- October 31, 2008
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Update Message concerning Reason Codes 38067 and 38068
Update Message concerning Reason Codes 38067 and 38068: Until FISS implements the correction to this problem, Highmark Medicare Services is continuing to suspend these claims for manual review.
Claims receiving these reason codes in error are being released to continue processing. Those claims that correctly received these reason codes are being returned. Original Message: Reason Codes 38067 and 38068 are being incorrectly applied to Inpatient/Outpatient overlap claims. FISS has identified the problem and is working diligently to get this resolved as quickly as possible.
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MLN Matters Articles from CMS
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- October 30, 2008
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Effective immediately, the Medical Information Form (MIF) will no longer be available for use.
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Please join us for an informative teleconference on Medicare Updates on November 11, 2008. The handout material is now available.
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Effective November 1, 2008, the Centers for Medicare & Medicaid Services (CMS) awarded SafeGuard Services LLC (SGS), NEBISC, an extension of their current contract as a Program Safeguard Contractor (PSC) to perform fraud and abuse detection and prevention activities for Medicare Part A, including Home Health and Hospice services, and Part B services in Maryland, Delaware, District of Columbia as well as Pennsylvania for Home Health and Hospice services only.
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Mass Adjustments for MD Part A
Mass Adjustments have been scheduled to run this week (10-27-08), to correct a problem with certain Maryland (MD) Waiver claims. FISS made corrections to a problem that impacted payments for MD Waiver claims with a Type of Bill 12X, which paid via Fee Schedule and not .94%.
Claims affected had dates of service from 9-6-06 to 7-2-07. Adjustments will show DCNs ending with 'CR6440'.
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- October 29, 2008
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Please join us on November 6, 2008 at 12:00 pm (EST) for an informative Teleconference relating to the topic of Erythropoiesis Stimulating Agents (ESAs). Please note the teleconference dial-in number will be 1-888-476-6131 and participant code is 487794.
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The Comprehensive Error Rate Testing (CERT) errors received by providers can be lessons for both Highmark Medicare Services and other providers. CERT errors will be posted monthly so that providers can check their internal controls to ensure that they will not make the same error as their peers. It is your responsibility to bill and code correctly, you will benefit by saving time and money.
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Best Practice Checklist and Website Tour
Join us on November 11, 2008 at 10:00 AM or 2:00 PM (EDT) for an informative Webinar on best practices and an informative tour of the Highmark Medicare Services website. Learn to navigate our website, discuss issues of claim submission and payment, credit balance (CMS-838) reporting, contact information and our educational opportunities. We look forward to serving you. The handout material for the webinar has been posted. Please download it prior to the webinar on November 11, 2008.
An open telephone line and computer with a high speed internet connection are required to attend. There is still time to register.
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- October 28, 2008
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MLN Products Catalog is now interactive
The MLN Products Catalog is now an interactive downloadable document that lists all MLN products by media format.
The catalog has been revised to provide new customer-friendly links that are embedded within the document. All product titles and the word "download", when selected, will link you to the on-line version of the product. The word "hard copy", when selected, will automatically link you to the MLN Product Ordering page.
The Catalog is updated quarterly and the latest version is now available for download from the CMW website.
Each quarter the MLN will send out information on the latest products available to order. More information on The Medicare Learning Network is available on-line.
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Revised Medicare Physician Guide now available
The revised Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals (October 2008) is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network.
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- October 23, 2008
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MLN Matters Articles from CMS
New:
SE0836 – Influenza Pandemic Emergency -- The Medicare Program Prepares
Revised:
MM6093 – National Provider Identifier (NPI) for Secondary Providers
Rescinded:
MM6164 – Influenza Pandemic Emergency -- Policies Concerning the Medicare Program
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Advanced FISS Training is offered in a by-appointment only format. Appointments will be scheduled in one hour intervals per provider number. Appointments will be made on a first come first served basis. We have six appointments available. Register for an appointment if you are an experienced FISS user. You will learn how to complete claim adjustments, claim corrections, and Direct Data Entry.
