152015

1

Kathy Boehm Provider Outreach and Education

January 8 2015

J11 Medicare Part B Palmetto GBA

Medicare Updates Changes and Reminders

152015 1

Where Compliance and Education Meet for Error Free Claims

Where Compliance and Education Meet for Error Free Claims

Disclaimer

152015 2

The information provided in this presentation was current as of 152015

Any changes or new information superseding the information in this presentation is provided in articles with publication dates

after 152015 posted on our website at

wwwPalmettoGBAcomJ11B

CPT only copyright 2012 American Medical Association

All rights reserved The Code on Dental Procedures and Nomenclature is published in Current Dental

Terminology (CDT) Copyright copy 2012 American Dental Association (ADA) All rights reserved

Where Compliance and Education Meet for Error Free Claims

Agenda

152015 3

bull Medicare Updates and Changes

bull CERT

bull Medical Review Spotlight

bull Hot Topics and Reminders

bull News to Use and Resources

152015

2

Where Compliance and Education Meet for Error Free Claims

152015 4

Updates and Changes

Where Compliance and Education Meet for Error Free Claims

How to Access MLN Matters Details

152015 5

bull Full details for CMS MLN Matters Articles located on the CMS Website

bull httpwwwcmsgovOutreach-and-EducationMedicare-

Learning-Network-MLNMLNMattersArticles2014-MLN-Matters-Articleshtml

Where Compliance and Education Meet for Error Free Claims

2015 Part B Medicare Deductible

2015 PART A - HOSPITAL INSURANCE (HI)

bull Deductible $126000

bull Coinsurance ndash $31500 a day for 61st-90th day

ndash $63000 a day for 91st-150th day (lifetime reserve days)

ndash $15750 a day for 21st-100th day (Skilled Nursing Facility coinsurance)

2015 Part B

bull Standard Premium $10490 a month

bull Deductible $14700 a year

152015 6

MM8982

152015

3

Where Compliance and Education Meet for Error Free Claims

Provider Enrollment Form

bull CMS 855R (Reassignment of Benefits) form revised ndash Mandated use - May 31 2015

ndash Current or revised form accepted from the date the revised form is published through May 31 2015

ndash CMS will post revised form when available

bull Incorporation of Certain Provider Enrollment Policies in CMS-4159-F into Pub 100-08 Program Integrity Manual (PIM) Chapter 15 bull Effective March 18 2015

152015 7

MMSE1432

MM8901

Where Compliance and Education Meet for Error Free Claims

Laboratory Services for ESRD Claims

Effective April 1 2015

bull Elimination of the 5050 Payment Rule for Laboratory Services on End Stage Renal Disease (ESRD) Claims

bull ESRD PPS requires all renal dialysis laboratory services be paid in the ESRD facility bundled payment and therefore may only be billed by the ESRD facility

152015 8

MM8957

Where Compliance and Education Meet for Error Free Claims

Health Professional Shortage Area (HPSA)

bull CMS 2015 HPSA Zip Code Files

ndash Applicable on claims with dates of service on or after January 1 2015 through December 31 2015

bull Separate Primary Care and Mental Health Zip Code Files

ndash httpwwwcmsgovMedicareMedicare-Fee-for-Service-PaymentHPSAPSAPhysicianBonusesindexhtmlredirect=HPSAPSAPhysicianBonuses01_overviewasp

152015 9

MM8942

152015

4

Where Compliance and Education Meet for Error Free Claims

2015 Medicare Physician Fee Schedule Final Rule

bull lsquoFinal Rulersquo with comments in the Federal Register published on November 13 2014

ndash Updates payment policies and payment rates for services furnished under the Medicare PFS on or after January 1 2015

bull httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstrumentsPQRSDownloads2015_Medicare_Physician_Fee_Schedule_Final_Rulepdf

152015 10

Where Compliance and Education Meet for Error Free Claims

2015 Medicare Physician Fee Schedule Final Rule (continued)

bull Pathway for SGR Reform Act of 2013 established 05 percent update to the PFS conversion factor (CF) through March 31 2014

bull Protecting Access to Medicare Act of 2014 (PAMA) extended 05 percent update through December 31 2014

bull PAMA also provides for a 00 percent update to the PFS for services furnished on or after January 1 2015 and on or before March 31 2015

