9/10/2015. Supplier Website Tutorial

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Supplier Website Tutorial

P t d b

Presented by

Noridian Provider Outreach and Education Jurisdiction D DME MAC

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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 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 the Centers for Medicare & Medicaid Services (CMS). The most current edition of the information contained in this release can be found on the Noridian website at

med.noridianmedicare.com/web/jddmeand the CMS website at

www.cms.gov

The identification of an organization or product in this information does not imply any form of endorsement.

Noridian Jurisdiction D DME MAC

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Workshop Protocol

E i W k h

• Entering Workshop

– Attendee lines are muted upon entry

• Throughout Workshop

– Written questions in Q & A section

• Conclusion of Workshop: Q & A Session

– Use “Raise Hand” feature to ask questions aloudUse Raise Hand feature to ask questions aloud – When question finished, select “Lower Hand” button

• Certificate of Completion

– CEUs are NOT offered for this course

• Presentation was sent via email and can also be found at: med.noridianmedicare.com/web/jddme/education/event-materialsj

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How to Ask a Written Question

Click on Q&A Tab Address “All Panelists” Type your question into box Noridian Jurisdiction D DME MAC September 2015 4

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Acronyms

• ABN: Advance • F2F: Face-to-Face Beneficiary Notice of

Noncoverage

• CERT: Comprehensive Error Rate Testing

• DMEPOS: Durable

• LCD: Local Coverage Determination

• MLN: Medicare Learning Network • PA: Policy Article Medical Equipment,

Prosthetics, Orthotics and Supplies

• DOS: Dates of Service • DWO: Detailed Written

PA: Policy Article

• PAP: Positive Airway Pressure

• POD: Proof of Delivery • POS: Place of Service • DWO: Detailed Written

Order • RAD: Respiratory _{Assist Device}

med.noridianmedicare.com/web/jddme/help/acronyms-glossary www.cms.gov/apps/acronyms/

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Agenda

Web to r • Web tour – Home Pages – Enrollment – DMEPOS Category – Fees & News

P li i – Policies

– CERT & Reviews – Education & Outreach – Claims & Appeals – Forms

Contacts – Contacts

– Tools/External Resources/Keeping Current

• Resources & Reminders

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Noridian Home Page

https://www.noridianmedicare.com/

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Noridian DME Home Page

https://med.noridianmedicare.com/web/jddme/

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Search Feature & Guide

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Browse by Topic - Enrollment

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Browse by DMEPOS Category –

Therapeutic Shoes

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Fees & News

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Policies

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CERT & Reviews

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Education & Outreach

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Claims & Appeals

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Forms

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Contacts

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Tools/External Resources/

Keeping Current

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Comprehensive Error Rate

Testing (CERT)

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CERT 2014 Improper Payment Rates

Published 12/15/2014

September 2015 Noridian Jurisdiction D DME MAC 21

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CERT Letter

September 2015 Noridian Jurisdiction D DME MAC 22 www.certprovider.com

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CERT

• Randomly select submitted claims

• Request medical records from provider/supplier that submitted claim

• Review claims and medical record forReview claims and medical record for compliance with Medicare to include:

– Coverage – Coding

– Billing rules

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Reasons for CERT Errors

• Insufficient documentation • Insufficient documentation • No documentation

• Service incorrectly coded

• Medically unnecessary servicey y

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Decrease CERT Errors

• Educate staff

• Train coders/billers

• Submit correct information

– Beneficiary name social security number MedicareBeneficiary name, social security number, Medicare number, date of service

• Submit legible and complete records

– Dates, required signatures, etc.

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CERT Inquiries

• [email protected]

• Email should include:

– CERT Claim Identification (CID) – In Subject Line – Supplier name and addresspp

– Telephone number

– Explanation of the issues, concern or question

• DO NOT send Protected Health Information (PHI)

(PHI)

• Response within 2 business days

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Quick Look CERT

Documentation Chart

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ICD-10 Transition

• October 1, 2015, timeframe for ICD-10 Transition

– Sign up for list serve to get ICD-10 news

• Noridian • CMS

– Dedicated ICD-10 web page on Noridian websiteDedicated ICD 10 web page on Noridian website

• https://med.noridianmedicare.com/web/jddme/topics/icd-10

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Testing Opportunities

• Front-end (acknowledgement testing)( g g)

• Pass EDI front-end edits • Are ICD-10 codes valid? • Acknowledgement Testing

– Registration is not required – Can do this testing at any time

• Noridian/CEDI-CMS will be monitoring

activity during the designated testing weeks activity during the designated testing weeks • Make sure the claims you submit for testing

are “clean” claims

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ICD-10 Updated LCDs & PAs

• All Local Coverage Determinations and Policy Articles have been updated

– ICD-9 and ICD-10 LCDs and PAs are assigned new ID numbers to keep them separate

