5/8/2018 HOMES. Disclaimer. Website Survey. Your feedback is valuable Click Yes, I ll give feedback

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HOMES Presented by Noridian DME Outreach and Education May 16, 2018 Disclaimer This information release is the property of Noridian Healthcare Solutions, LLC.

The information is provided as is without any expressed or implied warranty.

All models, methodologies and guidelines are undergoing continuous improvement and modification by Noridian and the Centers for Medicare & Medicaid Services (CMS).

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

1 HOMES Presented by Noridian DME Outreach and Education May 16, 2018 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 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 and the CMS website. The identification of an organization or product in this information does not imply any form of endorsement. CPT codes, descriptors, and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Noridian Medicare Website ( CMS Website ( May 2018 Noridian DME Outreach and Education 2 Website Survey Your feedback is valuable Click Yes, I ll give feedback Choose your own time to respond Visit the Noridian DME website home page Select Website Survey May 2018 Noridian DME Outreach and Education 3 1

2 Acronyms ABN: Advance Beneficiary Notice of Noncoverage ACA: Affordable Care Act ADR: Additional Documentation Request CBA: Competitive Bidding Area CEDI: Common Electronic Data Interchange CERT: Comprehensive Error Rate Testing CMS: Center for Medicare & Medicaid Services CO: Contractual Obligation DMECS: Durable Medical Equipment Coding System DME MAC: Durable Medical Equipment Medicare Administrative Contractor DMEPOS: Durable Medical Equipment Prosthetics Orthotics and Supplies FAQ: Frequently Asked Question FFS: Fee for Service HCPCS: Healthcare Common Procedure Coding System HHA: Home Health Agency HICN: Heath Insurance Claim Number May 2018 Noridian DME Outreach and Education 4 Acronyms HMO: Health Maintenance Organization IOM: Internet Only Manual IVR: Interactive Voice Response (system) LCD: Local Coverage Determination MLN: Medicare Learning Network NCD: National Coverage Determination NSC: National Supplier Clearinghouse PA: Policy Article PHI: Protected Heath Information PIM: Program Integrity Manual POD: Proof of delivery PTAN: Provider Transaction Access Number RA: Remittance Advice RAC: Recovery Audit Contractor RUL: Reasonable Useful Lifetime SNF: Skilled Nursing Facility WOPD: Written Order Prior to Delivery May 2018 Noridian DME Outreach and Education 5 Agenda Comprehensive Error Rate Testing (CERT) New Medicare Card Project Documentation Resources and Reminders May 2018 Noridian DME Outreach and Education 6 2

Comprehensive Error Rate Testing (CERT) CERT 2017 Improper Payment Rates CERT: (https://www.cms.

html) Service Type Improper Payment Rate Improper Payment Amount Overall 9.51% $36.

3 Comprehensive Error Rate Testing (CERT) CERT 2017 Improper Payment Rates CERT: ( Systems/Monitoring-Programs/Medicare-FFS-Compliance- Programs/CERT/index.html) Service Type Improper Payment Rate Improper Payment Amount Overall 9.51% $36.21 B Part A Providers (excluding Hospital Inpatient Prospective Payment System (IPPS)) 11.31% $18.24 B Part B Providers 10.16% $9.85 B DMEPOS 44.60% $3.65 B Hospital IPPS 3.91% $4.46 B May 2018 Noridian DME Outreach and Education 8 CERT Letter May 2018 Noridian DME Outreach and Education 9 3

4 CERT Randomly select submitted claims Request medical records from provider/supplier that submitted claim Review claims and medical record for compliance with Medicare to include: Coverage Coding Billing rules May 2018 Noridian DME Outreach and Education 10 CERT Error Categories No documentation Insufficient documentation Medically unnecessary service Service incorrectly coded Other May 2018 Noridian DME Outreach and Education 11 Decrease CERT Errors Educate staff Train coders/billers Submit correct information Beneficiary name, social security number, Medicare number, date of service Submit legible and complete records Dates, required signatures, etc. CERT Inquiries May 2018 Noridian DME Outreach and Education 12 4