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FISS on-line training classes are designed to teach you how to interact with the Fiscal Intermediary Standard System (FISS). If you currently have on-line access to FISS and are a new user to FISS, we encourage you to register for one of the hands-on training classes.
This class is for the beginner FISS user. Register for this class if you have never used FISS or if you are just getting started with FISS. You will learn claim submission, claim inquiry, claim corrections, and claim adjustments, and eligibility verification.
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- October 22, 2008
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Attention Skilled Nursing Facility Providers
Skilled Nursing Facilities are currently experiencing difficulties with Reason Code 38305 when submitting claims for patients that have gone from non-skilled and back to skilled care within the same month.
We are diligently investigating the issues regarding that reason code and we will provide notification upon resolution. In the interim, please follow the billing instructions below.
- Ensure the OC 22 claim has been submitted and processed;
- Combine the no-pay days and subsequent skilled days on one claim;
- On the combined claim, report:
- covered and non-covered days,
- OSC 74 with the from and through dates of the no-pay/non-covered days,
- all other SNF required billing
- covered and noncovered charges
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The ICD-10-Clinical Modification/Procedure Coding System Fact Sheet, which provides general information about the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) including benefits of adopting the new coding system, structural differences between ICD-9-CM and ICD-10-CM/PCS, and implementation planning recommendations, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network.
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- October 21, 2008
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Holding Certain IPPS Claims for DRG 999
On October 14, 2008, the CMS instructed contractors to hold certain Hospital Inpatient Prospective Payment System (IPPS), Inpatient Psychiatric Facility (IPF), and Long Term Care Hospital (LTCH) Facility Claims pending further notice. Claims will include only those with DRG 999.
Claims to be held will include inpatient hospital claims (11X Type of Bills) that are assigned a diagnosis-related group (DRG) 999 for all IPPS, IPF, and LTCH providers. The CMS was informed of an issue with the incorrect assignment of hospital-acquired condition (HAC) logic for the aforementioned providers which could cause DRG 999 to be assigned incorrectly to the claim and cause incorrect payment. When the corrected logic has been received, providers will be notified of the release of claims through this notice. All other claims held for pricing verification have been released.
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CMS Updates Hospital Outpatient Department Payment Information for Value-Driven Health Care
To support the delivery of high-quality, efficient health care and enable consumers to make more informed health care decisions, President Bush directed the U.S. Department of Health and Human Services to make cost and quality data available to all Americans.
As part of this initiative, Medicare posted information in 2006 and 2007 about the payments it made during the previous year for common and elective procedures and services provided by Hospitals, Ambulatory Surgery Centers (ASCs), Hospital Outpatient Departments, and Physicians.
Earlier this year, Medicare updated the Hospital information and moved it to the Hospital Compare Website where it can be viewed along with hospital quality information.
On October 17, 2008, Medicare posted an update to the Hospital Outpatient Department data. ASC and Physician payment data were updated earlier this year. The information is being displayed in the same format as in previous years, updated with calendar year (CY)2007 data.
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SNF RUGS November 10, 2008 11:00am (EST)
Please join us for an informative teleconference on SNF RUGS November 10, 2008 at 11:00am EDT). All handout material will be posted prior to the November 10, 2008 teleconference. An open telephone line and computer with a high speed internet connection are required to attend. Click here to register.
Delaware Part A Webinar: Introduction to our Website - November 11, 2008 (10:00 AM or 2:00 PM)
The Provider Outreach and Education (POE) department at Highmark Medicare Services will be hosting a webinar for current National Government Services (NGS) Part A providers in Delaware on Tuesday November 11, 2008. POE will be hosting the webinar twice on November 11, 2008 from 10:00 am - 11:00 am (Registration) and another session at 2:00 pm - 3:00 pm (EDT) (Registration). Both an open telephone line and a personal computer with a high speed internet connection are required to participate.
Webinars, or web-based training, allow participants to engage in interactive training sessions via the internet. This webinar will feature an overview of our website and provide valuable information to ensure that you will be prepared for the transition to Highmark Medicare Services, which becomes effective November 14, 2008.
