Thursday, March 27, 2014

MLN Connects Provider eNews for Thursday March 27, 2014

Get the latest information on registration for the PQRS Group Reporting Option, EHR Incentive Program deadlines, and more in this week's eNews.

Click to view the complete issue of the MLN Connects™ Provider eNews for March 27, 2014.



Level III: Patient Navigator Supervisor and Evaluation Courses offered this May

The Patient Navigator Training Collaborative is pleased to announce that registration is open for two Level III Courses- Patient Navigator Supervisor and PN Evaluation courses this May.

DATES: PN Supervisor Workshop May 20, 2014; Evaluation Workshop May 21-22, 2014

Location: Anschutz Medical Campus, Health and Wellness Building, Classroom 4009
12348 East Montview Boulevard, Aurora, CO 80045

Course Descriptions:

Supervisor Course: Level III: Leading and Administering a Patient Navigation Program (1 day)

This course is designed for supervisors of navigators, program planners and administrators of patient navigator programs. The course provides a basic understanding of the patient navigator (PN) intervention model, reviews challenges facing PN program managers and provides strategies for an effective PN program. We will review evidenced-based clinical guidelines, utilizing registries for identifying patients, developing standard work flows, PN training, key supervision needs and evaluation of PN services.


After completing this course you will be able to:

• Demonstrate a basic understanding of patient navigator intervention model(s)
• Explain the role and responsibilities of patient navigators
• Develop strategies to identify qualified and appropriate staff for the PN position
• Describe six essential elements for patient navigator success
• Identify the training needs of your patient navigator staff
• Clarify the difference between process and outcome evaluation
• Determine potential data sources for both process and outcome evaluation of your PN program
• Understand how to use data for employee performance monitoring, quality improvement and program evaluation


Evaluation Course: Level III: Using Evaluation for Program Improvement and Capacity Building (2 days)



This two-day course is designed for patient navigator supervisors who want to increase basic program evaluation skills. Participants will learn to use evaluation to improve prevention interventions, define common evaluation terms, use logic models to describe interventions, develop and prioritize evaluation questions, identify steps to prepare for evaluation, and identify strategies for building evaluation capacity within their organization.

After completing this course you will be able to:

• Identify ways to use evaluation data to improve health promotion
• Define common evaluation terms
• Use logic models to describe interventions and assure fidelity
• Develop and prioritize evaluation questions
• Identify steps to prepare for evaluation
• Identify strategies for building evaluation capacity within their organization


You may register for either course or both courses.

Register for the Supervisor Course by clicking here.

Register for the Evaluation course by clicking here.


To register for both courses, you will need to register at both links.

Course details can also be found at: http://patientnavigatortraining.org/courses/level3/

Medicare Part A News-Jurisdiction H for March 26th, 2014

The following announcements are brought to you by Novitas Solutions.

Indian Health Service - Returning Overpayments to Medicare – Part A

Anytime a request is being made to Treasury to refund an overpayment to Novitas Solutions, please use the Part A – Indian Health Services Return of Monies Form or a similar document and attach additional detail as appropriate.

If you have already received an Overpayment Notification and would like to request immediate recoupment, a fax request can be sent to 412-802-1836. Section 24.4 A of Chapter 24 provides instructions and a suggested form for use.

CMS MLN Connects Weekly Provider e-News
The March 27, 2014 edition of the MLN Connects Provider e-News is now available. Get the latest information on registration for the PQRS Group Reporting Option, EHR Incentive Program deadlines and more in this week's eNews.

Novitas Educational Tips and Tools - NETTs: Reason Code 30905
You submitted an adjustment claim and now you are getting Reason Code 30905. What do you do now? Visit the Novitas Educational Tips and Tools - NETTs page and review the document titled "Reason Code 30905 Claim Submission Error Tips". You will find exactly what you are looking for in order to submit a successful adjustment claim. Visit this page often to see what has been added or join the Listserv and receive immediate notification when something is added or updated.

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 March 26th, 2014

The following announcements are brought to you by Novitas Solutions.

