 120 appeal timeliness only for claims under the probe and educate review process that occurred prior to January 30 2014 April 2014 53 Healthcare Solutions Quarterly Provider Updates Effective April 1 2014 Unless otherwise specified 8248 Termination of the Working File for Part A Provider Queries e Key Points CWF queries through MCS PPTN VMS VPIQ and FISS DDE will be discontinued April 2014 HIQA HIQH ELGA ELGH and HUQA will no longer be available Termination date has been delayed The use of DDE to submit claims or correct claims will not be impacted April 2014 CR8531 Update for DME Fee Schedule e CR Revised to include HCPCS updates The following new codes are in the prosthetics and orthotics PO payment category and effective 1 1 2014 L5969 18679 L0455 10457 10467 10469 L0641 L0643 L0648 L0651 L1812 11833 1848 13678 13809 L3916 13918 13924 3930 14361 14387 14397 2014 56 CR8531 Update for DME Fee Schedule 0430 is being deleted from the HCPCS file and DME fee schedule 1 1 2014 e The following codes are deleted fro
21. rify existing manual instructions regarding ABN issuance Making corrections to CR 8404 Expands use of ABN to include home health agency HHA providers Form replaces the HHABN Form CMS R 296 e ABN allows provider to charge beneficiary e If ABN isn t issued when required and Medicare doesn t pay Provider will be liable for charges April 2014 64 noiidian CR8585 Changes to NCD Edit Software Effective April 1 2014 for ICD 09 Coding Affects Diagnostic Labs submitting A B claims to Medicare e Laboratory Edit Module Updated Quarterly OM 100 04 Chapter 16 Section 120 2 April 2014 noiidian Healthcare Solutions CR8473 Influenza Virus Vaccine Code Implementation April 7 2014 Accurate effective dates for Q2033 January 1 July 1 2013 corrected dates Effective January 1 2014 90673 Contractors can pay claims beginning 1 1 14 Hospitals Skilled Nursing Facilities 12X 13X 22X 23X Reasonable Cost Renal Dialysis Facility hospital based 72 85X Critical Access Hospital CORFs RDFs independent 75 72X Lower actual charge or 9596 AWP April 2014 66 CR8473 Influenza Virus Vaccine Code Effective January 1 2014 90673 Physicians and NPPs must accept assignment Institutional claims held until system updated Implementation date April 7 2014 Condition code 15 Clean Claim Delayed in CMS s Proces
22. sing System Medicare Payer Only Code added April 2014 CR8526 Beta Amyloid Positron Emission Tomography PET e Effective for claims dates of service on or after September 27 2013 Medicare will allow one PET AB scan per patient e Only allowed through evidence development CED ie clinical trial data Refer to NCD Manual Chapter 1 Section 220 6 20 for the coverage Beta Amyloid PET in Neurodegenerative disease and dementia April 2014 68 Healthcare Solutions Ambulance noiidian CR8251 Ambulance Services Claims Processing Update e Nonscheduled transportation services do not require attending provider name and NPI no change to policy e Adding HCPC 0888 to list of mileage codes Allows correct billing effective April 2014 April 2014 Healthcare Solutions Hospice noiidian Healthcare Solutions CR8620 Vaccines Furnished during Hospice Election Effective October 1 2013 Implemented April 7 2014 Claims for vaccines Influenza PPV and Hepatitis B and vaccine administrations Must contain condition code 07 Date of service must fall within a hospice election April 2014 72 poridian CR8620 Vaccines Furnished during Hospice Election e Updating information posted in CR 8098 e Contractors shall adjust only those claims brought to their attention Must have dates of service on or a
23. t access passwords locked accounts functionality access User Security e Results specific claim information eligibility Customer Service e JE 855 609 9960 e JF 877 908 8431 April 2014 27 Do Not Share e Each user must register for his her own account e f contacted by anyone other than user account is deleted April 2014 Resources User Manual Step by step instruction on registration and usage e JE httos med noridianmedicare com web jea topics endeavor user manual e JF www noridianmedicare com parta claims e ndeavor endeavor user manual html April 2014 29 noiidian Survey Endeavor Portal Eligibility Benefits Inquiry Select a provider by clicking on the Select Provider button and complete all mandatory fields marked with an asterisk Select Provider Identifier Type NPI Identifier HICN Last Name First Name Date of Birth mm dd yyyy or mmddyyyy Suffix To Date From Date mm dd yyyy or mmddyyyy mm dd yyyy or mmddyyyy 2013 Noridian Healthcare Solutions Contact Us Endeavor Feedback April 2014 30 Healthcare Solutions CERT Reminders Post Payment Reviews CERT is Administered by CMS CMS CERT Team Governs all CERT efforts Livanta CERT Documentation AdvanceMed Contractor 4 z Reviews submitted CERT li documentation forwarded by Livanta
