Medicare
Administrative Contractor
The Medicare Administrative Contractor (MAC) for Jurisdiction 8 (Indiana
and Michigan) was awarded to Wisconsin Physician Services (WPS), and
National Government Services (NGS) was awarded Jurisdiction 6 (Illinois,
Wisconsin and Michigan). NGS protested the award for Jurisdiction 8;
an announcement is expected in February 2012. Also, WPS protested the
award of Jurisdiction 6.
For further information, please
visit here.
New Qualified Independent Contractor
Effective Nov. 15, 2011, C2C Solutions, Inc., will assume the Qualified
Independent Contractor (QIC) contract and begin processing reconsideration
requests for all four Durable Medical Equipment Medicare Administrative
Contractors (DME MACs). C2C Solutions, Inc., also holds the QIC contract
for Medicare Part B reconsiderations in the northern jurisdiction.
Learn more about C2C on their website.
All requests for reconsideration received by RiverTrust Solutions on
or after Nov. 15, 2011, are being forwarded to C2C. All requests for
reconsideration received on or before Nov. 14, 2011, will continue to
be processed by RiverTrust Solutions.
Effective, Nov. 15, 2011, DMEPOS suppliers should send all requests for
reconsideration to C2C Solutions, Inc., at the address below.
C2C Solutions, Inc.
Attn: DME QIC
P.O. Box 44013
Jacksonville, FL 32231-4013
New CMS-855 application
Signification revisions were made in the instructions for the
CMS-855. You should have discontinued use of the old forms
in October 2011.
The U.S. Office of Management and Budget recently approved
updates to the Medicare Provider-Supplier Enrollment Application
(CMS-855), as well as the new CMS-855O application form used
to enroll and refer items and/or services to Medicare beneficiaries.
The new forms are now available on the
CMS website.
Providers and suppliers enrolling for the sole purpose of ordering
and referring are required to use the new CMS-855O form immediately.
ID recertification
The Centers for Medicare & Medicaid Services (CMS) requires NGS to
conduct an annual recertification of all current Medicare online system
users for:
- Part A Fiscal Intermediary Standard System (FISS)/Direct
Data Entry (DDE) providers
- Medicare Part B Professional Provider Telecommunications
Network (PPTN) providers
- Durable medical equipment (DME) Claim Status Inquiry (CSI)
supplier entry
This process will recertify all IDs used by your employees
or third parties you have authorized to access NGS systems
on your behalf. Failure to complete recertification by Nov.
30, 2011, disrupts Medicare online system access. Therefore,
if you’re seeing an interruption to your access, it’s likely
because this deadline has passed.
Online system users required to complete the user ID recertification
should have received an authorization access code via email.
These access codes were emailed to all applicable providers/suppliers
Oct. 3-5, 2011.
If you received your access code, go
to this site and enter
your access code in the form field. Select enter and follow
the onscreen prompts. The provider recertification web form
will ask you to provide contact information. Once your recertification
is complete, the above web key code will no longer be valid,
and you will receive email confirmation that your recertification
is complete.
If you did not receive an email with access codes for your
user IDs, contact the Electronic Data Interchange (EDI) Help
Desk at (877) 273-4334 and provide:
- User IDs
- User names
- Region
- Email addresses
To review common questions on the recertification process,
visit here. Direct any additional
questions to the EDI Help Desk.
Enrollment revalidation
The AMA advised local medical societies
and physicians that they met with CMS regarding the enrollment
revalidation process. In a letter, the AMA stated the CMS
director agreed to extend the provider enrollment revalidation
process through 2015.
If you received a revalidation request letter from NGS, you
are still required to complete your enrollment forms for
revalidation and return them to NGS within 60 days from the
date of the letter. NGS will send a second letter soon.
If you receive a letter during that phase, you will also
need to comply within 60 days from the date of the letter
and revalidate your provider number by sending in a fully
completed CMS-855. Failure to do so may deactivate your Provider
Transaction Access Number (PTAN) and billing privileges to
Medicare.
Please remember that the revalidation process does not change
or alter normal provider enrollment laws for Medicare. If
you have a change of address, reassignments, additions to
practice, changes in authorized officials or other information
updates, you are still required to submit the changes within
30 days. Do not wait for revalidation to update.
Redaction of NPI
CMS recently published a list of providers
who were contacted to revalidate their Medicare enrollment.
In response to AMA advocacy, CMS has now revised the list
to redact providers’ National Provider Identifier numbers
(NPIs) – with only the last four digits displayed – to guard
against identity theft.
Periodically, check the list of providers contacted for revalidation
to ensure you have not missed your revalidation notice mailing
from MAC. While CMS has extended the revalidation effort
through 2015, physicians who are contacted to revalidate
must do so within 60 days or have their Medicare enrollment
deactivated.
CMS indicated the first set of providers contacted for revalidation
were those who are enrolled but not yet in CMS’ Medicare
Provider Enrollment, Chain and Ownership System (PECOS).