FISS Basic Part 2: Claim Entry/Corrections November 13, 2008 10:00 AM
Please join us on November 13, 2008 at 10:00am (EST)for Part 2 of our series on FISS Basic. The topic today will be Claim Entry and Claim Corrections in our FISS system.
All handout material will be posted prior to the November 13, 2008 webinar. An open telephone line and computer with a high speed internet connection are required to attend - click here to register.
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- October 20, 2008
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This message is for health care providers, particularly physicians and other practitioners, who have obtained National Provider Identifiers (NPIs) and have records in the National Plan and Provider Enumeration System (NPPES).
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ICD-10-CM/PCS National Provider Conference Call for Other Part A and Part B Providers
Other Part A and Part B providers may now register for the Centers for Medicare & Medicaid Services ICD-10-CM/PCS National Provider Conference Call that will be conducted on November 12, 2008 from 12:30 p.m. - 2:30 p.m. EST.
To find additional information about this conference call and to access the ICD-10 Overview Presentation that will be discussed during the call, visit the CMS site.
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MREP software is available for download
Version 2.5 of the MREP software is available for download on the CMS website.
For a description of the changes in this version, see the "What’s New" section of the MREP User Guide – Version 2.5.
Note: The latest Codes.ini file is now available. This file is necessary when the MREP software is distributed.
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We experienced some technical difficulties last week which affected our online registration process. The registration process is now fully functional for the October 22, 2008 MSP workshop being held at Johns Hopkins Asthma & Allergy Center and the October 24, 2008 New Provider Workshop being held in Pittsburgh.
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- October 17, 2008
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Please join us on November 18, 2008 at 10:00am (EST) for a Lunch and Learn on Hard Copy Claims. All handout material will be posted prior to the November 18, 2008 Lunch and Learn.
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Reminder: Please join us for an informative teleconference on Medicare Claims Errors. We will be reviewing frequent claim submission errors and how to resolve them. The handout material is now available for the October 21, 2008 Medicare Claim Errors teleconference.
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Please join us on November 11, 2008 at10:30am (EST) for an informative teleconference on Medicare Updates. The handout material for the teleconference will be posted prior to the teleconference. Please download the handouts before dialing into the November 11, 2008 Medicare Updates Teleconference.
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MLN Matters Articles from CMS
New:
SE0835 – Non-acceptance of Legacy Provider Numbers on Incoming Medicare Claims
Revised:
MM6048 – Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA)
SE0832 – The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS)—The Next Generation of Coding
Rescinded:
MM6164 – Influenza Pandemic Emergency -- Policies Concerning the Medicare Program
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Teleconference - Medicare Secondary Payer (MSP) Basics (November 20, 2008 @ 2:30 PM)
Please join us on November 20, 2008 at 2:30pm (EST) for an informative teleconference on Medicare Secondary Payer (MSP Basics. The handout material for the teleconference will be posted prior to the teleconference. Please download the handouts before dialing into the November 20, 2008 teleconferene on MSP Basics.
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Teleconference - Hospital Outpatient Rehab (November 19, 2008 @ 2:30 PM)
Please join us on November 19, 2008 at 2:30pm (EST) for an informative teleconference on Hospital Outpatient Rehab. The handout material for the teleconference will be posted prior to the teleconference. Please download the handouts before dialing into the November 19, 2008 teleconferene on Hospital Outpatient Rehab.
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- October 16, 2008
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CMS wants to alert providers to a valuable resource in the preparation for a potential influenza pandemic.
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Interim Study of Alternative Payment Localities Under the Medicare Physician Fee Schedule
Medicare is statutorily required to adjust payments for physician fee schedule services to account for differences in costs due to geographic location.
Medicare is statutorily required to adjust payments for physician fee schedule services to account for differences in costs due to geographic location. There are currently 89 different localities which have not been revised since 1997. In the CY 2009 Physician Fee Schedule notice of proposed rulemaking which was released on June 30, 2008, we indicated that we would post on the CMS website a preliminary study of several options for revising the payment localities. The report entitled: "Review of Alternative GPCI Payment Locality Structures", which was produced by Acumen, LLC under contract to CMS, may currently be found here.