• Not considered new policies

– Coding revisions do not change the intent of the coverage/non-coverage

• https://med.noridianmedicare.com/web/jddme/po licies/lcd/future

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“Road to 10”

• Small Physician’s Practice Route to ICD-10 • No-cost tool that will help you:

– Get an overview of ICD-10 – Explore Specialty References – Create your personal action plan

• Resources: • Resources: – ICD-10 Overview – Webcasts – FAQ – Quick References – Template LibraryTemplate Library – Events

– Coding Scenarios (NEW!)

• www.roadto10.org

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ICD-10: 5 Steps for a Quick Start

https://www.cms.gov/Medicare/Coding/ICD10/Dow nloads/ICD10QuickStartGuide20150622.pdf

1. Make a plan

– Get ICD-10 CodesGet ICD 10 Codes

2. Train Your Staff

– Identify 25 top codes

3. Update Your Processes

– Update your Forms

– Identify Gaps in Documentation

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ICD-10: 5 Steps for a Quick Start

[2] 4. Talk to Your Vendor and Health Plans

– Is your system ready?

5. Test Your Systems and Processes

– Front-end testing with Medicareg – Test with other Payers

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ICD-10 Transition

• http://cdn.roadto10.org/wp-uploads/2014/08/2015-ICD-10-CM-Tabular-List-of-Diseases-and-Injuries.pdf • http://cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM-and-GEMs.html September 2015 Noridian Jurisdiction D DME MAC 35

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Have a Verbal Question?

Be sure that you have entered the Attendee ID # on this screen to ensure you are correctly connected to the phone lines,

which will allow you to ask b l Noridian Jurisdiction D DME MAC verbal questions September 2015 37

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Asking a Verbal Question

Click on Must have a Click on Participants tab at top right Click on Hand phone or headset by your name Noridian Jurisdiction D DME MAC Click on Hand on bottom right September 2015 38

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Resources

• LCD/Policy Article – med.noridianmedicare.com/web/jddme/policies/lcd/active • Supplier Manual – med.noridianmedicare.com/web/jddme/education/supplie r-manual

• “Dear Physician” letters

– med.noridianmedicare.com/web/jddme/policies/physician -resources

• Documentation ChecklistDocumentation Checklist

– med.noridianmedicare.com/web/jddme/policies/documen tation-checklists

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New Supplier Curriculum

• General and policy specific

• Short presentations grouped by relevance

• Suppliers encouraged to view both general and policy specific curriculum

g p y

• Quiz at conclusion with certificate

• Great for new and existing suppliers existing suppliers

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We’ve Moved…

To A New

Improved Content A & Tuesday, April 21

To A New

Website!

Access & Navigation Browse By DMEPOS Category Browse By Topic September 2015 Noridian Jurisdiction D DME MAC 41

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New Web Site Home Page

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Endeavor

Functions • Eligibility Availability • Eligibility g y • Claim Status

– CMR and DCR claim processing comments – prepayment review

• Same or Similar

• Same or Same (Includes A, L, & V codes.)

Eligibility

– 24 hours/day, 7 days/week

• All other functions

– 6 a.m. – 8 p.m. CT, Mon.– Fri. – 7 a.m. – 3 p.m. CT, Sat. • Claim-Specific Remittance Advices • Overpayments • Reopening/Redetermination – Submission

– Status InquiryStatus Inquiry User Manual_{med noridianmedicare com/web/}

• PMD Prior Auth Request Status • ADR Requests Noridian Jurisdiction D DME MAC med.noridianmedicare.com/web/jddme/topics/portal September 2015 43 med.noridianmedicare.com/web/ jddme/topics/portal/user-manual

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Change in Endeavor Registration

CEDI Requirement

• Effective July 1, 2015, National Provider

Identifier (NPI) registered as electronic submitter with Common Electronic Data Interchange

(CEDI)

(C )

• Established Endeavor users still have access

– NPI additions must be registered with CEDI

• Enroll or questions, refer CEDI website

Q

• Questions on Endeavor

[email protected] Noridian Jurisdiction D DME MAC

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Common Electronic Data Interchange (CEDI)

• Single front end

l t i l ti

• CEDI works with: electronic solution

• Free software

• Front end error report manual

– DME MAC software vendors

– Billing services – Clearinghouses – Trading partners

Contact:

http://www.ngscedi.com/ Scroll down for information on home page E-mail: [email protected]

Phone:1-866-311-9184

CEDI 5010A1 Manual: www.ngscedi.com/ngs/wcm/connect/37def00b-12dc-43c8-8a5a-74f60db45b83/CEDI_Acknowledgement_File_Manual.pdf?MOD=AJPERES

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Denial Code Guidance

Why did Why did

l i

• Each denial code webpage includes:

– Claim adjustment reason code and description – Claim adjustment remark code and description – Common reason why Noridian uses that

my claim deny?

reason/remark code

– Next step (re-file, redetermination, reopening, etc.) – How to avoid these types of denials

– Applicable resources _{claim processed}Why was my

• More pages to come! this way?