152015 11

Where Compliance and Education Meet for Error Free Claims

2015 Medicare Physician Fee Schedule Final Rule (continued)

bull Special Note

ndash Even though the conversion factor remains the same through March 31 2015 other components of the formula and RVUs used to create the 2015 physician fee schedule and anesthesia reimbursement may have been modified for some or all codes based on legislation

ndash Background and details in the Final Rule

152015 12

152015

5

Where Compliance and Education Meet for Error Free Claims

2015 Medicare Physician Fee Schedule Final Rule (continued)

bull PAMA further extended same provisions through March 31 2015

ndash 10 floor on the work geographic practice cost index

ndash Exceptions process for outpatient therapy caps

ndash Manual medical review process for therapy services

ndash Application of the therapy caps and related provisions to services furnished in HOPDs

152015 13

Where Compliance and Education Meet for Error Free Claims

2015 Medicare Physician Fee Schedule Final Rule (continued)

bull Current law requires physician fee schedule rates to be reduced by an average of 212 percent from the CY 2014 rates

bull In most prior years Congress has taken action to avert a large reduction in PFS rates before they went into effect

bull Watch and wait approach for April 1 2015 and after for fee schedule announcements

152015 14

Where Compliance and Education Meet for Error Free Claims

Therapy Cap Values for Calendar Year (CY) 2015

bull Physical therapy and speech-language therapy combined - $1940

bull Occupational therapy - $1940

152015 15

MM8985

152015

6

Where Compliance and Education Meet for Error Free Claims

Pneumococcal Vaccine

bull Effective for dates of service on or after September 19 2014 (implementation on 222015) Medicare will cover ndash Initial pneumococcal vaccine to all Medicare

beneficiaries who have never received the vaccine under Medicare Part B and

ndash A different second pneumococcal vaccine one year after the first vaccine was administered (that is 11 full months have passed following the month in which the last pneumococcal vaccine was administered)

152015 16

MM9051

Where Compliance and Education Meet for Error Free Claims

Influenza Vaccine and Average Sale Price Files

bull Seasonal influenza virus vaccine payment allowances for 2014 ndash 2015 flu season

ndash httpwwwpalmettogbacompalmettoprovidersnsfDocsCatJurisdiction-11-Part-B~9PGHK46850

_______________________________________________________________________________________

January 2015 Quarterly ASP drug pricing files released

152015 17

MM8890

MM8912

Where Compliance and Education Meet for Error Free Claims

Anti-Markup and Reference Laboratory Claims

bull Effective dates

ndash January 1 2015 - Analysis Design and Programming

ndash April 1 2015 - Testing and Implementation

bull April 6 2015 ndash Edits turned on

ndash Anti-markup and reference laboratory claims must report bull Name address and ZIP code in block 32 or

electronic equivalent and

bull NPI of the provider who actually performed the service in block 32a or electronic equivalent

152015 18

MM8806

152015

6

Where Compliance and Education Meet for Error Free Claims

Pneumococcal Vaccine

bull Effective for dates of service on or after September 19 2014 (implementation on 222015) Medicare will cover ndash Initial pneumococcal vaccine to all Medicare

beneficiaries who have never received the vaccine under Medicare Part B and

ndash A different second pneumococcal vaccine one year after the first vaccine was administered (that is 11 full months have passed following the month in which the last pneumococcal vaccine was administered)

152015 16

MM9051

Where Compliance and Education Meet for Error Free Claims

Influenza Vaccine and Average Sale Price Files

bull Seasonal influenza virus vaccine payment allowances for 2014 ndash 2015 flu season

ndash httpwwwpalmettogbacompalmettoprovidersnsfDocsCatJurisdiction-11-Part-B~9PGHK46850

