Medicare Part B Updates

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Jurisdiction K – Part B

Medicare Part B Updates

AAHAM – January 23, 2015

Add doc ctrl no.

Today’s Presenter

Gail O’Leary

Provider Outreach & Education Representative

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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 http://www.cms.gov.

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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

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Updates

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New Corporate Name - Branding

WellPoint has changed its corporate name to

Anthem, Inc.

Effective December 3, 2014

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Addresses to List of Safe Senders

• Email correspondence sent from the NGS Provider Enrollment department will now display as: [email protected] or

[email protected]

• Email correspondence sent from PECOS will continue to display as [email protected]

• All individuals listed as enrollment application contacts should routinely verify their spam or junk email folder and add the

[email protected], [email protected] and

[email protected] to their safe senders list to prevent these emails from going into spam or junk email 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

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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: 717-565-3783

• Mail: P.O. Box 7108

Indianapolis, IN 46207-7108

• Connex: through the My Claims tab

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Part B Premiums/Deductibles

2014

2015

Monthly Part B Premium for Beneficiary - $104.90

Higher part B Premium

Monthly Part B Premium for Beneficiary -$104.90

Income above $85,000 up to $107,000 pay higher part B Premium $146.90

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

www.NGSMedicare.com and click on the Fee

Schedule Lookup tool

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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

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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

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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

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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

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2015 Annual Update to Therapy Code List

New Codes effective January 1, 2015

97607 (Negative pressure wound treatment) • Replaces G0456

97608 (Negative pressure wound treatment > 50cm) • Replaces G0457

The therapy code listing can be found at

Annual Therapy Update - Centers for Medicare & Medicaid Services

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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

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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 90846and 90847 and Psychoanalysis CPT code 90845

Prolonged E&M Services - CPT codes 99354 and 99355

Annual Wellness Visit -HCPCS G0438 and G0439

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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

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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

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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

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News Article - PA Services

Posted 11/14/14

For 2014, these are all new allowed services:

49405Image guided fluid collection drainage by catheter, …; visceral, percutaneous

49406Image guided fluid collection drainage by catheter..; peritoneal or retroperitoneal, percutaneous

49407Image guided fluid collection drainage by catheter,…;peritoneal or retroperitoneal, transvaginal or transrectal

10030Image guided fluid collection drainage by catheter… soft tissue, percutaneous

Additionally, 47525 Change of percutaneous biliary drainage catheter, will be allowed when performed by a PA

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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

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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

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(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

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment /HPSAPSAPhysicianBonuses

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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

)

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ICD-10

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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-10

http://www.gpo.gov/fdsys/pkg/FR-2014-08-04/pdf/2014-18347.pdf

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Transition Road Map

ICD-10-CM Implementation:

6 Phases

1. Planning

2. Communication and awareness

3. Assessment

4. Operational implementation

5. Testing

6. Transition

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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, 2015

8:00 a.m. - 5:00 p.m. Eastern Standard Time (ET)

• JK: 888-379-9132 • EDI Email Inquiry Form

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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).

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NGSConnex

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What is NGSConnex?

• http://www.ngsconnex.com

– Need Internet access and e-mail 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

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

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NGS Connex Feature - Electronic

Claims Submission

• Allows Part B providers to submit claims on

our secure

http://www.NGSConnex.com

portal

• It is faster than paper - 14-day turnaround!

• It is free to submit a claim

• You can edit errors immediately

• Receive e-mail 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

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Our Contact Information

IVR: 877-869-6504

Provider Contact Center: 866-837-0241 Fax on Demand: 866-709-1905

EDI Helpdesk: 888-379-9132 Correspondence

National Government Services

Part B Provider General Written Inquiries P.O. Box 6189

Indianapolis, IN 46207-6189

New Direct Telephone line for Provider Enrollment (JK): 888-379-3807

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Email Updates

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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!

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Medicare University

• http://www.MedicareUniversity.com

• Interactive online system available 24/7

• Educational opportunities available

– Computer-based training courses

– Teleconferences, webinars, live seminars/

face-to-face training

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