Indian Health Service - Returning Overpayments to Medicare – Part B

Anytime a request is being made to Treasury to refund an overpayment to Novitas Solutions, please use the Part B – Indian Health Services Return of Monies Form or a similar document and attach additional detail as appropriate.

If you have already received an Overpayment Notification and would like to request immediate recoupment, a fax request can be sent to 717-635-4222. Section 24.4 A of Chapter 24 provides instructions and a suggested form for use.


CMS MLN Connects Weekly Provider e-News

The March 27, 2014 edition of the MLN Connects Provider e-News is now available. Get the latest information on registration for the PQRS Group Reporting Option, EHR Incentive Program deadlines and more in this week's eNews found here.


CMS 1500 Claim Form Rejections for Expired Version of CMS 1500 (08/05) Eff 04/01/14

Effective 04/01/2014, Medicare is no longer accepting paper claims on the old CMS 1500 claim form with a date of 08-05 in the lower right hand corner. The new form has a date of 02-12. Qualifiers to identify an ordering, referring, or supervising role should be entered to the left of the dotted vertical line on item 17. Additional information regarding this initiative can be found at the CMS website.


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.






Wednesday, March 26, 2014

Medicare Part A News-Jurisdiction H for March 26th, 2014

The following announcements are brought to you by Novitas Solutions.

April, May, and June 2014 Outreach & Education Calendar of Events

The Outreach & Education April, May, and June 2014 Calendar of Events is now available! Visit the Education & Training Center on our website to check out all of the upcoming webinars and teleconferences!
The calendar can be found by clicking here.

Novitas Educational Tips and Tools - NETTs: Reason Code 30940

So you are trying to adjust a partially or fully medically denied claim, but you keep getting a submission error (Reason Code 30940). Need help or information on what to do next? Visit the Novitas Educational Tips and Tools - NETTs page and review "Reason Code 30940 Claim Submission Error Tips" for your answer. You are encouraged to review this site often and signup for the Listserv so you don't miss any new documents that are added or updated on the website.


Medicare Learning Network (MLN) Matters Articles from CMS

Medicare Part A News-Jurisdiction A for March 24th, 2014

The following announcements are brought to you by Novitas Solutions.


Novitas Educational Tips and Tools - NETTs: Reason Code 15202

Having issues with your "covered days" equaling the accommodation units and revenue codes (Reason Code 15202)? Look no further except your nearest Novitas Educational Tips and Tools (NETTs) page. NETTs article titled "Reason Code 15202 - Claim Submission Error Tips" is available and waiting to assist you with this issue. Please visit the NETTs page often and signup for the Listserv so you receive immediate notification of postings as they occur.
Information can be found by clicking here.


Medicare Learning Network (MLN) Matters Articles from CMS

Medicare Part B News-Jurisdiction H for March 25th, 2014

The following announcements are brought to you by Novitas Solutions.


April, May, and June 2014 Outreach & Education Calendar of Events

The Outreach & Education April, May, and June 2014 Calendar of Events is now available! Visit the Education & Training Center on our website to check out all of the upcoming webinars and teleconferences!
The calendar can be found by clicking here.



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

Date: March 27, 2014 (11:00am -12:00pm ET, 10:00 am-11:00am CT)

Join us for "Part Four-Scoring Medical Records Using the Score Sheet" of the Evaluation and Management Score Sheet series. This four part series was developed to increase your understanding of evaluation and management services. The complete series will be presented every month with one part each week. It is recommended to take the entire series in order to maximize your understanding. However, if you miss any part of the series, it will be presented again the following month in the same order.

The series will consist of the following:
Week One-Part One- Understanding the Key components of Evaluation and Management.
Week Two-Part Two- Introduction to the Score Sheet,
Week Three- Part Three- Using the Score Sheet
Week Four- Part Four- Scoring Medical Records Using the Score Sheet

If you are new to documenting and/or scoring evaluation and management services, this webinar event is for you. You must attend this event.

Webinar information and registration can be found here.


Part B Webinar Handout: "Part B Billing of Drugs and Biologicals" 


Date: March 26, 2014 (10:00-11:00am ET, 9:00am-10:00am CT)

Join us for this Part B presentation of Drugs and Biologicals as we discuss the overview of the Comprehensive Error Rate Testing (CERT) Program. We will review basic coverage guidelines for drugs and biologicals while exploring proper billing techniques. We will also review references, resources and self-services tools to assist you with Medicare billing of these types of claims. You do not want to miss this event!

