NGS Form Assistant
Kellie Templin, e-commerce consultant, gave a Web demonstration of the revised NGS Form Assistant for enrollment.
Save time and money by taking advantage of the free NGS Form Assistant software now available for National Government Services (NGS) Part A and Part B providers. The NGS Form Assistant software provides the following:
- Easy navigation and viewing of all CMS-855 forms
- Ability to print multiple blank and completed CMS-855 forms
- Access to the “Load Existing Form” that allows providers to easily find forms they’ve already completed
- Easy-to-use method to archive, restore and print CMS-855 forms
- Access to CMS-855A, CMS-855B, CMS-855I, CMS-855R, CMS¬-460 and CMS-588
Physicians can view and print as many or as few CMS-855 forms as needed.
Find the form here.
PPTN not up yet
At this writing, the Professional Provider Telecommunication Network (PPTN) is not up and fully operational. Please watch the EDI listserv for updates. If you do not receive the NGS listservs, you may sign up here; look under News and Publications and click on Listserv.
Retroactive cost-sharing waiver
Information was provided regarding waiver of retroactive beneficiary cost sharing due to an increase in payment under the Medicare Improvement for Patients and Provider Act (MIPPA).
The Office of the Inspector General (OIG) has issued a statement assuring Medicare providers, practitioners and suppliers affected by the retroactive increases in pay rates due to MIPPA in 2008 that they will not be subject to the OIG administrative sanctions if beneficiary cost-sharing is waived. That waiver would occur because of amounts attributable to the increased payment rates.
Billing NGS for hospitalists
A hospitalist would need to obtain a Part B Provider Transaction Account number (PTAN), or billing number, in order to submit claims with NGS. The hospitalist physician must follow the same rules as other physicians working independently in the hospital.
Provider enrollment revalidation effort
Physician enrollment revalidation started in September 2007. The top 100 billers identified received a revalidation request letter.
After completing this project, the Center for Medicare & Medicaid Servcices (CMS) has not introduced additional revalidation efforts. For further information on revalidation, refer to the Medicare Program Integrity Manual 100-08, Chapter 10, section 9.
A physician who registers no activity in a 12-month period will be terminated. This action occurs on a quarterly basis.
2008 NGS Fact Sheet
Find the National Government Services fact sheet here.
Physician Quality Reporting Initiative (PQRI)
Lindy Lady, provider outreach and education (Kentucky), presented the following on PQRI.
PQRI checks for Indiana were issued in July 2008. Checks (either electronic or paper) were sent to each tax identification number with a remittance advice. For paper checks, an explanatory message was attached that states: “This check is for a P4R payment.” For electronic transmissions, provider adjustment code “LS” (lump sum) appears.
The Financial Central Number (FCN) listed on the remittance will start with a two-digit region code (72), followed by two digits that indicate the year (08). The next three digits listed will be the Julian date (177); the next three digits will be the batch range (923), and the last three digits indicate the sequence in the range, which will be different for each provider (7208177923XXX).
The amount of the bonus is determined by claims submitted by providers who billed according to the PQRI guidelines. The amounts were calculated by a specialty contractor. National Government Services (NGS) received the file with the provider payment amounts.
If you question the fact that you didn’t receive a payment or question the amount of the payment, NGS can verify that a payment should or should not have been made and whether the amount matches the file received.
Use these contacts for assistance with PQRI:
Individuals Authorized Access to CMS Computer Services (IACS) registration questions:
EUS Help Desk at 1-866-484-8049
Help accessing the PQRI Report Delivery System (RDS), questions about feedback reports, including general questions regarding how an incentive payment was calculated:
- Quality Net Help Desk at
1-866-288-8912
- PQRI job aid: here
- PQRI registries: here
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EDS
Provider Relations Representative Mona Green discussed Medicaid coverage of K-codes for power mobility devices. Prior authorization is required for these devices, and requests are reviewed on a case-by-case basis. Find details in bulletin BT200832 dated July 17, 2008.
Green also reminded attendees that tamper-resistant prescription pad implementation is in its second phase. Prescribers who utilize Indiana Board of Pharmacy security prescription blanks are in full compliance with the Phase II requirements. For additional information, refer to BT200834 dated Aug. 21, 2008.