_______________________________________________________________________________________

January 2015 Quarterly ASP drug pricing files released

152015 17

MM8890

MM8912

Where Compliance and Education Meet for Error Free Claims

Anti-Markup and Reference Laboratory Claims

bull Effective dates

ndash January 1 2015 - Analysis Design and Programming

ndash April 1 2015 - Testing and Implementation

bull April 6 2015 ndash Edits turned on

ndash Anti-markup and reference laboratory claims must report bull Name address and ZIP code in block 32 or

electronic equivalent and

bull NPI of the provider who actually performed the service in block 32a or electronic equivalent

152015 18

MM8806

152015

7

Where Compliance and Education Meet for Error Free Claims

Screening and Preventive Services - Update

Effective January 1 2015

bull Intensive Behavioral Therapy for Obesity - HCPCS codes G0473 (Face-to-face behavioral counseling for obesity group (2-10) 30 minutes) ndash See NCD for coverage details

bull Digital Breast Tomosynthesis - newly created CPT code 77063 for screening digital breast tomosynthesis mammography ndash Same policies as other screening mammography codes

ndash Add-on code only paid when furnished in conjunction with a 2D digital mammography

152015 19

MM8874

Where Compliance and Education Meet for Error Free Claims

Screening and Preventive Services - Update (continued)

bull Anesthesia Furnished in Conjunction with Colonoscopy - effective with dates of service 112015

ndash Definition of ldquocolorectal cancer screening testsrdquo now includes anesthesia separately furnished in conjunction with screening colonoscopies

ndash Coinsurance and deductible not applicable

ndash Anesthesia professionals who furnish a separately payable anesthesia service in conjunction with a screening colonoscopy must include modifier 33 on the anesthesia service

152015 20

MM8874

Where Compliance and Education Meet for Error Free Claims

Definition of ldquoSpouserdquo Same-Sex Marriages

bull Effective January 1 2015

bull Definition of ldquospouserdquo to include opposite-sex and same-sex marriages

bull CMS is no longer prohibited from applying the Medicare Secondary Payer (MSP) Working Aged provision to individuals in a same-sex marriage

bull Action ndash review MLN for full details and application

152015 21

MM8875

152015

8

Where Compliance and Education Meet for Error Free Claims

NCCI and SNF Consolidated Billing Updates

bull National Correct Coding Initiative (NCCI) ndash Version 210 Effective January 1 2015

ndash Version 211 Effective April 1 2015 (file available mid-February)

____________________________________________________________________________________________________________

bull Skilled Nursing Facility (SNF) Consolidated Billing ndash 2015 Annual Update to Skilled Nursing

Facility (SNF) Consolidated Billing (CB) Enforcement

152015 22

MM8781

MM8908

MM8943

Where Compliance and Education Meet for Error Free Claims

DMEPOS Competitive Bidding Program

bull Quarterly Update for the Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) - April 2015

bull Calendar Year (CY) 2015 Update for Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) Fee Schedule

152015 23

MM8918

MM8999

Where Compliance and Education Meet for Error Free Claims

DMEPOS Jurisdictional List

bull 2015 Jurisdictional List of Correct Contractor to bill for covered supplies

ndash httpwwwcmsgovCenterProvider-TypeDurable-Medical-Equipment-DME-Centerhtml

ndash Under lsquoCodingrsquo select 2015 DMEPOS Jurisdiction List

152015 24

MM9018

152015

8

Where Compliance and Education Meet for Error Free Claims

NCCI and SNF Consolidated Billing Updates

bull National Correct Coding Initiative (NCCI) ndash Version 210 Effective January 1 2015

ndash Version 211 Effective April 1 2015 (file available mid-February)

____________________________________________________________________________________________________________

bull Skilled Nursing Facility (SNF) Consolidated Billing ndash 2015 Annual Update to Skilled Nursing

Facility (SNF) Consolidated Billing (CB) Enforcement

152015 22

MM8781

MM8908

MM8943

Where Compliance and Education Meet for Error Free Claims

DMEPOS Competitive Bidding Program

bull Quarterly Update for the Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) - April 2015

bull Calendar Year (CY) 2015 Update for Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) Fee Schedule