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PECOS Requirement

• Claims may be denied if: y

– The ordering/referring physician is NOT in PECOS and eligible to order and refer

– The ordering/referring physician is not of the specialty to order/refer – If the physician's name submitted on the claim does not match their

name in PECOS

• med.noridianmedicare.com/web/jddme/claims-appeals/claim-submission/pecos-edits

• See how to avoid these claim denials by properly submitting the ordering physician name from the CMS PECOS Report

• Implemented January 6 2014 • Implemented January 6, 2014

• View the PECOS DME on Demand on our website!

– www.brainshark.com/noridian/vu?pi=zHlzqyKBpz87uMz0

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ALJ Appeal Status Info System

(AASIS)

• Check the status of an ALJ appeal

September 2015 Noridian Jurisdiction D DME MAC 48 www.hhs.gov/omha/Appeal_Status_Lookup/index.html

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Email Updates

• Tuesday and Friday

• Latest updates and announcements • Customizable

• Sign-up in the lower • Sign-up in the lower

right corner of our new website!

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Website Survey

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esMD

(Electronic Submission of Medical Documentation)

• esMD is the ability to transmit documentation y

electronically for review

• Who accepts documentation via esMD?

– DME MAC (Noridian) – CERT

– CERT

– Recovery Auditor – ZPIC

• What types of requests can be sent via esMD?

C l M di l R i & PMD PAR

– Complex Medical Review & PMD PAR

• Find out more:

September 2015 Noridian Jurisdiction D DME MAC 51 www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/ESMD/index.html?redirect=/esmd

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MREP

M di R it E P i t

• Medicare Remit Easy Print

– Free software!

– View, search and print remits – Print and export reports

• CMS Brochure – www.cms.gov/MLNProducts/downloads/MedicareRe mit_0408.pdf • MREP Software – www.cms.gov/AccesstoDataApplication/02_Medicare RemitEasyPrint.asp Noridian Jurisdiction D DME MAC September 2015 52

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Medicare Learning Network (MLN)

• GuidesGuides • Training

• Articles • Educational Tools • Booklets Brochures Training Presentations • Web-Based Training • Special Initiatives

• Fact Sheets • Web Resources

September 2015 Noridian Jurisdiction D DME MAC 53 www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNGenInfo/index.html

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We Are Coming To You!!

If you are going to be in the following cities, If you are going to be in the following cities,

please come and visit us for

Adjust Your Sails for Medicare Success

– September

– September 15 Las Vegas NV

Now offering 30‐ minute 1‐on‐1

– September 15, Las Vegas, NV – September 17, Phoenix, AZ – September 29, Los Angeles, CA

– October – October 1, Riverside, CA – October 13, Seattle, WA sessions during our fall in‐person seminars. Register today to reserve your spot! – October 15, Portland, OR Noridian Jurisdiction D DME MAC med.noridianmedicare.com/web/jddme/education September 2015 54 spot!

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Education Opportunities

• Web-Based Workshops • Q & A Sessions

– 2nd _{Monday of each month @ 3 p.m. CT} • DME On DemandDME On Demand

• Education Request (Free one on one) • ACT

• med.noridianmedicare.com/web/jddme/education

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Single Toll Free Line

IVR 877‐320‐0390 Supplier Contact Center Telephone Reopenings September 2015 Noridian Jurisdiction D DME MAC 56 Monday‐Friday 8 a.m. – 6 p.m. Central Time Effective March 1, 2015

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Beneficiary Contact Information

• Suppliers please use Noridian Contact Center • Suppliers please use Noridian Contact Center

number for supplier inquiries only

• Beneficiaries who need assistance can be directed to:

– 1-800-Medicare (800-633-4227)

• Question on claims and coverage of equipment – Social Security Administration (800-722-1213)

• Update name/address, questions on premiums, Medicare entitlement

entitlement

– Benefits Coordination Recovery Center (800-999-1118) • Primary insurance information update

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