5 CERT Inquiries should include: CERT Claim Identification (CID) In Subject Line Supplier name and address Telephone number Explanation of the issues, concern or question DO NOT send Protected Health Information (PHI) Response within two business days Please use the appropriate address for your inquiry JA CERT: JD CERT: May 2018 Noridian DME Outreach and Education 13 New Medicare Card Project New Medicare Card Project Formerly know as Social Security Number Removal Initiative (SSNRI) Requires the removal of Social Security Numbers from Medicare cards by April 2019 Replaced with a Medicare Beneficiary Identifier (MBI) Distribution of new cards will begin April 2018 Noridian website: Claims & Appeals > Claim Submission > New Medicare Card Project CMS Overview webpage ( Card/index.html) May 2018 Noridian DME Outreach and Education 15 5

New Card Mailing Schedule Order STATES INCLUDED 1 Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia 2 Alaska, American Samoa, California, Guam, Hawaii, Northern Mariana

Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, Vermont 5 Alabama, Florida, Georgia, North Carolina, South Carolina 6 Arizona, Colorado, Idaho, Montana, Nevada,

6 New Card Mailing Schedule Order STATES INCLUDED 1 Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia 2 Alaska, American Samoa, California, Guam, Hawaii, Northern Mariana Islands, Oregon Group one and two will mail between April and June Arkansas, Illinois, Indiana, Iowa, Kansas, Minnesota, Nebraska, North Dakota, Oklahoma, South Dakota, Wisconsin 4 Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, Vermont 5 Alabama, Florida, Georgia, North Carolina, South Carolina 6 Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Texas, Utah, Washington, Wyoming 7 Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Puerto Rico, Tennessee, Virgin Islands Groups three through seven will mail after June 2018 May 2018 Noridian DME Outreach and Education 16 New Medicare Cards How will the new card look? Gender and signature line won t appear on new Medicare cards All cards will be printed on white paper Smaller size to match the size of a standard credit card May 2018 Noridian DME Outreach and Education 17 Railroad Retirement Board (RRB) No longer be able to distinguish RRB beneficiaries by the number on the new Medicare card Beginning in April 2018, we ll return a message on the eligibility transaction response for a RRB beneficiary "Railroad Retirement Medicare Beneficiary 271 Loop 2110C, Segment MSG The RRB will keep mailing cards with the RRB logo May 2018 Noridian DME Outreach and Education 18 6

7 Documentation Standard Documentation Requirements Dispensing Order If item was delivered based on dispensing order or for suppliercreated DWO DWO Medical Records Proof of Delivery Beneficiary Authorization Continued Use (if applicable) Continued Need Refill Requirements Items dispensed on a periodic basis May 2018 Noridian DME Outreach and Education 20 Standard Documentation Requirements Article A55426 Applicable to all DMEPOS items Noridian Website > Policies > Active LCDs > Standard Documentation Requirements Policy Article A55426 May 2018 Noridian DME Outreach and Education 21 7

8 Standard Documentation Requirements Article May 2018 Noridian DME Outreach and Education 22 Authorized to Order Treating Physician, MD, or DO DPM, if appropriate per policy requirements Nurse Practitioner (NP) Clinical Nurse Specialist (CNS) Physician Assistant (PA) May 2018 Noridian DME Outreach and Education 23 Authorized to Order (cont.) NP or CNS Treating beneficiary for condition for which item is needed Practicing independently of physician Bill Medicare for other covered services using own National Provider Identifier (NPI) Permitted to do so in state where services are rendered Physician Assistant Meet definition of physician assistant found in Section 1861(aa)(5)(A) of Social Security Act Treating beneficiary for condition for which item is needed Practice under supervision of MD or DO Have own NPI Permitted to perform services in accordance with state law May 2018 Noridian DME Outreach and Education 24 8