Green asked if any attendees had attempted provider enrollment updates on Web interChange. Providers can make the following profile updates using Web interChange:
- Ownership information (change of ownership must be on paper form)
- Changes in membership of a board of directors
- Name of office manager or other management personnel
- Ownership in subcontractor entities
- Enrollment or disenrollment in electronic funds transfer (EFT)
- Note: EFT deposits occur 18 days after submission of an enrollment via Web interchange.
- Address changes (changes to the home office address require submission of the Indiana Health Care Plan (IHCP) Name and Address Maintenance Form)
- Addition or removal of specialty designations
- Enrollment in HealthWatch, Medical Review Team (MRT), Pre-Admission Screening and Resident Review (PASRR) and 590 Programs
- Completion of the IHCP Provider Termination Form
Green, as well as the other presenters, reminded attendees of the annual IHCP Provider Seminar that was set for Oct. 6, 7 and 8. A wide range of topics was to be discussed and representatives from the managed care organizations and others were scheduled to present. Bulletin BT200836 provided all information needed for registration and session sign-up.
Green then led a discussion regarding the Healthy Indiana Plan (HIP), particularly the Enhanced Service Plan (ESP). The plan administrator for ESP is Indiana Comprehensive Health Insurance Association/Affiliated Computer Services.
All IHCP-enrolled providers are included in the “network” for ESP; no additional contract is required. Claims for ESP members should be mailed to Affiliated Computer Services (ACS) at the following address:
ACS – Attention ESP Claims Processing
P.O. Box 33077
Indianapolis, IN 46203-0077
Additional information regarding ESP is available here or in the IHCP Provider Manual, Chapter 2, Section 7 (here)
Attendees were reminded that HIP is a commercial product, not a Medicaid product. HIP member services, including ESP, are generally reimbursed at Medicare rates.
Address specific questions to Anthem and MDwise. Additional information regarding the HIP program can be found in Bulletin BT200730 dated Nov. 17, 2007.
CareSelect
Chris Kern from MDwise directed attendees to include the two-digit certification code and National Provider Identifier (NPI) of the patient’s primary care provider (PCP) on the CMS 1500 claim form.
He asked that practices notify MDwise of non-compliant CareSelect patients — rather than terminate a patient from the practice.
Providers are asked to complete a Member Reassignment form. The provider may also request an intervention with the patient’s care manager.
Both Kern and Kelvin Orr of Advantage Health Solutions stated that notification will be sent to PCPs regarding scheduling of care management care coordination meetings.
Each meeting will last approximately an hour and will revolve around a specific list of patients.
Providers can bill for each patient discussed in the meeting. Bulletin BT200804 provides billing instructions for these meetings.
The meeting was opened for attendees to ask questions regarding the two-digit certification code on CareSelect claims. Orr advised that Advantage is working with the Office of Medicaid Policy and Planning (OMPP) to revamp the certification code system. He stressed that providers must check eligibility each time a Medicaid patient is seen. MDwise has been working with OMPP in this area as well, according to Kern.
Hoosier Healthwise
Sherry Miles from MDwise discussed billing for family planning services in the global period of a pregnancy. A concern was raised that Package B claims were only paid when a pregnancy diagnosis is used. There were questions regarding the appropriateness of using a pregnancy diagnosis when family planning services are performed in the postpartum period.
Miles explained that the MDwise delivery systems have been directed to pay claims for family planning without the pregnancy diagnosis. MDwise has asked the state for clarification.
Cindy Ketchem of Managed Health Services (MHS) stated that the pregnancy diagnosis does not need to be primary on the family planning services claims. Jeane Maitland from Anthem stated the same was true for Anthem Hoosier Healthwise claims.
All three representatives concurred that prior authorization is not required for sterilization and hysterectomy services. Only a signed consent form is needed. Ketchem advised that MHS will accept the consent via fax and the claim electronically.
Ketchem discussed NPI electronic issues stating that MHS is now seeing a 4 percent rejection rate. Providers experiencing rejections should contact MHS.
Education and outreach
Green from EDS closed the meeting by telling attendees that EDS has educational Power Point programs that combine information regarding the EDS family tree and online eligibility education. If you would like in-office staff training, contact Green at (317) 488-5309.
The next coalition meeting is scheduled on Nov. 21, 2008.
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