MLN Connects™ Provider eNews for November 6, 2014
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In This Edition:
MLN Connects™ National Provider Calls
• 2015 Physician Fee Schedule Final Rule: Changes to Physician Quality Reporting Programs — Registration Opening Soon
• National Partnership to Improve Dementia Care in Nursing Homes — Registration Now Open
• Certifying Patients for the Medicare Home Health Benefit — Registration Opening Soon
• New MLN Connects™ National Provider Call Audio Recording and Transcript
MLN Connects™ Videos
• Monthly Spotlight: Medicare Preventive Services
Announcements
• CY 2015 Policy and Payment Changes to the Medicare Physician Fee Schedule
• CY 2015 Policy and Payment Changes for ESRD Facilities and Implementation of Competitive Bidding-Based Prices for DMEPOS
• CY 2015 Payment and Policy Changes for Hospital Outpatient and Ambulatory Surgical Centers
• CY 2015 Payment Changes for Medicare Home Health Agencies
• Raising Awareness of Diabetes in November
• Final Rule Changes for Open Payments
• Teaching Hospitals Receiving FTE Resident Caps Under Section 5506 of the Affordable Care Act
• CMS is Accepting Suggestions for Potential PQRS Measures
• Comparative Billing Report on Modifier 25: Family Practice
Medicare Learning Network® Educational Products
• “Medicare Appeals Process” Podcast — New
• “Skilled Nursing Facility Prospective Payment System” Fact Sheet — Revised
• “Inpatient Rehabilitation Facility Prospective Payment System” Fact Sheet — Revised
• Medicare Learning Network® Products Available in Electronic Publication Format
2015 Open Meeting Dates Now Posted
The scheduled dates for the 2015 Open Meetings are now posted.
Each Novitas Solutions Open Meeting will be a combined meeting for both Medicare Administrative Contractor (MAC) Jurisdiction H (JH) and MAC Jurisdiction L (JL) contract areas.
NOTE: The Open Meeting is not a forum for discussing specific claims; or for the submission of new drugs, indications, or marketing of forthcoming drugs or medical devices. Information regarding new drugs, indications, or marketing information should be submitted according to Novitas guidelines. Specific JH claim questions, including billing and coding, should be directed to our JH Customer Service Center at 1-855-252-8782.
MSP 1500 Paper Claim Submission Reporting for Item 11
If you are permitted to submit paper, rather than electronic claims to Medicare, this article is for you. Once you have submitted your claim to the primary insurer and received their statement of payment or denial, called an Explanation of Benefits (EOB), you are now ready to submit a claim to Medicare for secondary consideration.
Correct Reporting of Medicare Secondary Payer (MSP) Type on Electronic Claims
When submitting an electronic claim to Medicare, you are required to obtain MSP insurance information from the patient. The patient’s insurance is classified as either a group health plan (GHP) or a non-group health plan (NGHP). Examples of GHP coverage are Working Aged (WA), Disability, or End Stage Renal Disease (ESRD). These types of coverage are based on current or past employment. Examples of NGHP coverage are Automobile/no-fault, Workers’ Compensation (WC), and Liability. These types of coverage are typically the result of an accident, injury, or lawsuit. Although there are other types of MSP coverage, these are the most common.