9 Preliminary/Dispensing Order Some DMEPOS may be dispensed based on verbal/preliminary order Items provided based on a dispensing order must be followed up with a completed detailed written order Required elements Description of the item Beneficiary s name Prescribing physician s name Date of the order Signature Physician (written order) Supplier (verbal order) May 2018 Noridian DME Outreach and Education 25 Detailed Written Order (DWO) Claim may not be submitted without a DWO If no DWO Submit claim with an EY modifier May 2018 Noridian DME Outreach and Education 26 Detailed Written Order Basic Elements Beneficiary s name Physician s name Date of the order All items, options or additional features that are separately billed or require an upgraded code Narrative description, HCPCS code, HCPCS code narrative, or a brand name/model number Physician signature and signature date Program Integrity Manual (PIM) ( Guidance/Guidance/Manuals/Downloads/pim83c03.pdf) May 2018 Noridian DME Outreach and Education 27 9

10 DWO Additional Elements Item(s) to be dispensed Dosage or concentration, if applicable Route of administration Frequency of use Duration of infusion, if applicable Quantity to be dispensed Number of refills May 2018 Noridian DME Outreach and Education 28 Acceptable Detailed Written Order May be completed by someone other than physician Treating physician must review, sign and date Acceptable orders Fax Photocopy Electronic Original pen and ink May 2018 Noridian DME Outreach and Education 29 When is a New Order Required? For all claims for purchase or initial rentals Change in order When indicated in the medical policy Replacement Change in supplier If new supplier is unable to obtain valid order and documentation from original supplier May 2018 Noridian DME Outreach and Education 30 10

Medical Records Physician s office records Hospital records Nursing home records Home health agency records Healthcare professional records Test reports Must be available upon request!

11 Medical Records Physician s office records Hospital records Nursing home records Home health agency records Healthcare professional records Test reports Must be available upon request! May 2018 Noridian DME Outreach and Education 31 Resources and Reminders Acronyms CMS Acronym List ( Bottom of the Noridian Medicare Website May 2018 Noridian DME Outreach and Education 33 11

12 Beneficiary Contact Information Beneficiaries who need assistance can be directed to: Medicare ( ) Question on claims and coverage of equipment Social Security Administration ( ) Update name/address, questions on premiums, Medicare entitlement Benefits Coordination Recovery Center ( ) Primary insurance information update May 2018 Noridian DME Outreach and Education 34 Target Probe & Educate Goal is to improve claims payment error rate Reduce volume of appeals Existing data analysis determines supplier to review Claims with greatest financial risk High error rates that vary from peers Written notification sent to suppliers Review of claims One on one education to address errors Up to three rounds of probe reviews May 2018 Noridian DME Outreach and Education 35 Noridian Medicare Portal (NMP) Register on the Noridian DME website Browse by Topic > Noridian Medicare Portal It s free! View tutorials detailing registration and functionality Reset passwords and update user functionality as an administrator Issues with your Portal access? Call our Supplier Contact Center for assistance! May 2018 Noridian DME Outreach and Education 36 12

13 NMP Functions Eligibility Claim Status Medical Review Comments Additional Documentation Requests Self-Service Reopenings Appeals Submission and Status Same or Similar Claim-Specific Remittance Advices Financial (Checks and Overpayments) Power Mobility Device Prior Authorization Request Status May 2018 Noridian DME Outreach and Education 37 Self-Service Reopenings Self-Service Reopening Guidelines Claim must be finalized Needs to be denied/no payment Processed within one year Cannot be under review No other review or adjustment on claim Not unprocessable (MA130) Simple adjustments Add or remove diagnosis code Add or replace modifiers RR and MS Remove RA modifier Reprocess claim May 2018 Noridian DME Outreach and Education 38 Self Service Options Required Through IVR or NMP Eligibility details Same and Similar HCPCS lookup Payment Floor Checks Duplicate Remittance Advice (RA) Overpayments Provider Enrollment (Provider Enrollment, Chain, and Ownership System (PECOS) ordering/referring physician enrollment inquiry) Certificate of Medical Necessity (CMN) Status Pre-claim Crossover (Supplemental Insurance) Information requested as part of Eligibility request Claim Status including: Total Charges Payment and Date Check Number Claim Control Number (CCN) (including Internal Control Number (ICN) and Document Control Number (DCN)) Reason Code for Denial User Security Any information that is available via the IVR or NMP May 2018 Noridian DME Outreach and Education 39 13