Webinar information and registration can be found here.

Medicare Part B News- Jurisdiction H for March 24th, 2014

The following announcements are brought to you by Novitas Solutions.


Novitas Educational Tips and Tools - NETTs: 1995 Evaluation and Management (E&M) Score Sheet Companion

You are using the 1995 E&M Score Sheet to verify that the Evaluation and Management (E&M) code you selected is appropriate. You need a definition of a specific field on the form. A Score Sheet Companion is on the Novitas Educational Tips and Tools - NETTs page to assist you. Please visit the NETTs page and review the article titled "1995 Evaluation and Management (E&M) Score Sheet Companion". You are also encouraged to check back often and signup for the Listserv so you receive notification of the recent updates and additions. The link to Score Sheet Companion can be found here.

Medicare Learning Network (MLN) Matters Articles from CMS

Medicare Part B News-Jurisdiction H for March 20th, 2014

The following announcements are brought to you by Novitas Solutions.

Novitas Educational Tips and Tools - NETTs: Importance of Documentation

In an effort to bring the "Importance of Documentation" to the forefront and provide you a useful resource, Novitas Educational Tips and Tools - NETTs is providing a document for your reference and use. Please select and review the "Key Points" and additional "Reference" resources available so you will be "in the know" of what is expected with your general Evaluation & Management documentation. Continue to look for notifications of future additions and join our Listserv so you receive notification of updates and important "need to know" information.
The article can be found by clicking here.

System Alert-Issued Closed

Codes 76937 & 76942 denied when performed by a Physician Assistant or Nurse Practitioner
UPDATED: (3/20/14 @ 8:45AM)
As of March 20, 2014, all claims have been adjusted. This issue is now closed.

ORIGINALLY ISSUED: (2/27/14 @ 4:00PM)
Beginning August 2, 2013 Novitas Solutions incorrectly denied Current Procedural Terminology (CPT) codes 76937 and 76942 when performed by a Physician Assistant (PA) or Nurse Practitioner (NP) in the JH jurisdiction. We have updated our processing system to allow payment for these two codes as of February 28, 2014. A mass adjustment project is being initiated to automatically adjust claims that may have been denied in error. No provider action is necessary to request adjustment of claims.

Medicare Learning Network (MLN) Matters Articles from CMS


CMS MLN Connects Provider e-News

The March 20, 2014 edition of the MLN Connects Provider e-News is now available.

**Please take note of the article included in the Claims, Pricers and Codes section of this edition:
  • Medicare Only Accepting Revised CMS 1500 Claim Form (02/12) Starting April 1













CMS Regions 5-8 Open Payments Webinar


Dear Associations, Medical Societies, Physicians, Practitioners, and Practice Managers,


The Centers for Medicare & Medicaid Services (CMS) invites you to attend the Open Payments Webinar on Wednesday, April 16, 2014, from 12:00-1:00pm CDT (11:00am-12:00pm MDT)

Open Payments (Physician Payments Sunshine Act) is a program that increases public awareness of financial relationships between drug and device manufacturers and certain health care providers. This webinar will provide an overview of the final rule, information on your role in the program, resources available to you as a health care provider, and key program dates. The presentation will be followed by a question and answer session with staff from the Center for Program Integrity’s Data Sharing and Partnership Group.

This call is intended for association/medical society staff, physicians, practitioners, and practice managers located in CMS Regions 5, 6, 7, and 8. Associations/medical societies are encouraged to invite member providers.

CMS Speaker: Anne Carey, Nurse Consultant, Atlanta Regional Office
Webinar link: https://webinar.cms.hhs.gov/openpaymentsro5-8/
Telephone dial-in number: (877) 267-1577
Meeting ID number: 994 370 464

This meeting does not require a password

SAMHSA-HRSA Center for Integrated Health Solutions- News & Updates


The Magnificent Seven: Trainings for the Entire Integrated Care Team

Your integrated care team may include professionals from primary care, mental health, and substance use; to work together, they must understand how each sector works and what it takes to successfully integrate primary and behavioral healthcare.

