Medicare Part A News-Jurisdiction H for April 29th, 2014

The following information is provided by Novitas Solutions.

Medicare News

JH Part A Top Inquiries (January 2014 - March 2014)
The Part A Top Inquiries Frequently Asked Questions (FAQs) have been updated. Please take time to review these FAQs for answers to your questions.

Local Contractor Pricing Information is Now Available!
A new information page specific to Local Contractor Pricing has been added to the Fee Schedule section of our web site. This new page includes an overview of the local pricing process, information on drug pricing, a section of frequently asked questions, pricing references, and pricing resources.


Events

"Part A Understanding the Local Coverage Determination and National Coverage Determination Process" 

May 1, 2014 (11:00am-12:00pm ET, 10:00am-11:00am CT)
During this webinar, we will provide a basic understanding of the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) process, demonstrate how to locate LCDs and NCDs, as well as explore the information that can be found in an LCD.
Register today for this informative event!

****There will be no Continuing Education Units (CEUs) provided for this webinar.****

"Update - New Novitas Website" 

 May 16, 2014 (1:00pm-2:30pm CT)
We will demonstrate the improved Novitas Solutions website and how to navigate, inform you of the new available search tools, and provide tips to enhance your search results.
Register today for this informative event!

"Fiscal Intermediary Standard System (FISS) Part 1" 

May 13, 2014 (2:00pm-3:30pm ET, 1:00pm-2:30pm CT)
We will review the Fiscal Intermediary Standard System (FISS), increase your understanding of the functions within FISS, and promote end user confidence.
Register today for this informative event!

****There are no Continuing Education Unit (CEU) credits for this webinar.****

JH Part A/B Indian Health Service (IHS)/Tribal/Urban Indian Providers: "Ask-the-Contractor Teleconference Handout"

May15, 2014 (1:00pm-2:00pm CT)
Join us for the Indian Health Service (IHS)/Tribal/Urban Indian Providers Ask-the-Contractor Teleconference. During this teleconference, we will discuss the most current Medicare changes and allow you to interact directly with representatives from various departments within Novitas Solutions.

Representatives from various departments including Medical Policy, Medical Review, Appeals, Customer Service, Claims Processing, Provider Enrollment, Change Management, and our Outreach and Education Staff will be available to address your questions and concerns.

You do not want to miss this call! Register Today!


New Medicare Insights Weekly Podcasts Now Available
In this week's Medicare Insights Weekly podcast, we discuss the Comprehensive Error Rate Testing A/B Medicare Administrative Contractors Outreach and Education Task Force.


New name and logo for the CERT A/B MAC Contractor Task Force
Medicare Administrative Contractors (MACs) recently announced the launch of the CERT A/B MAC Contractor Task Force. All Part A and Part B MACs have come together with the intent to educate providers on costly claim denials and billing errors to Medicare. In response to positive feedback received by the provider community, the task force has modified its name to the CERT A/B MAC Outreach & Education Task Force. Visit the Novitas Solutions CERT Center to learn more about the task force as well as available resources.

Medicare Part B News-Jurisdiction H for April 28th, 2014

The following information is provided by Novitas Solutions. 

Medicare News

I.H.S. Face-to-Face Workshop in Sacramento, CA
The date for our upcoming event in Sacramento, CA has been change to 6/5/14. The location of the event remains the same.

California Area Office
650 Capitol Mall, Suite 7-100
Huntington Conference Room 1st floor
Sacramento, CA 95814

Register today!


JH Part B Top Inquiries (January 2014 - March 2014)
The monthly Part B FAQs have been updated. Please take some time to review these FAQs for answers to your questions.

Other Part B Frequently Asked Questions (FAQs) (January-March 2014)
The Other Frequently Asked Questions (FAQs) have been updated. Please visit our FAQs for the answers to your questions.



Part B Webinar Handout: "Evaluation and Management Score Sheet: Part Four- Scoring Medical Records Using the Score Sheet"

April 30, 2014 (11:00am-12:00pm ET, 10:00am -11:00am CT)
Join us for Part Four of the Evaluation and Management Score Sheet series.
In this session we will explore medical record documentation using the score sheet, we will tour the Evaluation and Management Center on the Novitas Solutions website and discuss the Comprehensive Error Rate Testing (CERT) center to assist you with understanding how to avoid common documentation errors. You do not want to miss this session! Register today!


JH Part B Webinar Handout: "Update - New Novitas Website" 

May 2, 2014 (11:00am-12:30pm CT)
Novitas Solutions values the feedback received from our provider communities. In an effort to assist you with searching for information on our website, we want you to join us for an informative webinar as we showcase new enhancements to our website. We will demonstrate the improved Novitas Solutions website and show you how to navigate it. We will inform you of new available search tools while providing you tips to enhance your search results. If you are new to Medicare, you must attend this event! Register today!


Access the MLN Connects Provider eNews for April 24, 2014 here.


Updates to CMS Internet-Only Manual

• Clarification to Publication 100-02, Medicare Benefit Policy Manual Regarding Antigens 
• Deletion of Section 13.14 from Chapter 13 of Publication 100-08: Medicare Program Integrity Manual 

View the updates here.


Medicare Learning Network (MLN) Articles from CMS
New:

• MM8739 - Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) for Solid Tumors (This Change Request (CR) rescinds and fully replaces MM 8468, dated February 6, 2014.)

Revised:

• MM8546 – Addition of New Fields and Expansion of Existing Model 1 Discount Percentage Field in the Inpatient Hospital Provider Specific File (PSF) and Renaming Payment Fields in the Inpatient Prospective Payment System (IPPS) Pricer Output

Medicare Part B-Self Service Tools

The following information is provided by Novitas Solutions.

Self-Service Tools
Did you know Novitas has many interactive apps to help answer your questions? We created these helpful tools to give you access to information you need, when you need it, without having to pick up the phone. Here are some of the great tools we offer to our providers:

• Appeals Status Tool- Check to see if your appeal had a favorable outcome! This app shows details on the appeals you’ve submitted to Medicare.
• Enrollment Status Tool- Have you filed an enrollment application or revalidation recently? Check to see where it’s at.
• Fee Schedule lookup App- This app provides quick access to fee rates for CY 2012, 2013, and 2014!
• Secondary liability calculator- Having trouble understanding the payment on Medicare Secondary claims? This tool helps you calculate what Medicare’s liability would be when there is another primary insurer. Also make sure to check out the Patient Responsibility Calculator afterwards to determine if there is a balance due from the patient 

Interactive Voice Response Unit (IVR)

If you can’t find the information you’re looking for with these tools, make sure to review our IVR user guide. The IVR will also give you comprehensive information on Claim Status and Patient Eligibility. You can also find out check status, order a duplicate remittance, or get a patient account number!

• IVR User Guide
• IVR Alphanumeric Conversion Tool
• IVR Name to Number Conversion Tool

Medicare Part A News-Jurisdiction H for April 28th, 2014

The following announcements are brought to you by Novitas Solutions.