Education Opportunities Webinars Q & A Sessions DME On Demand Education Request Ask the Contractor Teleconference (ACT) Education and Outreach Webpage located on the Noridian

Review claim specific questions Conducted using GoToMeeting Participants view presentation Able to spend one on one time with Noridian staff Educational Representative Medical

14 Education Opportunities Webinars Q & A Sessions DME On Demand Education Request Ask the Contractor Teleconference (ACT) Education and Outreach Webpage located on the Noridian Medicare Website May 2018 Noridian DME Outreach and Education 40 Electronic Supplier Visit (E-Visit) Customized education to fit your schedule Overview of policy information Review claim specific questions Conducted using GoToMeeting Participants view presentation Able to spend one on one time with Noridian staff Educational Representative Medical Review Nurse Referral sources welcome to attend May 2018 Noridian DME Outreach and Education 41 Electronic Supplier Visit (E-Visit) (2) May 2018 Noridian DME Outreach and Education 42 14

E-Visit Form May 2018 Noridian DME Outreach and Education 43 Available 24/7 Self-paced tutorials General and policyspecific topics Include completion certificate Recommended for new hire and ongoing

15 E-Visit Form May 2018 Noridian DME Outreach and Education 43 Available 24/7 Self-paced tutorials General and policyspecific topics Include completion certificate Recommended for new hire and ongoing staff training DME on Demand & Medicare Midterms Medicare Midterms Short quizzes Test your retention of the DME on Demand content Education & Outreach > DME on Demands May 2018 Noridian DME Outreach and Education 44 Monday Live Chat Online question and answer sessions with members of the Education staff via written/verbal communication New! Now weekly thirty minute sessions Mondays 12PM Pacific 2PM Central 3PM Eastern Located on the Noridian Medicare Website Education and Outreach > Schedule of Events May 2018 Noridian DME Outreach and Education 45 15

16 Find us on Facebook! Look for updates through articles and links previously published on our website Upcoming educational events Self-paced tutorials Give us a Like and Follow us to stay connected Noridian DME Jurisdiction A Noridian DME Jurisdiction D May 2018 Noridian DME Outreach and Education Level Webinars What to Expect minutes in length Brief policy/coverage overview May include CERT Error Data Suppliers are encouraged to be well-versed in the policy requirements prior to attending 200-level webinars Real Life Scenarios Created by the POE team with the assistance of MR Some may be based on supplier-submitted examples These can be faxed at any time to Verbal questions taken following each scenario Brief documentation overview May 2018 Noridian DME Outreach and Education 47 Pre-Claim Hotline Questions Regarding Advance Determination of Medicare Coverage (ADMC) Power Mobility Device Prior Authorization Demonstration Condition of Payment Prior Authorization Required Information Supplier name Phone number Hours of availability and time zone Beneficiary name Beneficiary Medicare number or Medicare Beneficiary Identifier (MBI) Brief description of question or issue May 2018 Noridian DME Outreach and Education 48 16

17 Tuesday and Friday Latest updates and announcements Customizable Sign-up in the lower right corner of our website Click subscribe Updates May 2018 Noridian DME Outreach and Education 49 Questions? Thank you for attending! 17

The American Legion NATIONAL MEMBERSHIP RECORD

The American Legion NATIONAL MEMBERSHIP RECORD www.legion.org 2016 The American Legion NATIONAL MEMBERSHIP RECORD 1920-1929 Department 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 Alabama 4,474 3,246