152015 23

MM8918

MM8999

Where Compliance and Education Meet for Error Free Claims

DMEPOS Jurisdictional List

bull 2015 Jurisdictional List of Correct Contractor to bill for covered supplies

ndash httpwwwcmsgovCenterProvider-TypeDurable-Medical-Equipment-DME-Centerhtml

ndash Under lsquoCodingrsquo select 2015 DMEPOS Jurisdiction List

152015 24

MM9018

152015

9

Where Compliance and Education Meet for Error Free Claims

Documentation Requests

bull Effective April 1 2015

bull Documentation for pre-payment reviews must be submitted within 45 calendar days of request

bull Claims denied on day 46

152015 25

MM8583

Where Compliance and Education Meet for Error Free Claims

Administrative Law Judge (ALJ) and Federal District Court Appeals

bull Calendar Year 2015 Amount in Controversy

ndash ALJ requests

bull Filed prior to January 1 2015 - $140

bull Filed January 1 2015 and after - $150

ndash Federal District Court requests

bull Filed prior to January 1 2015 - $1430

bull Filed January 1 2015 and after - $1460

152015 26

Where Compliance and Education Meet for Error Free Claims

152015 27

Comprehensive Error Rate Testing

(CERT) A Partnership

152015

10

Where Compliance and Education Meet for Error Free Claims

2014 Medicare FFS Program

Improper Payment Rate

152015 28

127 - representing $458 billion in improper payments

compared to the FY 2013 improper payment rate of 101

percent or $360 billion in improper payments

The reporting period for this improper payment rate is

July 1 2012 -June 30 2013

Service Type Improper Payment

Rate Improper Payment

Amount2

PhysicianLabAmbulance 121 $110Billion

Where Compliance and Education Meet for Error Free Claims

CERT Tips

152015 29

bull Review denials

bull Submit missing documentation directly to CERT if denial is not a medical necessity denial

bull Appeal medical necessity denials ‒ CERT Redetermination Request Form

bull Designate a CERT ldquoPoint of Contactrdquo (POC)

ndash httpswwwcertprovidercom

Where Compliance and Education Meet for Error Free Claims

CERT Help and Task Force

152015 30

152015

10

Where Compliance and Education Meet for Error Free Claims

2014 Medicare FFS Program

Improper Payment Rate

152015 28

127 - representing $458 billion in improper payments

compared to the FY 2013 improper payment rate of 101

percent or $360 billion in improper payments

The reporting period for this improper payment rate is

July 1 2012 -June 30 2013

Service Type Improper Payment

Rate Improper Payment

Amount2

PhysicianLabAmbulance 121 $110Billion

Where Compliance and Education Meet for Error Free Claims

CERT Tips

152015 29

bull Review denials

bull Submit missing documentation directly to CERT if denial is not a medical necessity denial

bull Appeal medical necessity denials ‒ CERT Redetermination Request Form

bull Designate a CERT ldquoPoint of Contactrdquo (POC)

ndash httpswwwcertprovidercom

Where Compliance and Education Meet for Error Free Claims

CERT Help and Task Force

152015 30

152015

11

Where Compliance and Education Meet for Error Free Claims

152015 31

Medical Review Spotlight

Where Compliance and Education Meet for Error Free Claims

Active Medical Reviews

152015 32

httpwwwpalmettogbacompalmettoprovidersnsfDocsCatProviders~Jurisdiction201120Part20B~Medical20Review~General~9NNJBX6701openampnavmenu=Medical^Review||||

Where Compliance and Education Meet for Error Free Claims

Comparative Billing Report (CBR)

bull Developed by eGlobalTech (eGT) and Palmetto GBA

bull National CBR on use of modifier 25 by providers under family practice specialty code

bull CBR contains data-driven tables and graphs with an explanation of findings that compare providers billing patterns to those of their peers in the state and across the nation for claims filed with Modifier 25

bull httpwwwcbrinfonetcbr201409html

152015 33

152015

12

Where Compliance and Education Meet for Error Free Claims

152015 34

Hot Topics and Reminders

Where Compliance and Education Meet for Error Free Claims

Enrollment Application Status

bull Interactive Voice Response (IVR) Unit

ndashUse DCN number or PTAN associated with that provider enrollment application

bull Status information updated approximately 24 hours after each transaction

152015 35

Where Compliance and Education Meet for Error Free Claims

Specific Modifiers for Distinct Procedural Services

bull Effective January 1 2015

ndash Implementation - January 5 2015

bull Four new HCPCS modifiers to define subsets of the -59 modifier ndash Modifier 59 will continue to be recognized

however CPT instructions state that modifier 59 should not be used when a more descriptive modifier is available