Medicare News

I.H.S. Face-to-Face Workshop in Sacramento, CA
The date for our upcoming event in Sacramento, CA has been change to 6/5/14. The location of the event remains the same.

California Area Office
650 Capitol Mall, Suite 7-100
Huntington Conference Room 1st floor
Sacramento, CA 95814

Register today!


Other Part A Frequently Asked Questions (FAQ)
Our Other Part A FAQs have been updated. Please take time to review these FAQs for answers to your questions.


Medicare Learning Network (MLN) Articles from CMS
New:

• MM8739 - Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) for Solid Tumors (This Change Request (CR) rescinds and fully replaces MM 8468, dated February 6, 2014.)

Revised:

• MM8546 – Addition of New Fields and Expansion of Existing Model 1 Discount Percentage Field in the Inpatient Hospital Provider Specific File (PSF) and Renaming Payment Fields in the Inpatient Prospective Payment System (IPPS) Pricer Output

The MLN Connects Provider eNews for April 24, 2014 is now available here.



Updates to CMS Internet-Only Manual

• Clarification to Publication 100-02, Medicare Benefit Policy Manual Regarding Antigens 
• Deletion of Section 13.14 from Chapter 13 of Publication 100-08: Medicare Program Integrity Manual 

Manual Updates can be viewed here.

Payment File for the Medicare Physician Fee Schedule Database (MPFSDB)
The JH April 2014 payment files for the Medicare Physician Fee Schedule Database (MPFSDB) and Retroactive Provisions under the Patient Protection and Affordable Care Act have been posted here.

Novitas Solutions Self-Service Tools

The following information is provided by Novitas Solutions.

Self-Service Tools
Did you know Novitas has many interactive apps to help answer your questions? We created these helpful tools to give you access to information you need, when you need it, without having to pick up the phone. Here are some of the great tools we offer to our providers:

Appeals Status Tool
-Check to see if your appeal had a favorable outcome! This app shows details on the appeals you’ve submitted to Medicare.
Enrollment Status Tool
-Have you filed an enrollment application or revalidation recently? Check to see where it’s at.
Credit Balance Status Tool
-If you've filed a Credit Balance Report recently, you can check the status here.

Interactive Voice Response Unit (IVR)
If you can’t find the information you’re looking for with these tools, make sure to review our IVR user guide. The IVR will give you comprehensive information on Claim Status and Patient Eligibility. You can also get check status or obtain the patient status code to bill your discharges correctly.

IVR User Guide
IVR Alphanumeric Conversion Tool
IVR Name to Number Conversion Tool

Info for Certified RHCs who have lost their geographic or low-income HPSA score!

If you are a RHC ineligible for a HPSA score, you can apply for an automatic HPSA. This is a different designation than a HPSA under a geographic or low-income designation. For more information and to apply, visit http://bhpr.hrsa.gov/shortage/hpsas/ruralhealthhpsa.html. There are certain requirements that your clinic must meet to be eligible for this score which include a Sliding Fee Scale in accordance with the Federal Poverty Guidelines. With a HPSA score, your RHC certification is secure and you may be eligible to be an approved site for the National and Colorado Health Service Corps loan repayment programs. 

To find out what your HPSA score is, visit http://hpsafind.hrsa.gov/ or contact Sara Leahy at 303-565-5848/sl@coruralhealth.org.

Novitas Solutions- Online Meeting for New Website Input

As a valuable partner of Novitas Solutions we are seeking your input into our newly redesigned website. Your input will provide us with the information we need to finalize this redesign in a way that will meet our customers’ needs.

We ask that you join us, representing your association’s members, for an invitation only online meeting to view the redesign and provide input. Please click this link to register: https://novitas-solutions.webex.com/novitas-solutions/onstage/g.php?t=a&d=661724610 Please register by April 23.

In preparation for this meeting, please complete a short survey in which you will be asked to review the redesigned website and provide your initial impression/feedback of the website. Please complete the survey before the event as we will be using this preliminary feedback to guide our conversation.

Novitas Solutions looks forward to your valuable input!

Medicare Part B News-Jurisdiction H for April 16th, 2014

The following information is provided by Novitas Solutions. 

Medicare News

Part A/B Getting Ready for ICD-10 Webinar Has Been Cancelled!
The Part A/B Getting Ready for ICD-10 webinar scheduled for April 17, 2014 at 2:00pm ET/1:00pm CT has been cancelled. At this time, it has not been rescheduled. We apologize for any inconvenience this may cause you.


Contact Centers Closed for All-CSR Meeting May 16, 2014 09:45 am - 12:30 pm CT
The Contact Centers will close on May 16, 2014 from 9:45 am to 12:30 pm CT for an All-CSR-Meeting with the Centers for Medicare and Medicaid Services (CMS). You may continue utilizing EDI Services, the Interactive Voice Response Unit (IVR), Direct Data Entry (DDE) functions (online claims entry or the Health Insurance Query Access (HIQA) transaction for beneficiary eligibility), and Professional Provider Telecommunications Network (PPTN) during this time.


MLN Connects Provider eNews for April 17, 2014
Please take note of the articles included in the Claims, Pricers and Codes section:

• PC Print Version 4.3.0 Incompatible with Microsoft XP 
• SNF Consolidated Billing: Exclusion of HCPCS Code G0463 for Certain Outpatient Hospital Clinic Visits 
• Hold on CAH Claims for Non-Patient Specimen Analysis 
• Hold on Some Part B Claims Following April Inpatient Payment Policy Update 

Read the newsletter here.

Medicare Part A News-Jurisdiction H for April 16th, 2014

The following information is provided by Novitas Solutions.

Medicare News

Reopenings and Appeals of Inpatient Probe and Educate Claims
On August 2, 2013 the Centers for Medicare & Medicaid Services (CMS) issued a final rule, CMS-1599-F, updating fiscal year FY 2014 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital Prospective Payment System (LTCH PPS). The final rule modifies and clarifies CMS’s longstanding policy on how Medicare contractors review inpatient hospital and critical access hospital (CAH) admissions for payment purposes. CMS subsequently released guidance on September 5, 2013 and January 30, 2014 that clarified the physician order and physician certification requirements for hospital inpatient admissions. Read the full article here.


MLN Connects Provider eNews for April 17, 2014
Please take note of the articles included in the Claims, Pricers and Codes section:

• PC Print Version 4.3.0 Incompatible with Microsoft XP 
• SNF Consolidated Billing: Exclusion of HCPCS Code G0463 for Certain Outpatient Hospital Clinic Visits 
• Hold on CAH Claims for Non-Patient Specimen Analysis 
• Hold on Some Part B Claims Following April Inpatient Payment Policy Update

Read the newsletter here.

Part A/B Getting Ready for ICD-10 Webinar Has Been Cancelled!