Our study of possible alternative payment locality configurations is in the early stages of development. At this time we are not proposing to make any changes to the payment localities. We encourage interested parties to submit comments on the options presented in the report as well as suggestions for other options. These comments will be considered in the development of possible future notice and comment rulemaking. When we are ready to propose any changes to the locality configuration, we will provide extensive opportunities for public comment (for example, a town hall meeting or open door forum) on specific proposals before implementing any change.
Electronic comments on the interim report may be submitted to MPFS@cms.hhs.gov until November 3, 2008. (Note: Address for sending comments has been corrected, and comment period extended).
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The Medicare Learning Network's (MLN) Learning Management System (LMS) that hosts our web-based training courses and product ordering page is now available and has a new look. All of your certificates and product ordering history is still available and you can use your same user id and password. There is no need to register again. If you have any questions, please send them to MLN@cms.hhs.gov.
To access the system, click link above and click on web-based training modules or MLN product ordering page at the bottom of the page.
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- October 14, 2008
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Helpful Hint for Converting a Name on the IVR
Have you had trouble converting a beneficiary's name from letters to numbers on the IVR? We have the perfect tool to assist you.
When using the Interactive Voice Response System (IVR) you are required to either speak or enter the beneficiary's name during the eligibility and claims status authentication process. For those keying the beneficiary's name you are required to enter the first 6 letters of the last name plus the first letter of the first name (ex. John Smith = SmithJ). To assist you when keying a name into the IVR, Highmark Medicare Services has provided a tool to convert the beneficiary's name into numbers. SmithJ easily converts into 764845. The IVR name to number conversion will save you time and energy. No longer will you will scan your telephone key pad to find what number corresponds with the letter S on you key pad. This web site is definitely worth bookmarking as one of your favorites. For more information on IVR please visit HMS's web site. The telephone number for the IVR is 1-877-235-8073.
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Calling the Provider Contact Center
How can you reduce the amount of time you spend on hold? It is very simple, be prepared. When calling the Provider Contact Center please have the required information that pertains to your inquiry. Have the PTAN, NPI, HIC number, date of service (MMDDYYYY), beneficiary date of birth (MMDDYYYY), which is relevant to your call. When you do not have this information in front of you, it causes the call to be extended. By being prepared it will allow the customer contact representative to assist you more efficiently and reduce the amount of time you are hold. The more prepared you are the faster we can answer your question. Every second counts.
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Please join us for an informative Lunch and Learn on the Comprehensive Error Rate Testing (CERT) program on October 16, 2008 at 12:30pm (EST). We will discuss the CERT program, the proper billing of claims and local coverage determinations (LCDs).
The handout material is now available for the October 16, 2008 Lunch and Learn.
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MLN Matters Articles from CMS
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- October 13, 2008
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Appeal Forms and Appeals Quick Reference Guide updated
Appeals forms have been updated to provide Delaware providers with the appeals address. Also the Appeals Quick Reference Guide has been updated in regard to Demand Letters.
The following forms have been updated to include the address for Delaware claims (effective November 14, 2008).
Part A Redetermination Request Form
Part A Clerical Error Reopening Request Form
In addition, the Appeal Quick Reference Guide has been updated to include instructions on submitting a copy of the Demand Letter when the appeal request involves an overpayment.
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The Fourth Quarter 2008 Hospital Outpatient PPS Pricer downloads have been posted on the CMS website.
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This bookmark explains the ICD-10-Clinical Modification/Procedure Coding System (CM/PCS) including the benefits of adopting the system, recommended steps to be taken in order to plan and prepare for implementation of the system, and where additional information about the system can be found. To place your order, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page."
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The Centers for Medicare & Medicaid Services (CMS) recently announced aggressive new steps to find and prevent waste, fraud and abuse in Medicare. CMS is working closer with beneficiaries and providers; consolidating its fraud detection efforts; strengthening its oversight of medical equipment suppliers and home health agencies; and launching the national recovery audit contractor (RAC) program.