152015 36

MM8863

152015

13

Where Compliance and Education Meet for Error Free Claims

New Modifiers

bull A Service That Is Distinct Because It Occurred During A Separate Encounter

XE ndash Separate Encounter

bull A Service That Is Distinct Because It Was Performed On A Separate OrganStructure

XS ndash Separate Structure

bull A Service That Is Distinct Because It Was Performed By A Different Practitioner

XP ndash Separate Practitioner

bull The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service

XU - Unusual Non-Overlapping Service

Where Compliance and Education Meet for Error Free Claims

Home Health Certifications

bull Require documentation of a face-to-face encounter by eligible certifying provider within 90 days prior to start of care or within 30 days after start of care

bull Documentation of the encounter must include ldquohellipan explanation of why the clinical findings of such encounter support that the patient is homebound and in need of either intermittent skilled nursing services or therapy serviceshelliprdquo

152015 38

SE1436

Where Compliance and Education Meet for Error Free Claims

PQRS Payment Adjustments

bull Eligible professionals who do not satisfactorily report data on quality measures for covered professional services will be subject to a payment adjustment under PQRS beginning in 2015

ndash 2015 - 15

ndash 2016 and subsequent years - 20

httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstrumentsPQRSPayment-Adjustment-Informationhtml

152015 39

152015

13

Where Compliance and Education Meet for Error Free Claims

New Modifiers

bull A Service That Is Distinct Because It Occurred During A Separate Encounter

XE ndash Separate Encounter

bull A Service That Is Distinct Because It Was Performed On A Separate OrganStructure

XS ndash Separate Structure

bull A Service That Is Distinct Because It Was Performed By A Different Practitioner

XP ndash Separate Practitioner

bull The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service

XU - Unusual Non-Overlapping Service

Where Compliance and Education Meet for Error Free Claims

Home Health Certifications

bull Require documentation of a face-to-face encounter by eligible certifying provider within 90 days prior to start of care or within 30 days after start of care

bull Documentation of the encounter must include ldquohellipan explanation of why the clinical findings of such encounter support that the patient is homebound and in need of either intermittent skilled nursing services or therapy serviceshelliprdquo

152015 38

SE1436

Where Compliance and Education Meet for Error Free Claims

PQRS Payment Adjustments

bull Eligible professionals who do not satisfactorily report data on quality measures for covered professional services will be subject to a payment adjustment under PQRS beginning in 2015

ndash 2015 - 15

ndash 2016 and subsequent years - 20

httpwwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstrumentsPQRSPayment-Adjustment-Informationhtml

152015 39

152015

14

Where Compliance and Education Meet for Error Free Claims

Physician Quality Reporting Programs

bull Changes included in the 2015 Physician Fee Schedule (PFS) ldquoFinal Rulerdquo ndash Includes changes in reporting mechanisms individual

measures and measures groups for inclusion in 2015 criteria for satisfactory reporting under claims-based reporting qualified registry-based reporting and EHR-based reporting options

ndash Value-based Payment Modifier - CMS continues to phase in and expand the application of the Value-based Payment Modifier in 2017 based on performance in 2015

152015 40

Where Compliance and Education Meet for Error Free Claims

Physician Quality Reporting Programs (Continued)

ndash Changes to hardship exceptions for the Medicare EHR Incentive Program

ndash Medicare Shared Savings Program

ndash Physician Compare Website

bull CMS Fact Sheet - Changes for Calendar Year 2015 Physician

Quality Programs and Other Programs in the Medicare Physician Fee Schedule

bull httpcmsgovNewsroomMediaReleaseDatabaseFact-sheets2014-Fact-sheets-items2014-10-31-6htmlDLPage=1ampDLSort=0ampDLSortDir=descending