The Part A/B Getting Ready for ICD-10 webinar scheduled for April 17, 2014 at 2:00pm ET/1:00pm CT has been cancelled. At this time, it has not been rescheduled. We apologize for any inconvenience this may cause you.


Contact Centers Closed for All-CSR Meeting May 16, 2014 09:45 am - 12:30 pm CT
The Contact Centers will close on May 16, 2014 from 9:45 am to 12:30 pm CT for an All-CSR-Meeting with the Centers for Medicare and Medicaid Services (CMS). You may continue utilizing EDI Services, the Interactive Voice Response Unit (IVR), Direct Data Entry (DDE) functions (online claims entry or the Health Insurance Query Access (HIQA) transaction for beneficiary eligibility), and Professional Provider Telecommunications Network (PPTN) during this time.

Medicare Part B News-Jurisdiction H for April 14th, 2014

The following information is provided by Novitas Solutions.

Medicare News

JH Part B Webinar "Update-New Novitas Website" Date/Time Change
The dates and times of the following JH and JL Part B Webinars have been changed. We apologize for any inconveniences this may have caused. If you have registered for these events, no further action is required. You will receive an update via WebEx regarding the change.
June 4, 2014 JL Part B Update-New Novitas Website changed to June 6, 2014 from 10-11:30 ET.

New Medicare Insights Weekly Podcasts Now Available
In this week's Medicare Insights Weekly podcast, we discuss a few provisions in the Protecting Access to Medicare Act of 2014. As we conclude this week’s episode, we invite you to join us for the Novitas Solutions 2014 Medicare Symposium. A transcript of this program is included with the MP3 file. To view the transcript, please enable lyrics on your player.

Podcast available here.


Medicare Learning Network (MLN) articles from CMS
New:

• SE1417 - Implementation of Fingerprint-Based Background Checks
• SE1413 – Certifying Physicians and the Phase 2 Ordering and Referring Denial Edits for Home Health Agencies (HHAs)

Revised

• MM8651 – Implement Operating Rules - Phase III ERA EFT: CORE 360 Uniform Use of Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) Rule - Update from CAQH CORE - February 1, 2014 version 3.0.4
• MM8629 – Implementation of National Automated Clearinghouse Association (NACHA) Operating Rules for Health Care Electronic Funds Transfers (EFT)
• MM8675 – April 2014 Update of the Ambulatory Surgical Center (ASC) Payment System

Medicare Part B News-Jurisdiction H for April 9th, 2014

The following information is provided by Novitas Solutions.

Medicare News

New homepage for Clinical Trial and Device Information!
We are pleased to announce a new look and location for our Clinical Trial and Device information. Simply move your cursor to LCDs/Medical Policy located on the left menu and then click on Clinical Trials/Devices. You can find the most up-to-date information on Clinical Trials, Investigational Device Exceptions (IDEs), Humanitarian Device Exemptions (HDEs), Humanitarian Use Devices (HUDs), Pre-Market Approvals (PMAs), PMA Post-Approval Extension Studies, and Pre-Market Notification (PMN) (510(k)).


Centralized Billing for Influenza Virus and Pneumococcal Vaccine
This notice provides instructions on becoming a Centralized Biller for Influenza Virus and Pneumococcal Vaccines.


Medicare Learning Network (MLN) Matters Articles from CMS

New:

• MM8703 – Remittance Advice Remark Code (RARC) and Claims Adjustment Reason Code (CARC) and Medicare Remit Easy Print (MREP) and PC Print Update
• MM8705 – New Waived Tests

Revised:

• MM8485 – Reporting Principal and Interest Amounts When Refunding Previously Recouped Money on the Remittance Advice (RA)
• MM8566 - Rescind/Replace Reclassification of Certain Durable Medical Equipment from the Inexpensive and Routinely Purchased Payment Category to the Capped Rental Payment Category
• MM8664 – April Update to the Calendar Year (CY) 2014 Medicare Physician Fee Schedule Database (MPFSDB)

CMS MLN Connects™ Provider e-News

The April 10, 2014 edition of the MLN Connects Provider e-News * is now available. Get the latest announcements from CMS or check to see if there is a National Provider Call you want to attend!

Medicare Part A News-Jurisdiction H for April 14th, 2014

The following information is provided by Novitas Solutions. 

Medicare News

Join us for our webinar "Part A Medicare Updates" 

April 15, 2014 (10:00am-11:30am ET, 9:00am-10:30am CT)
We will provide a clear understanding of the changes in Medicare, assist the provider community in complying with new guidelines by providing educational information and resources, explain the Comprehensive Error Rate Testing (CERT) Program and provide tips in preventing the most frequent errors, as well as identify and promote the use of self service options and preventive services.

Don't miss this informative event! Register today!


New Medicare Insights Weekly Podcasts Now Available
In this week's Medicare Insights Weekly podcast, we discuss a few provisions in the Protecting Access to Medicare Act of 2014. As we conclude this week’s episode, we invite you to join us for the Novitas Solutions 2014 Medicare Symposium. A transcript of this program is included with the MP3 file. To view the transcript, please enable lyrics on your player.

Podcast available here.


Medicare Learning Network (MLN) articles from CMS
New:

• SE1417 - Implementation of Fingerprint-Based Background Checks
• SE1413 – Certifying Physicians and the Phase 2 Ordering and Referring Denial Edits for Home Health Agencies (HHAs)

Revised:

• MM8651 – Implement Operating Rules - Phase III ERA EFT: CORE 360 Uniform Use of Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) Rule - Update from CAQH CORE - February 1, 2014 version 3.0.4
• MM8248 – Termination of the Common Working File ELGH, HIQH, and HUQA Part A Provider Queries
• MM8629 – Implementation of National Automated Clearinghouse Association (NACHA) Operating Rules for Health Care Electronic Funds Transfers (EFT)
• MM8569 – Enforcement of the 5 Day Payment Limit for Respite Care under the Hospice Medicare Benefit

Medicare Part A News-Jurisdiction H for April 9th, 2014

The following information is provided by Novitas Solutions.

Medicare News

New homepage for Clinical Trial and Device Information!
We are pleased to announce a new look and location for our Clinical Trial and Device information. Simply move your cursor to LCDs/Medical Policy located on the left menu and then click on Clinical Trials/Devices. You can find the most up-to-date information on Clinical Trials, Investigational Device Exceptions (IDEs), Humanitarian Device Exemptions (HDEs), Humanitarian Use Devices (HUDs), Pre-Market Approvals (PMAs), PMA Post-Approval Extension Studies, and Pre-Market Notification (PMN) (510(k)).


