Agenda. Agenda 03/22/ th Annual Spring Payer Panel March 29, Program News and Announcements. Clinical News and Reviews
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1 6 th Annual Spring Payer Panel March 29, 2018 wpsgha.litmos.com Agenda Program News and Announcements New Medicare Cards WPS GHA Portal Enhancements Medicare Day of Learning CMS Electronic Cost Report Submission Portal Outpatient Therapy News 2 Agenda Clinical News and Reviews Targeted Probe and Educate (TPE) CMS Review Reason Codes MAC Satisfaction Indicator (MSI) Resources 3 1
2 Program News and Announcements 4 Replacing Health Insurance Claim (HIC) Numbers New Medicare Cards 5 6 2
3 7 Medicare Beneficiary Identifier Where: C Numeric 1 thru 9 A Alphabetic Character (A...Z); Excluding (S, L, O, I, B, Z) N Numeric 0 thru 9 AN Either A or N ***NOTE: Alphabetic characters are Upper Case ONLY Position 1 numeric values 1 thru 9 Position 2 alphabetic values Athru Z (minus S, L, O, I, B, Z) Position 3 alpha-numeric values 0 thru 9 and A thru Z (minus S, L, O, I, B, Z) Position 4 numeric values 0 thru 9 Position 5 alphabetic values Athru Z (minus S, L, O, I, B, Z) Position 6 alpha-numeric values 0 thru 9 and A thru Z (minus S, L, O, I, B, Z) Position 7 numeric values 0 thru 9 Position 8 alphabetic values A thru Z (minus S, L, O, I, B, Z) Position 9 alphabetic values A thru Z (minus S, L, O, I, B, Z) Position 10 numeric values 0 thru 9 Position 11 numeric values 0 thru 9 8 Transition Timeline 9 3
4 10 Look-Up Tool Date of birth First and last name Social Security Number 11 New Card Mailing Schedule Wave States Included Cards Mailing Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia Alaska, American Samoa, California, Guam, Hawaii, Northern Mariana Islands, Oregon Arkansas, Illinois, Indiana, Iowa, Kansas, Minnesota, Nebraska, North Dakota, Oklahoma, South Dakota, Wisconsin Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, Vermont Alabama, Florida, Georgia, North Carolina, South Carolina Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Texas, Utah, Washington, Wyoming Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Puerto Rico, Tennessee, Virgin Islands April June 2018 April June 2018 After June 2018 After June 2018 After June 2018 After June 2018 After June
5 Help Spread the Word 13 More Info Improving Provider Self-Service Tools Portal Enhancements 14 Claim Detail Access line-specific detail Information on related claims Recommended actions Link to associated policy Verify enrollment View other insurance Details regarding duplicate and overlapping claims 15 5
6 Code Lookup Claim Adjustment Reason Code (CARC) Remittance Advice Reason Code (RARC) Part A Reason Code Search by CPT/HCPCS coming soon! Find any associated policy/coverage article Similar to former crosswalk 16 Multi-Factor Authentication Secure access required by CMS Must enter a unique, temporary code Sent by , phone or app Code valid for 8 hours 17 Bringing the Payer and Providers Together Medicare Day of Learning 18 6
7 The Particulars Who: All providers in Jurisdiction 5 What: Multiple breakout sessions Topics related to Part A and Part B Billing and clinical Guest speakers Question & Answer forum 19 The Particulars When: August 7, 2018 Where: Ankeny, IA Why: Understand billing and coverage criteria Receive proper reimbursement 20 Additional Dates April 24, 2018 St. Charles, MO July 17, 2018 Grand Island, NE July 19, 2018 Olathe, KS 21 7
8 More Efficient Acceptance and Tentative Settlement CMS Electronic Cost Report Submission Portal 22 MCReF Coming Soon Medicare Cost Report Electronic Filing Same website currently used for PS&R data Use not mandatory but encouraged Easier to submit documentation More efficient acceptance and tentative settlement No need for separate hardcopy settlement page 23 Changes and Updates Outpatient Therapy News 24 8
9 Outpatient Therapy Updates Bipartisan Budget Act of 2018 Section Repeals financial limitation (therapy caps) Retains cap amounts (OT & PT/SLP) Eliminates waiting for notification Exception process and review threshold 25 Exceptions and Review Updates KX Modifier still required Attests to need for continued therapy Services above $2,010 (updated annually) Medical review threshold Therapy in excess of $3,000 Rate in effect until 2028 Targeted rather than mandatory 26 Clinical News and Reviews 27 9