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Highmark Medicare Services has updated the FISS hours of availability for all regions. Click on "FISS" under Provider Information for details.
- October 10, 2008
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On Monday, October 6, 2008, the Centers for Medicare & Medicaid Services (CMS) released the preliminary FY 2010 wage index PUFs. Also included is the FY 2010 wage index development timetable.
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- October 09, 2008
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Please join us for one of an informative webinar on the basics of the Fiscal Intermediary Shared System (FISS) on October 13, 2008 at 1:00pm (EDT). Learn about Beneficiary/CWF, DRG (Pricer/Grouper), Claims, Revenue Codes, Claim Count Summary, Checking History , Reason, HCPCS, DX/Proc, Adjustment and ANSI Reason Codes and the Zip Code File.
All handout material will be posted prior to the October 13, 2008 webinar, please visit our website to download the material by clicking the link above. An open telephone line and computer with a high speed internet connection are required to attend. Click here to register.
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- October 08, 2008
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The ICD-10-CM/PCS National Provider Conference Call for Hospital Staff will be conducted on October 14, 2008 from 12:30 p.m. - 2:30 p.m. EDT.
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A new MLN Matters Special Edition Article entitled, "SE0832 - The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS)-The Next Generation of Coding," has recently been released.
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A Medicare Learning Network (MLN) Matters Special Edition article on the 2009 CAP postponement is now available on the CMS website.
This article contains billing, drug ordering, claims processing, and other information for Participating CAP Physicians on the transition from CAP to the ASP "buy and bill" methodology for 2009. This article is available by clicking the link above. For additional information on the CAP and the program's postponement for 2009 is available here on the CMS CAP website.
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October Flu Shot Reminder
Flu Season Is Upon Us! Begin now to take advantage of each office visit as an opportunity to encourage your patients to get a flu shot. It’s still their best defense against combating the flu this season.
(Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies.) And don’t forget, health care personnel can spread the highly contagious flu virus to patients. Protect Yourself. Don’t Get the Flu. Don’t Give the Flu. Get Your Flu Shot. Remember - Influenza vaccine plus its administration are covered Part B benefits. Note that influenza vaccine is NOT a Part D covered drug.
For information about Medicare’s coverage of the influenza virus vaccine and its administration as well as related educational resources for health care professionals, please link here on the CMS website.
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A final rule that would allow more Medicaid beneficiaries to be in charge of their own personal assistance services, including personal care services, instead of having those services directed by an agency, was recently announced by the Centers for Medicare & Medicaid Services (CMS). For more information, please click link above.
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- October 07, 2008
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Claims Returned With RC 37540
Claims with Reason Code 37540 were being returned to the provider for correction. Effective immediately, these claims will instead be suspended. Highmark Medicare Services will also initiate a special effort to manually move these claims on an expedited basis given the impact to payment rather than wait for a systematic correction. No provider action is necessary at this time. This is a national problem that is affecting all Part A providers and is not related to the MAC transition to Highmark Medicare Services.
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Attention NJ Part A Providers Only - Claims Suspended in Status Location SMCABL
Due to a CWF processing problem, claims were being suspended in Status Location SMCABL. In lieu of awaiting a systematic correction, Highmark Medicare Services has taken steps to aggressively move these claims. We expect all claims in this location, due to this reason, to be released by close of business October 8, 2008.
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Centers for Medicare & Medicaid Services Issues New Resources on ESRD Conditions for Coverage
CMS has developed a "Frequently Asked Questions" ESRD document that condenses questions they have received from the provider community. The FAQs are available online here on the CMS website. To view them, click on the second Spotlight.
CMS has developed a crosswalk that compares the former conditions to the final revised conditions, which were issued in the Federal Registeron April 15, 2008. The crosswalk will help you navigate the new organization structure of the condition as well as some revised provisions of the conditions themselves. The crosswalk is available online here on the CMS website. To view the Crosswalk, click on the third Spotlight.