Medicare Learning Network (MLN) Matters Articles from CMS

New:

• MM8703 – Remittance Advice Remark Code (RARC) and Claims Adjustment Reason Code (CARC) and Medicare Remit Easy Print (MREP) and PC Print Update
• MM8705 – New Waived Tests

Revised:

• MM8485 – Reporting Principal and Interest Amounts When Refunding Previously Recouped Money on the Remittance Advice (RA)
• MM8566 - Rescind/Replace Reclassification of Certain Durable Medical Equipment from the Inexpensive and Routinely Purchased Payment Category to the Capped Rental Payment Category
• MM8664 – April Update to the Calendar Year (CY) 2014 Medicare Physician Fee Schedule Database (MPFSDB)

CMS MLN Connects™ Provider e-News

The April 10, 2014 edition of the MLN Connects Provider e-News * is now available. Get the latest announcements from CMS or check to see if there is a National Provider Call you want to attend!


Join us for our webinar "Part A Billing of Drugs and Biologicals" 

April 11, 2014 (11:00am ET/10:00am CT)

We will describe policies related to drugs and biologicals, improve understanding of stated content related to drugs and biologicals, properly develop claims for submission, and remain compliant with the Medicare program. Don't miss this informative event! Register today!

Medicare Part A News- Jurisdction H for April 10th, 2014

The following information is provided by Novitas Solutions.

Self-Service Tools

Did you know Novitas has many interactive apps to help answer your questions? We created these helpful tools to give you access to information you need, when you need it, without having to pick up the phone. Here are some of the great tools we offer to our providers:

• Appeals Status Tool: Check to see if your appeal had a favorable outcome! This app shows details on the appeals you’ve submitted to Medicare.
• Enrollment Status Tool: Have you filed an enrollment application or revalidation recently? Check to see where it’s at.
• Credit Balance Status Tool If you've filed a Credit Balance Report recently, you can check the status here.

Interactive Voice Response Unit (IVR)
If you can’t find the information you’re looking for with these tools, make sure to review our IVR user guide. The IVR will give you comprehensive information on Claim Status and Patient Eligibility. You can also get check status or obtain the patient status code to bill your discharges correctly.

• IVR User Guide
• IVR Alphanumeric Conversion Tool
• IVR Name to Number Conversion Tool

Customer Contact Center Survey
Your feedback is important to us. Please take a moment to complete the Customer Contact Center Survey so we can better assist you.

Medicare Part A News-Jurisdiction H for April 10th, 2014

The following information is provided by Novitas Solutions.

Medicare News

Enhanced Provider Enrollment Status Inquiry Tool
We have updated our online status tool to include the status of Phase 3 revalidation applications (i.e., requests issued after September 20, 2013). We apologize for the inconvenience and appreciate your patience as we worked through this issue. We request that you utilize the online tool as your source of information for application status so our Customer Service Representatives can be utilized for more complex inquiries.


Chapter 24 Section 24.2.C “Unsolicited Return of Money – Part A and Part B” of the Reference Manual has been updated
Please ensure that all required fields on the “Return of Monies to Medicare” form are completed. If the required claim specific information is not provided, we will phone develop to the provider. If phone development is not successful, all funds will be kept and applied to a manually established receivable within our system and appeal rights will be lost.
If you are returning an Overpayment due to a Medicare Secondary Payer (MSP) situation, the following items are needed to complete the appropriate adjustment activity:

• Primary Insurer’s explanation of benefits (EOB) 
• Type of Medicare Secondary Payer involved 
• Other Insurer Information 
• Employer Information if Applicable 
• Date of Loss (if available) 

There is a section on the “Return of Monies to Medicare” form for this information to be provided. If this information is not provided up front, phone development will be needed to your office to obtain the missing information, which may cause a delay in your overpayment being processed. If information is not obtained during phone development, a full claim adjustment may be completed resulting in a balance due letter being generated to the provider.

Do not use the “Return of Monies to Medicare” form if you are making payment in response to an overpayment demand letter received.

If refunding a high volume of claims, we recommend that you list all the claim numbers and required data on an Excel spreadsheet. The Excel spreadsheet should be placed on a CD and forwarded along with your check and “Return of Monies to Medicare” form to the appropriate address listed above.

Medicare Part B News- Jurisdiction H for April 10th, 2014

The following information is brought to you by Novitas Solutions.

Self-Service Tools
Did you know Novitas has many interactive apps to help answer your questions? We created these helpful tools to give you access to information you need, when you need it, without having to pick up the phone. Here are some of the great tools we offer to our providers:

• Appeals Status Tool Check to see if your appeal had a favorable outcome! This app shows details on the appeals you’ve submitted to Medicare.
• Enrollment Status ToolHave you filed an enrollment application or revalidation recently? Check to see where it’s at.
• Fee Schedule lookup AppThis app provides quick access to fee rates for CY 2012, 2013, and 2014!

Secondary liability calculator Having trouble understanding the payment on Medicare Secondary claims? This tool helps you calculate what Medicare’s liability would be when there is another primary insurer. Also make sure to check out the Patient Responsibility Calculator afterwards to determine if there is a balance due from the patient


Interactive Voice Response Unit (IVR)
If you can’t find the information you’re looking for with these tools, make sure to review our IVR user guide. The IVR will also give you comprehensive information on Claim Status and Patient Eligibility. You can also find out check status, order a duplicate remittance, or get a patient account number!

• IVR User Guide
• IVR Alphanumeric Conversion Tool
• IVR Name to Number Conversion Tool

Customer Contact Center Survey
Your feedback is important to us. Please take a moment to complete the Customer Contact Center Survey so we can better assist you.

Part B Webinar Handout: "Part B Billing of Drugs and Biologicals" - April 15, 2014 (2:00-3:00pm ET, 1:00pm-2:00pm CT)
Join us as we discuss the Comprehensive Error Rate Testing (CERT) Program, review basic coverage guidelines for drugs and biologicals, and explore proper billing techniques. We will review references and resources to ensure you are aware of what self-service options are available to keep you compliant with the Medicare program. You do not want to miss this informative webinar on Billing of Drugs and Biologicals! Register here today.

2014 NHSC New Site Application Cycle Now Open

The 2014 NHSC New Site Application cycle is now open to those sites that have never been approved as an NHSC site. All completed applications must be submitted by June 16, 2014, at 11:59 pm, ET to be considered for an award. Please refer to the NHSC’s Site Reference Guide for all of the program requirements.

In order to apply to become an NHSC-approved site, a facility must submit an NHSC Site Application through the NHSC’s Customer Service Portal. For the upcoming application cycle, only sites that have never been approved as NHSC sites are eligible to apply. Previously approved NHSC sites will have an opportunity to recertify in fall 2014. The NHSC encourages eligible sites to apply as early as possible. On average the site application cycle can take 2-3 weeks from start to finish.

Before applying to become an NHSC-approved site, please encourage facilities you come in contact with to closely review the NHSC’s Site Reference Guide. Please note that all auto-approved sites do not need to apply but must contact Regional Office staff found on page two of the “Resources in Your Community” document to add new sites to the NHSC system of record. Auto-approved site types are listed in the NHSC’s Site Reference Guide.