152015 41

Where Compliance and Education Meet for Error Free Claims

Health Professional Shortage Areas (HPSA) Incentive

bull Submitting HPSA modifiers on claims that do not qualify for the HPSA incentive payment may result in

ndash Erroneous incentive payments

ndash A referral to the Zone Program Integrity Contractor (ZPIC) for fraud and abuse investigation

bull Palmetto GBA will suppress HPSA payments for providers with four or more quarters of erroneous billing of the AQ HCPCS modifier

httpwwwpalmettogbacompalmettoprovidersnsfdocsCatProviders~Jurisdiction201120Part20B~Browse20by20Topic~Incentive20Programsopenampexpand=1ampnavmenu=Browse^by^Topic||

152015 42

152015

15

Where Compliance and Education Meet for Error Free Claims

Reminder - Electronic Health Records (EHR)

bull When applicable payment adjustments begin in 2015

152015 43

bull httpwwwcmsgovRegulations-and-GuidanceLegislationEHRIncentiveProgramsindexhtml

EHR Details Requirements

and Background

bull httpwwwcmsgovRegulations-and-GuidanceLegislationEHRIncentiveProgramsDownloadsPaymentAdj_HardshipExcepTipSheetforEPpdf

EHR Payment Adjustments Background

Where Compliance and Education Meet for Error Free Claims

Screening and Preventive Services

bull CMS Preventive Services Quick Reference Guide outlines all covered services httpwwwcmsgovMedicarePreventionPrevntionGenInfoDownloadsMPS_QuickReferenceChart_1pdf

152015 44

Where Compliance and Education Meet for Error Free Claims

ICD-10 ndash Resources

October 1 2015

152015 45

bull httpwwwcmsgovMedicareCodingICD10indexhtmlredirect=icd10

ICD-10 - CMS

bull httpwwwpalmettogbacompalmettoicdnsfDocsCatHomeICD-10

ICD-10

Palmetto GBA

152015

16

Where Compliance and Education Meet for Error Free Claims

InvalidUntimelyDismissed Appeals

152015 46

Where Compliance and Education Meet for Error Free Claims

Top Provider Contact Center Inquiries - October

152015 47

Eligibility

812

Denials - Contractual Obligation

1681

Duplicates

981

Coding ErrorsModifiers

1189

MSP

915

Where Compliance and Education Meet for Error Free Claims

152015 48

News to Use and Resources

152015

17

Where Compliance and Education Meet for Error Free Claims

Appeals

bull Before appealing verify you have appeal rights

bull Send all documentation necessary to support your appeal

bull Use the right form

bull Send it to the right address or fax number

152015 49

Where Compliance and Education Meet for Error Free Claims

Self Service Tools

152015 50

wwwPalmettoGBAcomJ11B

Where Compliance and Education Meet for Error Free Claims

OPS ndash New Features

bull Submission of documentation to satisfy an Additional Documentation Response (ADR)

ndash Unlimited PDF attachments (each up to 40 MB for a maximum total of 150MB)

bull Select lsquoMedical Reviewrsquo then lsquoMR ADR Responsersquo form

152015 51

152015

18

Where Compliance and Education Meet for Error Free Claims

Palmetto GBA Advanced Clinical Editing (P-ACE)

bull Available at no cost to all direct submitters and those transmitting claims through a clearinghousebilling service

bull lsquoSmart editsrsquo will appear on claim rejection reports (277CA)

bull Claims failing the pre-adjudication editing afford providers an opportunity to review the claim for correctness and resubmission or if appropriate modifications can be made to the claim and then resubmitted

bull There is no software to download

152015 52

Where Compliance and Education Meet for Error Free Claims

Physician Fee Schedule

Tool

53

Where Compliance and Education Meet for Error Free Claims

CMS National and Open Door Calls and E-News

bull National Provider Calls and Events ndash httpwwwcmsgovOutreach-and-

EducationOutreachNPCNational-Provider-Calls-and-Eventshtml

bull Open Door Forums ndash httpwwwcmsgovOutreach-and-

EducationOutreachOpenDoorForumsindexhtml

bull CMS E-News

‒ httpwwwcmsgovOutreach-and-EducationOutreachFFSProvPartProgProvider-Partnership-Email-Archivehtml

