TMP-EDO-0006 Version 2.0
description
Transcript of TMP-EDO-0006 Version 2.0
Welcome to
2006 Updates for ANCO
Presented by NHICProvider Education and Outreach
RepresentativesJanuary 2006
TMP-EDO-0006 Version 2.0
Fee Schedule Update
November, 2005 published fee schedule
Proposed change before Congressional
Congressional Action – Month end?
www.medicarenhic.com
2006 Deductible: $124
Medicare Part B Deductible
NPI Enrollment Choices
Web based applicationPaper ApplicationElectronic file application
https://www.cms.hhs.gov
Chose 1 method only
NPI Transition Time Line
1-3-06 - 10-1-06 PIN only, or PIN & NPI
10-2-06 – 5-22-07 PIN or NPI
5-23-07 NPI only
NPI EnumeratorFox Systems, Inc.
1-800-465-3203 (NPI Toll-Free)1-800-692-2326 (NPI TTY)
NPI EnumeratorPO Box 6059Fargo, ND 58108-6059
NPI Information
Link fromOur website
National Provider Identifier(NPI)
http://www.cms.hhs.gov/NationalProvIdentStand/ (NEW)
http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/SE0528.pdf (NEW)
Medlearn Matters article SE0555 at http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/SE0555.pdf (NEW)
Surrogate UPIN Reporting
Surrogate UPIN # OTH000 will become invalid as of April 1st, 2006
Claims will reject Ordered or referred service must
contain a valid UPINUPIN Registry
http://www.upinregistry.com/
Appeals Changes
RedeterminationReconsideration as of January 1Administrative Law JudgeDepartmental Review BoardFederal Courts
Redetermination – First Level
No Telephone ReviewNew form CMS 20027www.cms.hhs.gov/forms/
CMS20027.pdf
Written Redeterminations
Copy of claimCopy of Remittance AdviceAdditional documentationPertinent claim information
Reopenings by Telephone
Correct clerical errors – Provider or CarrierDates of service entered incorrectly (i.e.,
09152003 instead of 09152004)Units entered as 0001 instead of 0010Dollars entered as 2.00 instead of
200.00 (only obvious errors; not just to increase billed amount)
CMS Medicare Contractor Provider Satisfaction Survey
• National in scope
• Gather provider’s opinions about Contractor’s performance
• NHIC’s providers selected to participate
CMS Medicare Contractor Provider Satisfaction Survey
Notification packets sent out
Respond on-line, by mail or Fax
Respond by January 25,2006
Further Information: http://www.cms.hhs.gov/MCPSS/
Recovery Audit Contractor (RAC)
Targets providers in CA, FL, NYGoal: to identify overpayments and
underpaymentsTwo recovery audit contractors
MSP- Diversified CollectionsClaim Review- PRG Shultz
Recovery Audit Contractor (RAC)
Letters requesting informationAddress questions directly to RAC, not
NHICRAC has 60 days to review the
documentationResource: Medlearn Matters SE0565
http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/SE0565.pdf
WEBSITE – www.medicarenhic.com
JoinourMailingList
Reduce Paper RAs
Use ERA
Obtain software free from CMS “Medicare Remit Easy Print”
http://www.medicarenhic.com/edi/download/mrepsoftware_1005.htm
Medicare Secondary Payer
Can be billed electronicallyUse appropriate fields
Claim will develop for primary RA if needed
MSP Electronic Claim Submission
Primary payer name & address Insured’s effective date & termination date
with primary payerPrimary payer allowed amountPaid amountDeductible amountCoinsurance amount when applicableDisallowed amountCost-containment amount when applicable
CR-3916 MSP Denial for Invalid GHP
Updated MSP info by the Coordination of Benefits Contractor
Re-process claims 1 yearAutomatically