The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) worked with experts to produce a variety of skill development trainings for members of the integrated care team.

Take a look: 
  • Social Workers: The Integrated Healthcare Curriculum for Schools of Social Work, developed with the National Association of Deans and Directors of Schools of Social Work and the Council on Social Work Education, is a downloadable curriculum – including slides, suggested readings, and activities – that introduces social work students to the practice of integrated behavioral health in primary care and develops skills in engagement, assessment, intervention planning and implementation, and practice evaluation. 
  • Addiction Treatment Professionals: This 5-hour self-paced online course, developed in collaboration with the Addiction Technology Transfer Center Network and the Morehouse School of Medicine National Center for Primary Care, is a five part training that provides resources and information to help addiction treatment and other behavioral health professionals understand whether working in a primary care setting is a good fit for them. Continuing education (CE) credits are available for professionals who complete the course. 
  • Psychiatrists: This online training curriculum for psychiatrists working in primary care, from the University of Washington AIMS Center, consists of five modules that describe the basic structure of integrated behavioral health in a primary care setting and the role for a consulting psychiatrist in an integrated care team. 
  • Peer Specialists: Whole Health Action Management (WHAM) prepares peer providers to serve as health educators and coaches. The curriculum guides participants through a person-centered planning process to set a whole health and resiliency goal and implement a weekly action plan. The training helps the peer workforce move into service models like health homes. The curriculum is available in both English and Spanish. 
  • Case Managers: The Case to Care Management Training is a one-day course that expands the traditional case manager role from helping clients with serious mental illness in navigation and behavior change toward a broader role of helping them learn to manage co-occurring physical and mental illnesses. 
  • Behavioral Health Consultants: A Certificate Program in Integrated Care Management, from the Department of Family Medicine and Community Health at the University of Massachusetts Medical School, offers licensed mental health professionals certification to expand their care management skills for Patient Centered Medical (or Health) Homes. 
  • Frontline staff: Mental Health First Aid creates capacity within primary care (e.g., nursing aides, psychiatric technicians, social workers, human services assistants) to identify, understand, and respond to signs of mental illnesses and substance use disorders. CIHS supported the development of Mental Health First Aid tools designed for application in rural communities, as well as a Spanish adaptation of the curriculum to address the needs of diverse communities across the country. 

What else can you do to develop your integrated care team? Check out the Core Competencies for Integrated Primary Care and Behavioral Health, and visit our education and training page for additional professional development resources for integrated care. And email integration@thenationalcouncil.org to let us know of trainings you find useful for your integrated care team.
P.S. Primary Care Clinicians – we’ll have additional training for you soon. Be on the lookout for the Primary Care Physician Training Curriculum, for clinicians working in behavioral health settings, in the next few months. All resources will be shared on our workforce web page.

Affordable Care Act Grace Period Information

To learn more about how the ACA grace period will affect providers, read "5 Pointers on 'Grace Period' Patients" by clicking here.

Lean Six Sigma Training for Healthcare

Excellence In Healthcare Delivery

Lean Six Sigma Excellence in healthcare delivery means helping improve patient outcomes while driving down the cost of patient care! Apply the concepts of continuous improvement to create and sustain a more productive, efficient and cost effective healthcare delivery organization. 


Become Black Belt Certified!

The program provides for a quality principles overview, in-depth instruction in management by fact, along with a structured performance improvement methodology used by Lean Six Sigma Black Belts and Master Black Belts world wide.

The course curriculum is derived from five sources:

1. The American Society of Quality's Lean Six Sigma Body of Knowledge.
2. The Malcolm Baldrige Healthcare Criteria for Performance Excellence.
3. The isixsigma.com Lean Six Sigma Body of Knowledge.
4. The Project Management Institute's Project Management Body of Knowledge.
5. Curriculum and Best Practices from the finest Healthcare Systems nationwide. 

Classes start 3/28/2014. For more information on course curriculum and enrollment, click here.