It is an exciting time to become an NHSC-approved site. The benefits include access to:

• NHSC Loan Repayment and Scholarship Program providers who are currently seeking employment at NHSC-approved sites; 
• The NHSC Jobs Center, where NHSC-approved sites post job openings and site profiles, which attracts over 22,000 unique visitors each month; and 
• NHSC Virtual Job Fairs, which enable NHSC-approved sites the opportunity to recruit providers in a cost effective manner since interaction is facilitated online via the internet and phone.

A technical assistance conference call will take place on May 1, 1-3 pm ET. Please encourage applicants to access the call by having them dial 1-888-391-7045, passcode 2240736. An on-demand webinar will also be posted on the NHSC Website shortly after the New Site Application cycle opens. In addition, please view a video of Cuba Health Center, one of our member sites, to learn about the benefits of becoming an NHSC-approved site.

We appreciate your continued support with helping us to spread the word!

AHA, others sue HHS over two midnight rule

Yesterday, the American Hospital Association and several other health care groups and individual hospitals filed two suits against the Department of Health and Human Services over the long-term legality of the two midnight rule. Among other items, the suits allege that the rule is arbitrary, places undue burdens on hospitals based on unlawful standards, requires documentation that is not authorized by law and refuses proper Medicare reimbursements for some inpatient stays. The suit, filed in the DC Federal District Court, is yet to be scheduled for motions or trial.

View article here.

Novitas Self-Service Tools

Did you know Novitas has many interactive apps to help answer your questions? We created these helpful tools to give you access to information you need, when you need it, without having to pick up the phone. Here are some of the great tools we offer to our providers:

• Appeals Status Tool: Check to see if your appeal had a favorable outcome! This app shows details on the appeals you’ve submitted to Medicare.
• Enrollment Status Tool: Have you filed an enrollment application or revalidation recently? Check to see where it’s at.

Credit Balance Status Tool: If you've filed a Credit Balance Report recently, you can check the status here.

RWJFs Flip The Clinic- Changing the Culture of Healthcare

RWJF’s Flip The Clinic wants to take the frustration out of the standard doctor visit

The Robert Wood Johnson Foundation is hoping that many “small flips” can build to a big flip and change the culture of healthcare. Its latest project – Flip the Clinic – launches today and is meant to redesign the average doctor visit to make it satisfying instead of frustrating. Flip the Clinic is similar to Flip the Classroom where lessons are watched at home and then discussed in the classroom. Flip the Clinic is meant to make the time doctors and patients spend together in the same room more valuable – less lecture, more conversation.

Read more: http://medcitynews.com/2014/03/rwjfs-flip-clinic-wants-take-frustration-standard-doctor-visit/#ixzz2ysywRuY4

Infographic: State-by-State Variation in Early Elective Delivery Rates

A new Commonwealth Fund infographic highlights data from WhyNotTheBest.org to illustrate the wide variation in rates of early elective deliveries across the U.S. In a few states, there are no early induced deliveries, while in others one of three babies is born before 39 weeks. Babies born too early are more likely to have breathing problems, develop serious infections, and face other complications. Click here to read the full article.

Identifying Meaningful Outcome Measures for the Intensive Care Unit

As part of a Commonwealth Fund–supported study, researchers surveyed nearly 200 physicians about their views on nine outcome measures proposed for evaluating the quality and safety of care provided in hospital intensive care units (ICUs). The results, which appear in the American Journal of Medical Quality, show consensus on the reliability of five measures. Click here to read the full article.

CMS proposes adoption of updated Life Safety Code

Overview:

The Centers for Medicare & Medicaid Services (CMS) today announced a proposed rule on the adoption of updated life safety code (LSC) that CMS would use in its ongoing work to ensure the health and safety of all patients, family and staff in every provider and supplier setting. The updated code contains new provisions that are vital to the health and safety of all patients and staff.

A key priority of CMS is to ensure that patients and staff continue to experience the highest degree of safety possible, including fire safety. CMS intends to adopt the National Fire Protection Association’s (NFPA) 2012 editions of the (LSC) and the Health Care Facilities Code (HCFC). This would reduce burden on health care providers, as the 2012 edition of the LSC also is aligned with the international building codes and would make compliance across codes much simpler for Medicare and Medicaid-participating facilities.

Background:

Currently, CMS applies the standards set out in the 2000 edition of the LSC to facilities in order to ensure patients’ and caregivers’ health and safety. CMS is now proposing to adopt the 2012 editions of the LSC and the Health Care Facilities Code. The LSC sets out fire safety requirements for new and existing buildings, and is issued by the NFPA, a private, nonprofit organization dedicated to reducing loss of life due to fire.

The Health Care Facilities Code contains more detailed provisions specific to health care and ambulatory care facilities. Adoption of this code would provide minimum requirements for the installation, inspection, testing, maintenance, performance, and safe practices of health care facility materials, equipment and appliances.

The new edition of the LSC applies to: hospitals, long term care facilities (LTC), critical access hospitals (CAHs), Programs for All Inclusive Care for the Elderly (PACE), religious non-medical healthcare institutions (RNHCIs), hospice inpatient facilities, ambulatory surgical centers (ASCs), and intermediate care facilities for individuals with intellectual disabilities (ICF-IIDs).

Adoption of the new LSC for Health Care Facilities Code (applicable to hospitals, LTC facilities, CAHs, Hospice inpatient facilities, PACE, RNHCIs) would make the following changes:

• Would allow facilities to increase suite sizes; 
• Would require all high-rise buildings over 75’ are required to be fully sprinklered within 12 years; 
• Would allow controlled access doors to prevent wandering patients; 
• Would address issues of alcohol based hand rub dispensers in corridors and patient rooms; 
• Would require a fire watch (The assignment of a person or persons to an area for the express purpose of notifying appropriate people during an emergency) or building evacuation if a sprinkler system is out of service for more than 4 hours; and 
• Would require smoke control in anesthetizing locations. 

The key changes for ASCs are:

• Would require interior non-bearing walls have a minimum of 2 hour fire resistance rating and be constructed with fire retardant treated wood; 
• Would require all doors to hazardous areas have to be self-closing or automatic closing; 
• Would address the issue of placing alcohol based hand rub dispensers in corridors; 
• Would require a fire watch or building evacuation if sprinkler system is out of service for more than 4 hours; and 
• Would require smoke control in anesthetizing locations. 

The major changes for Intermediate Care Facilities for individuals with Intellectual Disabilities (ICF-IIDs) are:

• Would have expanded sprinkler requirements to include habitable areas, closets, roofed porches, balconies and decks in new facilities; 
• Would require all attics to be sprinklered if they are used for living purposes, storage or housing of fuel fired equipment- if they are not used for these purposes, attics may have heat detection systems instead; 
• Would require all designated means of escape be free from obstruction; 
• New facilities are required to have smoke alarms installed on all levels; 
• Would allow access-controlled egress doors to be equipped with electrical lock hardware to prevent residents from wandering away; 
• Would require hazardous areas to be separated from other parts of the building by smoke partitions; and 
• Would require existing facilities to include certain fire alarm features when they choose to update their fire alarm systems. 