We hope you find these tools helpful as you work to implement the revised conditions. For more information on ESRD, please visit here on the CMS website.
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MLN Matters Articles from CMS
New:
MM6113 – Ambulance Inflation Factor (AIF) for CY 2009
MM6213 – Laboratory National Coverage Determination (NCD) Edit Software for October 2008
MM6164 – Influenza Pandemic Emergency -- Policies Concerning the Medicare Program
Revised:
SE0832 – The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS)—The Next Generation of Coding
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The Centers for Medicare & Medicaid Services (CMS) recently announced that, beginning October 1, 2008, it will publish most of the edits utilized in its Medically Unlikely Edit (MUE) program to improve the accuracy of claims payments.
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Compliance with the DMEPOS Quality Standards: What You Need To Know
On October 14, the Centers for Medicare & Medicaid Services will conduct an on-site conference that will provide guidance to the DMEPOS suppliers on how to comply with the DMEPOS quality standards.
JOIN THE CMS CONFERENCE!
Tuesday, October 14, 2008
1:00-5:30 PM EST
CMS Auditorium, Baltimore, MD 21244To register for the conference, visit here.
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On September 3, 2008, the Centers for Medicare & Medicaid Services (CMS) announced a list of Durable Medical Equipment Prosthetics/Orthotics, and Supplies (DMEPOS) providers that were exempt from meeting the quality standards for DMEPOS accreditation.
CMS would like to clarify that pharmacists and pharmacies were not included in this provider exemption; therefore, pharmacists and pharmacies do need to obtain accreditation. For example, if a pharmacy is providing DMEPOS supplies to Medicare beneficiaries, such as diabetic supplies and enteral/parenteral nutrition, they would need to be accredited by the September 30, 2009 deadline. For more information about DMEPOS Accreditation, please visit here.
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The Centers for Medicare & Medicaid Services (CMS) is soliciting nominations for individuals to serve on the Program Advisory and Oversight Committee (PAOC) that advises CMS on various issues relating to the competitive bidding program for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). Visit (link below) for more information.
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The Centers for Medicare & Medicaid Services has released the SNF PC Pricer for FY 2009. If you use SNF PC Pricer software, please go to the web page and download version FY 2009.0, posted on October 1, 2008.
- October 06, 2008
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The September 2008 Medicare Part A Newsletter has been published. This edition has important information regarding: Documentation for NOC Codes, Herpe Zoster Vaccine, HPTC Update for October 2008, Proper Use of MSP Value Code 44 and the MLN Matters that were issued during the month of September from CMS.
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- October 03, 2008
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Medicare Part B Drug Competitive Acquisition Program (CAP): 2009 CAP Postponement
A Medicare Learning Network (MLN) Matters Special Edition article on the 2009 CAP postponement is now available on the CMS website.
This article contains billing, drug ordering, claims processing, and other information for Participating CAP Physicians on the transition from CAP to the ASP. This article is available on the CMS website.
Additional information on the CAP and the program's postponement for 2009 is available on the CMS CAP website.
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- October 02, 2008
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Flu Season Is Upon Us! Begin now to take advantage of each office visit as an opportunity to encourage your patients to get a flu shot.
It's still their best defense against combating the flu this season. (Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies.) And don't forget, health care personnel can spread the highly contagious flu virus to patients. Protect Yourself. Don't Get the Flu. Don't Give the Flu. Get Your Flu Shot.
Remember - Influenza vaccine plus its administration are covered Part B benefits. Note that influenza vaccine is NOT a Part D covered drug.
For information about Medicare's coverage of the influenza virus vaccine and its administration as well as related educational resources for health care professionals, please go to link above.
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- October 01, 2008
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An article to all Medicare Provider's billing Medicare Secondary Payer (MSP).
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Medicare-A Online System screen MAP1713 Claim Entry (Page 3) will be updated to include a new field named 'NDC CODE.'
This field identifies the National Drug Code, used for the Crossover Medicaid drug rebate.
A screenshot has been created for further clarification. -
MLN Matters Article from CMS
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