10 Aiming to Improve the Claim Review Process Targeted Probe and Educate 28 Focus of TPE Specific provider/supplier that bill a particular item or service Highest claim denial rates Billing practices that vary significantly from their peers 29 Identification 30 10
11 Notification 31 The Review Dedicated Nurse Analyst claims per provider/service Per item or service Per round Up to 3 rounds 32 Getting Results Individual Claim Review (ICR) issued Uploaded to WPS GHA Portal 33 11
12 Education Ongoing to prevent errors 1:1 session offered 34 Next Step Remove (next) Round Refer
13 Current Part A Topics Hyperbaric Oxygen Therapy G0277 and Skilled Nursing Facility (SNF) RUG Utilization Diagnostic Related Group (DRG) Validation Inpatient Rehabilitation Facility or Unit (IRF/IRU) Non-Emergent Ambulance Transports Dialysis Services (Modifier J ) Facilities Billing Emergency Room Services Current Part B Topics Hyperbaric Oxygen Therapy G0277 and Non-Emergent Ambulance Transports Dialysis Services (Modifier J ) Emergency Department Visits Outpatient Evaluation and Management Services Inpatient Evaluation and Management Services
14 Submitting Documentation 40 Methods for Submission Upload to WPS GHA Portal Mail paper records Fax documentation Send a password-protected CD Via Electronic Submission of Medical Records (esmd) 41 Promoting Continuity and Understanding CMS Review Reason Codes 42 14
15 Standardized Review Codes Review contractors develop denial codes and messages MAC, RAC, SMRC may all be different CMS implemented codes and statements Contain common language from existing Alleviate confusion 43 Generic Codes and Statements Part A Part B Durable Medical Equipment Power Mobility Devices Non-Emergent Ambulance Transport Non Emergent Hyperbaric Oxygen Home Health Services Inpatient Rehabilitation Facilities (IRF) 44 Evaluate WPS GHA MAC Satisfaction Indicator (MSI) 45 15
16 Evaluate your MAC Take the MSI survey Opportunity to share your experience with CMS Honest feedback is encouraged Promotes awareness of areas to implement improvements Link on our Portal 46 Get More Information Resources 47 Resources New Medicare Card CMS webpage - Medicare-Card Fact sheet - and-education/medicare-learning-network- MLN/MLNProducts/Downloads/Transitionto NewMedicareNumbersandCards pdf Outreach materials
17 Resources WPS GHA Portal User Manual /mac/9916b d42-955b- 27e44f269c72/transactional-portal-usermanual.pdf WPS GHA Learning Center 49 Resources Targeted Probe and Educate Data-and-Systems/Research-Statistics-Dataand-Systems.html Change Request Guidance/Guidance/Transmittals/2017Downl oads/r1919otn.pdf 50 Resources CMS Review Reason Codes and Statements Data-and-Systems/Computer-Data-and- Systems/ESMD/Review-Reason-Codes-and- Statements.html MAC Satisfaction Indicator (MSI) te/training/news-and-updates/msi-evaluateour-services/ 51 17
18 52 Disclaimer This program was designed for informational purposes only. The current Medicare regulations will always prevail. The provider alone is responsible for correct submission of claims. The official Medicare Program provisions change frequently and are contained in the relevant laws, regulations and rulings and can be found on the Centers for Medicare & Medicaid Services (CMS) website at Recording is not allowed; this includes audio, video, or photographic capture of educational material by any electronic or digital means, either original or copied/shared
3+ 3+ N = 155, 442 3+ R 2 =.32 < < < 3+ N = 149, 685 3+ R 2 =.27 < < < 3+ N = 99, 752 3+ R 2 =.4 < < < 3+ N = 98, 887 3+ R 2 =.6 < < < 3+ N = 52, 624 3+ R 2 =.28 < < < 3+ N = 36, 281 3+ R 2 =.5 < < < 7+
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TABLE 3c: Congressional Districts with Number and Percent of Hispanics* Living in Hard-to-Count (HTC) Census Tracts**
living Alaska 00 47,808 21,213 44.4 Alabama 01 20,661 3,288 15.9 Alabama 02 23,949 6,614 27.6 Alabama 03 20,225 3,247 16.1 Alabama 04 41,412 7,933 19.2 Alabama 05 34,388 11,863 34.5 Alabama 06 34,849 4,074
TABLE 3b: Congressional Districts Ranked by Percent of Hispanics* Living in Hard-to- Count (HTC) Census Tracts**
Rank State District Count (HTC) 1 New York 05 150,499 141,567 94.1 2 New York 08 133,453 109,629 82.1 3 Massachusetts 07 158,518 120,827 76.2 4 Michigan 13 47,921 36,145 75.4 5 Illinois 04 508,677 379,527