Public Input Invited:

The proposed rule is currently on display at http://ofr.gov/inspection.aspx and will be published in the April 16, 2014 Federal Register. The deadline to submit comments is June, 16, 2014.

Medicare Part B News - Jurisdiction H for April 7th

The following information is provided by Novitas Solutions.

Medicare News

Jurisdiction H 2014 Medicare Symposium Brochure
The 2014 Medicare Symposium Brochure is now available! The brochure includes the event description, locations, the symposium agenda, course descriptions, and helpful event day reminders. Get all the details today and learn everything you need to know to attend our upcoming symposiums.


New Medicare Insights Weekly Podcasts Now Available
In this week's Medicare Insights Weekly podcast, we include a list of newly effective and retired policies and tell you about an update to the provider enrollment online status tool. In addition, we review more Novitas Educational Tips and Tools documents. Don't miss this episode. Download it today!


Medicare Learning Network (MLN) Matters Articles from CMS

New:

• SE1416 – Updating Beneficiary Information with the Benefits Coordination & Recovery Center (formerly known as the Coordination of Benefits Contractor)

Revised:

• MM8526 – Medicare National Coverage Determination (NCD) for Beta Amyloid Positron Emission Tomography (PET) in Dementia and Neurodegenerative Disease

Rescinded:

• SE1205 – Updating Beneficiary Information with the Coordination of Benefits Contractor

Medicare Part A News - Jurisdiction H for April 7th

The following information is provided by Novitas Solutions.


Medicare News

Jurisdiction H 2014 Medicare Symposium Brochure
The 2014 Medicare Symposium Brochure is now available! The brochure includes the event description, locations, the symposium agenda, course descriptions, and helpful event day reminders. Get all the details today and learn everything you need to know to attend our upcoming symposiums.


New Release of PEPPER for LTCHs
The Long-Term Care Hospital (LTCH) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through September 2013 will be available for download through the Secure PEPPER Access page at PEPPERresources.org beginning April 7, 2014.


JH Part A Top Claim Submission Errors
The Part A Top Claim Submission Errors for March 2014 have been posted. Please review resolutions to the errors that may impact you.


March 2014 Medicare Part A Newsletter
The March 2014 Newsletter is now available! Please take a few moments to review


New Medicare Insights Weekly Podcasts Now Available
In this week's Medicare Insights Weekly podcast, we include a list of newly effective and retired policies and tell you about an update to the provider enrollment online status tool. In addition, we review more Novitas Educational Tips and Tools documents. Don't miss this episode. Download it today!

Medicare Learning Network (MLN) Matters Articles from CMS

New:

• SE1416 – Updating Beneficiary Information with the Benefits Coordination & Recovery Center (formerly known as the Coordination of Benefits Contractor)

Revised:

• MM8526 – Medicare National Coverage Determination (NCD) for Beta Amyloid Positron Emission Tomography (PET) in Dementia and Neurodegenerative Disease

Rescinded:

• SE1205 – Updating Beneficiary Information with the Coordination of Benefits Contractor

2014 Medicare Symposium Brochure

Novitas Solutions will be hosting a Symposium near you. The 2014 Medicare Symposium Brochure is now available! The brochure includes the event description, locations, the symposium agenda, course descriptions, and helpful event day reminders. Get all the details today and learn everything you need to know to attend our upcoming symposiums.

2014 Medicare JH Symposium Brochure is available here.

Frontier Focus: Protecting Access to Medicare Act of 2014

President Obama Signs the Protecting Access to Medicare Act of 2014 

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014. This new law prevents a scheduled payment reduction for physicians and other practitioners who treat Medicare patients from taking effect on April 1, 2014. This new law maintains the 0.5 percent update for such services that applied from January 1, 2014 through March 31, 2014 for the period April 1, 2014 through December 31, 2014. It also provides a zero percent update to the 2015 Medicare Physician Fee Schedule (MPFS) through March 31, 2015.

The new law extends several expiring provisions of law. We have included Medicare billing and claims processing information associated with the new legislation. Please note that these provisions do not reflect all of the Medicare provisions in the new law, and more information about other provisions will be forthcoming.

Section 101 – Physician Payment Update – As indicated above, the new law provides for a 0.5 percent update for claims with dates of service on or after January 1, 2014, through December 31, 2014. It also provides a zero percent update to the 2015 Medicare Physician Fee Schedule (MPFS) through March 31, 2015. CMS is currently revising the 2014 MPFS to reflect the new law’s requirements as well as technical corrections identified since publication of the final rule in November. For your information, the 2014 conversion factor is $35.8228.

Section 102 - Extension of Work GPCI Floor - The existing 1.0 floor on the physician work geographic practice cost index is extended through March 31, 2015. As with the physician payment update, this extension will be reflected in the revised 2014 MPFS.

Section 103 - Extension of Therapy Cap Exceptions Process - The new law extends the exceptions process for outpatient therapy caps through March 31, 2015. Providers of outpatient therapy services are required to submit the KX modifier on their therapy claims, when an exception to the cap is requested for medically necessary services furnished through March 31, 2015. In addition, the new law extends the application of the caps, exceptions process, and threshold to therapy services furnished in a hospital outpatient department (OPD). Additional information about the exception process for therapy services may be found in the Medicare Claims Processing Manual, Pub.100-04, Chapter 5, Section 10.3.

The therapy caps are determined for a beneficiary on a calendar year basis, so all beneficiaries began a new cap for outpatient therapy services received beginning on January 1, 2014. For physical therapy and speech language pathology services combined, the 2014 limit on incurred expenses for a beneficiary is $1,920. There is a separate cap for occupational therapy services which is $1,920 for 2014. Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached, and also apply for services above the cap where the KX modifier is used.

The new law also extends the mandate that Medicare perform manual medical review of therapy services furnished January 1, 2014 through March 31, 2015, for which an exception was requested when the beneficiary has reached a dollar aggregate threshold amount of $3,700 for therapy services, including OPD therapy services, for a year. There are two separate $3,700 aggregate annual thresholds: (1) physical therapy and speech-language pathology services combined, and (2) occupational therapy services.

Section 104 - Extension of Ambulance Add-On Payments - The new law extends the following two expiring ambulance payment provisions: (1) the 3 percent increase in the ambulance fee schedule amounts for covered ground ambulance transports that originate in rural areas and the 2 percent increase for covered ground ambulance transports that originate in urban areas is extended through March 31, 2015 and (2) the provision relating to payment for ground ambulance services that increases the base rate for transports originating in an area that is within the lowest 25th percentile of all rural areas arrayed by population density (known as the “super rural” bonus) is extended through March 31, 2015. The provision relating to air ambulance services that continued to treat as rural any area that was designated as rural on December 31, 2006, for purposes of payment under the ambulance fee schedule, expired on June 30, 2013.