24. ts Ask the Contractor Teleconferences ACT Provider Outreach and Education POE Advisory Group Self Paced san Consolidated Training Tutoria ee Resources Advance Beneficiary Notice of Noncoverage ABN Tutorial Reed More Appeals and Part One PDF Reopenings Part One 1 5 hours POF N A Read Answers https med noridianmedicare com we b jea education event materials April 2014 JF Part A oiidian Healthcare Solutions Noridian Home Medicare Part A You are here Meridian Home gt Medicare Part A gt Ede Select for expanded navigation Medicare Part A Question about our site aa https Medicare Administrative Contract MAC Jurisdiction F idaho Montana North Dakota Oregon South Dakota Utah Washington Wyoming Site Map Search Guide Advanced Search Quick Search WORKSHOPS Noridian offers web based workshops using Internet meeting forum software and audio conferencing to help providers learn more about Medicare At these sessions Noridian staff covers a variety of topics and providers can ask questions and network with other providers These workshops are convenient and help providers save time and money Workshop Instructions and Connection Information Print Workshop Materials from PDF Web based Workshops Date Time Workshop Register Materials CEU 11 20
25. utpatient Code Editor Updates otatus indicators updated Edits modified e HCPCS added or deleted Version 20 0 of the NCCI edits implemented Updates to procedure device and add on primary procedure codes for specific services Full list of OCE specifications is available at http www cms gov Regulations and Guidance Guidance Transmittals Downloads R290 OCP pdf April 2014 61 SSH CR8664 April Update to Medicare Physician Fee Schedule Database MPFSDB e CR Effective January 1 2014 e CR revisions implemented April 7 2014 Revised to reflect Protecting Access to Medicare Act of 2014 Signed by President on April 1 2014 Per CMS contractors will not search their files to either retract payment for claims already paid or to retroactively pay claims Contractors will adjust claims brought to their attention April 2014 62 SSH CR8488 Incarcerated Beneficiary Liability and Messages for Claims Revised e New Claims Adjustment Reason Code CARC 258 Claim service not covered when patient is in custody incarcerated Applicable federal state or local authority may cover the claim service e Remittance Advice Remark Code N103 Verbiage updated e Group code OA Other Adjustment April 2014 63 E CR8597 Correction Advanced Beneficiary Notice of Noncoverage ABN Form CMS R 131 e Effective May 15 2014 Minor editorial changes to cla
26. wing topics Noridian Where We Are Now Enrollment The First Step Claims Getting it Right the First Time Medical Review Seeing Through Medicare s Eyes Reopenings vs Redeterminations Provider Contact Center Effective Uses Endeavor listserv and the Website Resources View all dates locations and register at https www noridianmedicare com parta train workshops in_person seminars html NOTE Space is limited so please limit attendance to two representatives per facility April 2014 17 Sign Up to Get Medicare News Now e Receive the most J Be the first to receive iMedicare news and information recent Noridian and CMS news information Regulation and policy updates Payment and reimbursement updates Keep current Workshop and educational event notices Noridian hours of availability and related notifications April 2014 HEU Noridian Loves Website Feedback ePlease complete Foresee Results Website Survey Provide constructive complimentary feedback Thank you for visiting Noridian Medicare Upon leaving our website you may be selected to take part in a customer satisfaction survey The feedback you provide will help Noridian Medicare enhance its site and serve you better in the future All results are strictly confidential Yes I ll give fe
27. yer MSP Savings Report and the Originating Contractor State Operations Manual SOM Appendix AA revisions for Intermediate Care Facilities for Individuals with Intellectual Disabilities 2014 02 14 State Operations Manual SOM Appendix revisions for Intermediate Care Facilities for Individuals with Intellectual Disabilities ICF IID 2014 02 14 MM Article Article Release Date Y oridian ENS 43 noridian JE Fees amp News Latest Updates Browse Browse Fees amp News by Topic by Provider Type EE JE Part A Fees amp News Latest Updates FEES amp NEWS Fee Schedules Bulletins Latest Updates Email List Sign Up FAQs Eo April 2014 Latest Updates Articles posted in the Latest Updates are compiled and published into a bulletin approximately every six weeks LATEST UPDATES SEE ALL Oct 21 2013 Provider Portal Endeavor Login Contact Us Help Policies Audit amp CERT amp Education amp Enrollment Reimbursement Reviews Outreach Audit Cost Report CERT MR Recovery Training Events Enroll Changes Downloadable Forms LCDs NCDs IDEs Credit Balance Auditor Materials ACTs Revalidation and Links Statement Covers Dates for Two Midnight Inpatient Admission Provisions Noridian has received questions from hospitals regarding the correct way of showing the service dates for situations where the inpatient cl
Download Pdf Manuals
Related Search