CMS also recently updated a MLNMatters article on revalidation
that provides additional information. Read it at www.ismanet.org/go/MLN1126.
For the list of providers contacted to revalidate, see the
CMS website (click on “Revalidation Phase 1 Listing”).
Billing provider address in 5010
If you submit claims electronically, you
will be required to use only a street address or physical
location as the billing provider address, not a P.O. box
or lock box address. Continuing to report a P.O. box in the
billing provider address field will cause your claims to
be rejected.
Practices that wish to continue having payments sent to a
P.O. box or lock box should report this address in the “pay-to”
address field.
You may need to work with your practice management system
vendor, billing service or clearinghouse to make this address
change for your claims. This work needs to be completed prior
to Jan. 1 to prevent claims rejections and interruptions
in cash flow.
Under the Health Insurance Portability and Accountability
Act (HIPAA), all physicians and other health care providers
who submit claims electronically are required to transition
to the Version 5010 transactions Jan. 1.
90-day grace period for 5010 enforcement
While the compliance deadline for HIPAA
version 5010 electronic transactions remains Jan. 1, CMS
announced it will not enforce compliance until March 31.
CMS granted this 90-day grace period because progress toward
industry-wide compliance with the new version of electronic
transactions – which includes health care claims – has been
slow. However, you should still prepare your practice to
be compliant by Jan. 1.
CMS plans to investigate complaints of non-compliance with
version 5010 standards beginning in January. Physicians who
face a complaint must provide evidence of efforts to become
fully compliant. |
| The ISMA’s Government Relations staff extended an invitation
to this coalition meeting to state legislators on the Joint
Committee on Medicaid and the Health Finance Committee who
worked on a summer study committee earlier this year.
Accepting this ISMA invitation to attend the Nov. 11 meeting
were: Sen. Brandt Hershman, R-Buck Creek; Sen. Jean Leising,
R-Oldenburg; Sen. Jean Breaux, D-Indianapolis; Rep. Tim Brown,
M.D., R-Crawfordsville; Rep. William Crawford, D-Indianapolis;
and Rep. Donald Lehe, R-Brookston.
“The meeting participants from physician offices were well
informed and organized,” said ISMA director of Government
Relations Mike Rinebold. “The examples and details presented
provided legislators the information they needed to make
sure resolution to these problems can be achieved, to improve
administrative efficiency and remove barriers to care.”
Testimony from medical practices
John McCullough, Department of Family Resources Liaison and
Provider Relations manager/Family and Social Services Administration
Civil Rights LEP Coordinator, was not in attendance due to
the state holiday, though the meeting date had been previously
approved. However all the managed care entities (MCEs) and
HP had representatives present.
John Barth, vice president of Compliance and Regulatory Affairs
at MHS, advised he will take the lead in organizing a group
to bring more consistency among the MCEs.
Terri Oatis from South Bend Medical Foundation testified
about difficulties with the varying information the MCEs
request on the 1500 form. The differences are noted in boxes
24H, box 31 and box 33.
Currently, information requested on the 1500 form varies
with each plan. A cost savings in the form of fewer denials
requiring less follow up could be realized if all the MCEs
and Traditional Medicaid would agree to accept the same information.
Patricia Migas, administrator from Integrated Billing Solutions,
testified regarding the need for a universal comprehensive
list of published diagnosis codes for emergency room services,
in order to determine prudent lay person.
Migas also testified about difficulties with credentialing,
which is different for all the MCEs. This issue negatively
impacts hospital-based physicians in particular because they
cannot pre-screen their patients.
Attendees agreed all MCEs should be required to honor the
effective date the state uses for physicians who are unable
to screen MCE payers prior to seeing them. Reimbursement
should be at the same level as the group’s contract with
the MCE.
Jan Hooker, a billing and coding consultant from Indianapolis
Medical Management, testified about HP loosing credentialing
applications. HP is working on their process, but improvement
is still needed. HP agreed to back date to the requested
effective date, but this still delays the credentialing process
for physicians.
Many months may be required to enroll a provider as a result
of lost applications. Since the MCEs cannot enroll providers
until they are enrolled with HP, and the MCEs cannot back-date
their effective dates to HP’s effective date, physicians
and practices lose money, potentially costing the state more
by forcing the patient to seek care at an emergency room.
If the law and process are changed so MCEs can use the same
effective date HP has for the provider, a cost savings for
the state would result.
Other
Relia Manns Wilford of HP provided a presentation on ICD-10.
Please see the Dec. 19 ISMA Reports for more information
on the meeting and photographs.
Several legislators requested the opportunity to appear again
at the coalition meeting. ISMA staff will follow up to ensure
issues like credentialing delays are resolved. Consider attending
a meeting in 2012 and continue reading the quarterly Medicare/Medicaid
Coalition Report for more on these topics.
REMINDER: Dec. 31, 2011, is the target date to start shutting
down MyAnthemSM links to certain functionalities, including
Eligibility & Benefits Inquiry and Claims Status Inquiry.
Access to this information will then be available exclusively
through Availity.
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