Section 105 - Extension of Increased Inpatient Hospital Payment Adjustment for Certain Low-Volume Hospitals - The new law extends, through March 31, 2015, a provision that allowed qualifying low-volume hospitals to receive add-on payments based on the number of Medicare discharges from the hospital. To qualify, the hospital must have less than 1,600 Medicare discharges and be 15 miles or greater from the nearest like hospital.

Section 106 - Extension of the Medicare-Dependent Hospital (MDH) Program - The MDH program provides enhanced payment to support small rural hospitals for which Medicare patients make up a significant percentage of inpatient days or discharges. This provision extends the MDH program through March 31, 2015.

New Guidance on the Fair Labor Standards Act

The following information is provided by the Centers for Medicare & Medicaid Services (CMS).

This is to make you aware of a final rule, published by the Department of Labor (DOL) entitled, “Application of the Fair Labor Standards to Domestic Service” (78 Fed. Reg. 60454, effective January 1, 2015). This rule may impact many in-home programs that are part of state Medicaid programs and DOL and the Centers for Medicare & Medicaid Services (CMS) want to ensure that states understand the obligations of the Fair Labor Standards Act (FLSA) and the implications of the final rule.

Accordingly, CMS has been working with DOL on implementation of this final rule in state Medicaid systems. Shortly after the final rule was announced, DOL, with assistance from the Department of Health and Human Services (HHS), held a series of webinars about the final rule, including two webinars targeted to state Medicaid, disability service, and labor officials. In these webinars, stakeholders asked about the impact of the final rule on “shared living” programs, a term used to describe a broad range of programs in which an individual receiving services lives together with the person providing those services, which may be called “adult foster care,” “host home,” “paid roommate,” “supported living,” “life sharing,” or by some other name.

DOL has issued two guidance documents describing how the FLSA applies to shared living programs: (1) an Administrator’s Interpretation providing a detailed analysis of the FLSA issues applicable to shared living programs; and (2) a Fact Sheet summarizing the FLSA analysis in the Administrator’s Interpretation by type of shared living program. These guidance documents, along with additional information about the final rule, are available at http://www.dol.gov/whd/homecare/. Further questions for DOL about the guidance documents on shared living programs or other inquiries about the final rule can be directed to homecare@dol.gov.

CMS will help disseminate any further guidance to states and other stakeholders on this topic from the Department of Labor. In addition, CMS stands ready to assist states with questions about Medicaid coverage or in-home program design, including shared living programs, as a result of the final rule. Please contact Dianne Kayala at Dianne.Kayala@cms.hhs.gov for further information.

Medicaid Home and Community-Based Services

The following information is provided by the Centers for Medicare & Medicaid Services (CMS).

A new set of answers to frequently asked questions is available online regarding the new requirements in the recently published home and community-based services final regulations. The frequently asked questions are available here.

For more information about Medicaid home and community-based services, please visit http://www.medicaid.gov/hcbs.

Medicaid Disproportionate Share Hospital (DSH) Audit and Report Information

The following information is provided by the Centers for medicare & Medicaid Services (CMS).

New guidance is available regarding Medicaid DSH audits and reporting required by section 1932(j) of the Social Security Act and implementing regulations. The new guidance, titled Additional Information on the DSH Reporting and Auditing Requirements – Part 2, is available on Medicaid.gov at http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Financing-and-Reimbursement/Medicaid-Disproportionate-Share-Hospital-DSH-Payments.html. We are providing this guidance in advance of the SPRY 2011 DSH audits and reports that are due to CMS by December 31, 2014. These audits and reports are the first that fall outside of the regulatory transition period established at 42 CFR 455.304(e).

To ensure proper oversight and assist states in appropriate implementation, we have conducted desk reviews of all relevant state audits and reports for State Plan Rate Years (SPRY) 2005 through 2009. Additionally, we have conducted in-depth onsite reviews of various states and hospitals throughout the country. The onsite and desk reviews were part of an effort to obtain a nationwide representation of audit implementation and to produce a greater understanding of how states, hospitals, and auditors completed the initial DSH audits and reports. The results of the reviews have informed the development of this guidance, which is designed to ensure proper implementation, consistent practice, and protection for states and hospitals as we approach the end of the regulatory transition period.

The transition period was designed to allow adequate time for CMS, states, auditors, and hospitals to work cooperatively in developing and refining DSH reporting and auditing techniques required by statute and regulation while attempting to mitigate or to eliminate the immediate and future fiscal impact realized by states and hospitals. Beginning for SPRY 2011 DSH audits and reports, CMS will regard audit findings demonstrating DSH payments that exceed the hospital-specific DSH limits as representing discovery of overpayments to providers. Such overpayments, pursuant to 42 CFR Part 433, Subpart F, trigger the return of the federal share of the payment to the Federal government. However, if the excess DSH payments are redistributed by the state to other qualifying hospitals as part of the federally approved Medicaid state plan, the federal share is not required to be returned.

We look forward to continued efforts and commitment in ensuring that the DSH audits and reports comport with section 1923(j) of the Act, implementing regulations, and related guidance. Should you have any questions please contact Rory Howe at 410-786-4878 or by email at Rory.Howe@cms.hhs.gov.

Upcoming Accountable Care Collaborative Stakeholder Meetings

The Department of Health Care Policy and Financing is seeking stakeholder input and feedback on the future of the Accountable Care Collaborative (ACC).

Through a series of stakeholder meetings, the Department, in collaboration with the Colorado Health Institute (CHI), seeks to collect client, provider, and stakeholder input on the next phase of the ACC strategic plan. Additionally, the stakeholder meetings will inform the Department’s development of the next Request for Proposals (RFP) process for the Regional Care Collaborative Organizations (RCCO).

All stakeholder meetings are open to the public. For more information click here or visit Colorado.gov/HCPF/ACC then click on ACC Updates and News in the left navigation bar.


If you have questions about the upcoming stakeholder meetings or RFP process, please contact RCCORFP@state.co.us.

Transportation Survey

Transportation Survey- 

Rural Advocacy Groups Look for Solutions 

A good, strong transportation system is needed in Colorado and is essential to statewide economic prosperity. CLUB 20, Action 22 and Progressive 15 members recognize the challenges in maintaining state highways as funding sources decline.

The three organizations have been working with the Metro Mayors, CDOT and other statewide stakeholders to identify options for a state-wide funding approach that is sensible for Colorado in addressing the growing maintenance and capacity concerns related to the state highway system.

In an effort to collect information regarding this issue from members and rural communities, Action 22, CLUB 20, and Progressive 15, have joined forces to conduct a survey regarding transportation in each of their perspective regions. The survey can be found at the link below and will be open until midnight on April 15th. The groups are requesting that members share the survey with their networks to get a broad sense of how declining roads throughout Colorado can be better maintained.

