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
Program News and Announcements 4 Replacing Health Insurance Claim (HIC) Numbers New Medicare Cards 5 6 2
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
10 Look-Up Tool Date of birth First and last name Social Security Number 11 New Card Mailing Schedule Wave States Included Cards Mailing 1 2 3 4 5 6 7 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 2018 12 4
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
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 email, phone or app Code valid for 8 hours 17 Bringing the Payer and Providers Together Medicare Day of Learning 18 6
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
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
Outpatient Therapy Updates Bipartisan Budget Act of 2018 Section 50202 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
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
Notification 31 The Review Dedicated Nurse Analyst 20-40 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
Education Ongoing to prevent errors 1:1 session offered 34 Next Step Remove (next) Round Refer 35 36 12
Current Part A Topics Hyperbaric Oxygen Therapy G0277 and 99183 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 99281-99285 37 Current Part B Topics Hyperbaric Oxygen Therapy G0277 and 99183 Non-Emergent Ambulance Transports Dialysis Services (Modifier J ) Emergency Department Visits 99281-99285 Outpatient Evaluation and Management Services 99211-99215 Inpatient Evaluation and Management Services 99221-99223 38 39 13
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
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
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 - https://www.cms.gov/medicare/new- Medicare-Card Fact sheet - https://www.cms.gov/outreach- and-education/medicare-learning-network- MLN/MLNProducts/Downloads/Transitionto NewMedicareNumbersandCards-909365.pdf Outreach materials - https://productordering.cms.hhs.gov 48 16
Resources WPS GHA Portal User Manual https://www.wpsgha.com/wps/wcm/connect /mac/9916b093-2279-4d42-955b- 27e44f269c72/transactional-portal-usermanual.pdf WPS GHA Learning Center https://wpsgha.litmos.com/online-courses 49 Resources Targeted Probe and Educate https://www.cms.gov/research-statistics- Data-and-Systems/Research-Statistics-Dataand-Systems.html Change Request 10249 - https://www.cms.gov/regulations-and- Guidance/Guidance/Transmittals/2017Downl oads/r1919otn.pdf 50 Resources CMS Review Reason Codes and Statements https://www.cms.gov/research-statistics- Data-and-Systems/Computer-Data-and- Systems/ESMD/Review-Reason-Codes-and- Statements.html MAC Satisfaction Indicator (MSI) https://www.wpsgha.com/wps/portal/mac/si te/training/news-and-updates/msi-evaluateour-services/ 51 17
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 www.cms.gov. 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. 53 18