54

152015

17

Where Compliance and Education Meet for Error Free Claims

Appeals

bull Before appealing verify you have appeal rights

bull Send all documentation necessary to support your appeal

bull Use the right form

bull Send it to the right address or fax number

152015 49

Where Compliance and Education Meet for Error Free Claims

Self Service Tools

152015 50

wwwPalmettoGBAcomJ11B

Where Compliance and Education Meet for Error Free Claims

OPS ndash New Features

bull Submission of documentation to satisfy an Additional Documentation Response (ADR)

ndash Unlimited PDF attachments (each up to 40 MB for a maximum total of 150MB)

bull Select lsquoMedical Reviewrsquo then lsquoMR ADR Responsersquo form

152015 51

152015

18

Where Compliance and Education Meet for Error Free Claims

Palmetto GBA Advanced Clinical Editing (P-ACE)

bull Available at no cost to all direct submitters and those transmitting claims through a clearinghousebilling service

bull lsquoSmart editsrsquo will appear on claim rejection reports (277CA)

bull Claims failing the pre-adjudication editing afford providers an opportunity to review the claim for correctness and resubmission or if appropriate modifications can be made to the claim and then resubmitted

bull There is no software to download

152015 52

Where Compliance and Education Meet for Error Free Claims

Physician Fee Schedule

Tool

53

Where Compliance and Education Meet for Error Free Claims

CMS National and Open Door Calls and E-News

bull National Provider Calls and Events ndash httpwwwcmsgovOutreach-and-

EducationOutreachNPCNational-Provider-Calls-and-Eventshtml

bull Open Door Forums ndash httpwwwcmsgovOutreach-and-

EducationOutreachOpenDoorForumsindexhtml

bull CMS E-News

‒ httpwwwcmsgovOutreach-and-EducationOutreachFFSProvPartProgProvider-Partnership-Email-Archivehtml

54

152015

18

Where Compliance and Education Meet for Error Free Claims

Palmetto GBA Advanced Clinical Editing (P-ACE)

bull Available at no cost to all direct submitters and those transmitting claims through a clearinghousebilling service

bull lsquoSmart editsrsquo will appear on claim rejection reports (277CA)

bull Claims failing the pre-adjudication editing afford providers an opportunity to review the claim for correctness and resubmission or if appropriate modifications can be made to the claim and then resubmitted

bull There is no software to download

152015 52

Where Compliance and Education Meet for Error Free Claims

Physician Fee Schedule

Tool

53

Where Compliance and Education Meet for Error Free Claims

CMS National and Open Door Calls and E-News

bull National Provider Calls and Events ndash httpwwwcmsgovOutreach-and-

EducationOutreachNPCNational-Provider-Calls-and-Eventshtml

bull Open Door Forums ndash httpwwwcmsgovOutreach-and-

EducationOutreachOpenDoorForumsindexhtml

bull CMS E-News

‒ httpwwwcmsgovOutreach-and-EducationOutreachFFSProvPartProgProvider-Partnership-Email-Archivehtml

54

152015

19

Where Compliance and Education Meet for Error Free Claims

Educational Opportunities

152015 55

Where Compliance and Education Meet for Error Free Claims

Contacts

152015 56

855-696-0705 Provider Contact Center

Resources

Palmetto GBA J11 Part B Home Page wwwpalmettogbacomj11b

Palmetto GBA E-Mail Updates wwwpalmettogbacomj11b Select E-MAIL UPDATES

Provider Enrollment Resources wwwpalmettogbacomj11b Click on lsquoBrowse By Topicrsquo then

lsquoProvider Enrollmentrsquo

Contact Us By Email J11PartBPalmettoGBAcom

Self Service Tools wwwpalmettogbacomJ11B (center of home page)

Going Beyond the Diagnosis Blog and Twitter

httppalmgbacomgbd BeyondDx

Where Compliance and Education Meet for Error Free Claims

Social Networking

152015 57

152015

20

Where Compliance and Education Meet for Error Free Claims

Thank you for attending

152015 58

Post- Test Evaluation