The transportation funding formula is also under consideration by the Transportation Commission and modifications may be enacted. The current distribution formula is based on vehicle miles traveled, lane miles and truck miles. New formula considerations include a potential reduction in vehicle miles traveled and lane miles in favor of a population based component, negatively impacting funding in rural Colorado. As rural Colorado has the greatest number of lane miles, those roads could fall into further disrepair. State highways are Colorado assets and, as such, Colorado has an obligation to maintain them throughout the state. State highway funding has been declining in Colorado for a number of years, resulting in 52% of the state's highways declining to "poor" condition.  Modifications to the state funding formula will further jeopardize rural roads and economies.

The link to the survey is:  

 https://www.surveymonkey.com/s/ruraltransportation

If others would like the opportunity to share information regarding potential transportation solutions not reflected in the survey, please contact Action 22, CLUB 20 or Progressive 15    

Medicare Part B News-Jurisdiction H for April 3rd, 2014

The following information is brought to you by Novitas Solutions.

Medicare News

President Obama Signs the Protecting Access to Medicare Act of 2014
On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014. This new law prevents a scheduled payment reduction for physicians and other practitioners who treat Medicare patients from taking effect on April 1, 2014. This new law maintains the 0.5 percent update for such services that applied from January 1, 2014 through March 31, 2014 for the period April 1, 2014 through December 31, 2014. It also provides a zero percent update to the 2015 Medicare Physician Fee Schedule (MPFS) through March 31, 2015. More information can be found here.


MLN Connects Provider eNews for April 3, 2014
Please take note of the articles included in the Claims, Pricers and Codes section of this edition:

• Appeals for Cancelled Claims Related to Medicare Beneficiaries Classified as “Unlawfully Present" in the U.S. 
• Mandatory Payment Reduction of 2% Continues through March 31, 2015, for the Medicare FFS Program — “Sequestration” 
• Adjustment of Community Mental Health Center Claims for Telehealth Originating Facility Fees 
• Incorrect Overpayments and Denials for Some New Patient Visit Claims 

New Medicare Insights Weekly Podcasts Now Available
In this week's Medicare Insights Weekly podcast we cover submitting medical records by disc and the addition of Telehealth services to the Reference Manual. We also introduce you to the Novitas Educational Tips and Tools. This is a program you can't miss. Podcast information and subscription can be found here.


Part B Webinar Handout: "Part B Medicare Updates-2014 Second Quarter"

April 3, 2014 (10:00am-11:00am ET, 9:00am-10:30am CT)
Attention! Attention! You must register for the 2014 Second Quarter Medicare Updates now! This session will provide a clear understanding of the changes in Medicare and assist you with staying compliant with new Medicare guidelines. We will provide you with educational information and resources that will both explain the Comprehensive Error Rate Testing (CERT) Program and provide tips on preventing common errors. You will learn to identify and promote the use of self service options as well as preventive services. You do not want to miss this informative event!


The JH Part B Top Inquiries Frequently Asked Questions (FAQ's) December 2013-Febuary 2014
The JH Part B Top Inquiries Frequently Asked Questions (FAQs) have been updated. Please visit our FAQs for the answers to your questions.

Medicare Part A News-Jurisdiction H for April 2nd, 2014

The following information is brought to you by Novitas Solutions.

Medicare News

President Obama Signs the Protecting Access to Medicare Act of 2014
On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014. This new law prevents a scheduled payment reduction for physicians and other practitioners who treat Medicare patients from taking effect on April 1, 2014. This new law maintains the 0.5 percent update for such services that applied from January 1, 2014 through March 31, 2014 for the period April 1, 2014 through December 31, 2014. It also provides a zero percent update to the 2015 Medicare Physician Fee Schedule (MPFS) through March 31, 2015. Further information can be found here.


MLN Connects Provider eNews for April 3, 2014
Please take note of the articles included in the Claims, Pricers and Codes section of this edition:

• Appeals for Cancelled Claims Related to Medicare Beneficiaries Classified as “Unlawfully Present" in the U.S. 
• Mandatory Payment Reduction of 2% Continues through March 31, 2015, for the Medicare FFS Program — “Sequestration” 
• Adjustment of Community Mental Health Center Claims for Telehealth Originating Facility Fees 
• Incorrect Overpayments and Denials for Some New Patient Visit Claims 

New Medicare Insights Weekly Podcasts Now Available
In this week's Medicare Insights Weekly podcast we cover submitting medical records by disc and the addition of Telehealth services to the Reference Manual. We also introduce you to the Novitas Educational Tips and Tools. This is a program you can't miss. Podcast information and subscription can be found here.


Credit Balance Reports for quarter ending 03/31/2014 are due 04/30/2014
There is a new number in which to fax your zero balance certifications. The new fax number is 410-891-5230. Faxes that come through under the old fax number (410-891-5550) will only be routed for a short time so please begin using the new number as soon as possible. Fore information located here.

MLN Connects: Weekly Provider eNews for April 3rd, 2014

Click here to view the complete issue of the MLN Connects™ Provider eNews for April 3, 2014.

CMS Updates to Coverage

Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) Meetings

4/30/2014 - Lung Cancer Screening with Low Dose Computed Tomography
Posted revised questions to panel:
http://www.cms.gov/medicare-coverage-database/details/medcac-meeting-details.aspx?MEDCACId=68

Medicare Approved Facilities/Trials/Registries

Carotid Artery Stenting
Added new facility:
http://www.cms.gov/Medicare/Medicare-General-Information/MedicareApprovedFacilitie/Carotid-Artery-Stenting-Facilities.html

Important Payment Adjustment Information for Medicare Eligible Professionals

Eligible professionals participating in the Medicare EHR Incentive Program may be subject to payment adjustments beginning on January 1, 2015. CMS will determine the payment adjustment based on meaningful use data submitted prior to the 2015 calendar year. Eligible professionals must demonstrate meaningful use prior to 2015 to avoid payment adjustments.

Determine how your EHR Incentive Program participation start year will affect the 2015 payment adjustments:

If you began in 2011 or 2012…
If you first demonstrated meaningful use in 2011 or 2012, you must demonstrate meaningful use for a full year in 2013 to avoid the payment adjustment in 2015.

If you began in 2013…
If you first demonstrated meaningful use last year, you needed to demonstrate meaningful use for a 90-day reporting period to avoid the payment adjustment in 2015.

If you plan to begin in 2014…
If you first demonstrate meaningful use in 2014, you must demonstrate meaningful use for a 90-day reporting period in 2014 to avoid the payment adjustment in 2015. This reporting period must occur in the first 9 months of calendar year 2014, and eligible professionals must attest to meaningful use no later than October 1, 2014, to avoid the payment adjustment.

Avoiding Payment Adjustments in the Future
You must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years.

If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the payment adjustments. You may demonstrate meaningful use under either Medicare or Medicaid.

If you are only eligible to participate in the Medicaid EHR Incentive Program, you are not subject to these payment adjustments.

Helpful Resources
For more information on payment adjustments, view the Payment Adjustments and Hardship Exceptions Tipsheet for eligible professionals.


Want more information about the EHR Incentive Programs?
Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.