Unemployment Rate (%) Rank State. Unemployment
States Ranked by February 2018 Unemployment Rate Seasonally Adjusted Unemployment Unemployment Unemployment 1 Hawaii 2.1 19 Alabama 3.7 33 Ohio 4.5 2 New Hampshire 2.6 19 Missouri 3.7 33 Rhode Island 4.5
Unemployment Rate (%) Rank State. Unemployment
States Ranked by November 2015 Unemployment Rate Seasonally Adjusted Unemployment Unemployment Unemployment 1 North Dakota 2.7 19 Indiana 4.4 37 Georgia 5.6 2 Nebraska 2.9 20 Ohio 4.5 37 Tennessee 5.6
Unemployment Rate (%) Rank State. Unemployment
States Ranked by April 2017 Unemployment Rate Seasonally Adjusted Unemployment Unemployment Unemployment 1 Colorado 2.3 17 Virginia 3.8 37 California 4.8 2 Hawaii 2.7 20 Massachusetts 3.9 37 West Virginia
Unemployment Rate (%) Rank State. Unemployment
States Ranked by August 2017 Unemployment Rate Seasonally Adjusted Unemployment Unemployment Unemployment 1 North Dakota 2.3 18 Maryland 3.9 36 New York 4.8 2 Colorado 2.4 18 Michigan 3.9 38 Delaware 4.9
Unemployment Rate (%) Rank State. Unemployment
States Ranked by March 2016 Unemployment Rate Seasonally Adjusted Unemployment Unemployment Unemployment 1 South Dakota 2.5 19 Delaware 4.4 37 Georgia 5.5 2 New Hampshire 2.6 19 Massachusetts 4.4 37 North
Unemployment Rate (%) Rank State. Unemployment
States Ranked by September 2017 Unemployment Rate Seasonally Adjusted Unemployment Unemployment Unemployment 1 North Dakota 2.4 17 Indiana 3.8 36 New Jersey 4.7 2 Colorado 2.5 17 Kansas 3.8 38 Pennsylvania
Unemployment Rate (%) Rank State. Unemployment
States Ranked by December 2017 Unemployment Rate Seasonally Adjusted Unemployment Unemployment Unemployment 1 Hawaii 2.0 16 South Dakota 3.5 37 Connecticut 4.6 2 New Hampshire 2.6 20 Arkansas 3.7 37 Delaware
Unemployment Rate (%) Rank State. Unemployment
States Ranked by September 2015 Unemployment Rate Seasonally Adjusted Unemployment Unemployment Unemployment 1 North Dakota 2.8 17 Oklahoma 4.4 37 South Carolina 5.7 2 Nebraska 2.9 20 Indiana 4.5 37 Tennessee
Unemployment Rate (%) Rank State. Unemployment
States Ranked by November 2014 Unemployment Rate Seasonally Adjusted Unemployment Unemployment Unemployment 1 North Dakota 2.7 19 Pennsylvania 5.1 35 New Mexico 6.4 2 Nebraska 3.1 20 Wisconsin 5.2 38 Connecticut
Unemployment Rate (%) Rank State. Unemployment
States Ranked by July 2018 Unemployment Rate Seasonally Adjusted Unemployment Unemployment Unemployment 1 Hawaii 2.1 19 Massachusetts 3.6 37 Kentucky 4.3 2 Iowa 2.6 19 South Carolina 3.6 37 Maryland 4.3
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Cooperative Program Allocation Budget Receipts January 2014 Cooperative Program Allocation Budget Current Current $ Change % Change Month Month from from Contribution Sources 2013-2014 2012-2013 Prior
Cooperative Program Allocation Budget Receipts Southern Baptist Convention Executive Committee April 2015
Cooperative Program Allocation Budget Receipts April 2015 Cooperative Program Allocation Budget Current Current $ Change % Change Month Month from from Contribution Sources 2014-2015 2013-2014 Prior Year
Cooperative Program Allocation Budget Receipts Southern Baptist Convention Executive Committee March 2015
Cooperative Program Allocation Budget Receipts March 2015 Cooperative Program Allocation Budget Current Current $ Change % Change Month Month from from Contribution Sources 2014-2015 2013-2014 Prior Year
Cooperative Program Allocation Budget Receipts Southern Baptist Convention Executive Committee May 2016
Cooperative Program Allocation Budget Receipts May 2016 Cooperative Program Allocation Budget Current Current $ Change % Change Month Month from from Contribution Sources 2015-2016 2014-2015 Prior Year
Cooperative Program Allocation Budget Receipts Southern Baptist Convention Executive Committee December 2015
Cooperative Program Allocation Budget Receipts December 2015 Cooperative Program Allocation Budget Current Current $ Change % Change Month Month from from Contribution Sources 2015-2016 2014-2015 Prior
Table 1 Elementary and Secondary Education. (in millions)
Revised February 22, 2005 WHERE WOULD THE CUTS BE MADE UNDER THE PRESIDENT S BUDGET? Data Table 1 Elementary and Secondary Education Includes Education for the Disadvantaged, Impact Aid, School Improvement