Thursday, March 20, 2014

Medicare Part B- POE Advisory Group Meeting Minutes

JH Part B Provider Outreach and Education (POE) Advisory Group (AG) Meeting Minutes
 2/20/2014

The Jurisdiction H Part B Provider Outreach and Education (POE) Advisory Group (AG) Meeting Minutes for 2-20-2014 are now available for your review here.

Medicare Part A- POE Advisory Group Meeting Minutes

JH Part A Provider Outreach and Education (POE) Advisory Group (AG) Meeting Minutes
2/20/2014

The Jurisdiction H Part A Provider Outreach and Education (POE) Advisory Group (AG) Meeting Minutes for 2-20-2014 are now available for your review here.

Therapy Threshold Cap

Release of Therapy Threshold Cap claims effective 2/28/2014

Late Development of Therapy Threshold Cap Additional Development Requests (ADR’s)

CMS provided direction that February 28 is the last day a MAC may send Pre-Payment ADRs for the Recovery Auditor Prepayment Review Demonstration.

Due to the timing of system processing for Pre-Payment review activity, the late development of ADR’s were processed after February 28, 2014. If you receive a Pre-Payment ADR dated 2/28/2014 or after from Novitas, please disregard this request. You do not have to submit the Medical Records to the Recovery Auditor at this time. Claims that hit the threshold as of 2/28/2014 are still subject to Post Payment review by the Recovery Auditor. You must respond to any subsequent Post Payment request for documentation from the Recovery Auditor.

Medicare Part B-Route to ICD-10


Road to 10: The Small Physicians Practices Route to ICD-10

Are you a small physicians practice wondering how to transition to ICD-10? Well you’re in luck!!  We posted the Centers for Medicare & Medicaid Services, Road to 10: The Small Physicians Practices Route to ICD-10, on the ICD-10 Implementation page of our website. This on-line resource will help guide you through the ICD-10 process.

CREATE Tip of the Week - Self-Score

Self - Score Your Application Before A CREATE Review 

Did you know that the CREATE Scoring Tool used in CREATE Review’s by the Financial Waiver and Expert Review Committee’s is posted on the CREATE website? This tool is an outstanding tool for self-evaluating and improving each section of your grant application. Before you submit your application for the next review, take time to self-score and also ask others in your agency to score your application and provide feedback. It’s up to you to make sure that your application directly speaks to the reviewer and provides enough detail that they can offer you high passing scores and a demonstrated understanding of your need for emergency or trauma education / training. For more information or to apply for CREATE, contact Grants Manager, Lakesha Jones by email at lj@coruralhealth.org or visit our website at http://www.coruralhealth.org/programs/create/ .

Medicare Part B-"Ask the Contractor Teleconference"

JH Part B Teleconference Handout: "Ask-the-Contractor Teleconference" 
March 20, 2014 (10:00am-11:30am CT)

The Jurisdiction H Part B Ask-the-Teleconference Agenda for March 20, 2014 is available for your viewing pleasure by clicking here.

Place of Service Codes Webinar

Part B Webinar Handout: "Using Place of Service Codes Correctly"

March 19, 2014 (2:00pm -3:00pm ET, 1:00pm-2:00pm CT)

If you are struggling to determine which place of service codes you need to use to complete your Medicare billing, then you must attend our webinar on "Using Place of Service Codes Correctly." We will discuss place of service code definitions, common place of service code resources and the
Comprehensive Error Rate Testing (CERT) Program. If that is not enough, we will also provide you with self service options to assist you with locating information quickly. You must register for this event today!





Medicare Part A-Important Announcement for J12901 and J04911 Providers

UPDATED: Important Announcement for J12901 and J04911 Providers Connecting to the Hewlett-Packard (HP) Data Center

Effective Monday, March 24, 2014, you will no longer access FISS via HP Data Center. Instead, you will be accessing through the Companion Data System (CDS). Please read the full details of this article so you can be prepared for the change.

Medicare Part A- "Dark Days" for Common Working File Hosts

April 2014 Release "Dark Days" for the Common Working File (CWF) Hosts

For the upcoming April 2014 Release, Change Request (CR) 8382, Common Working File (CWF) Part A Claim Record Expansion, the CWF Hosts will be performing a history conversion. Due to the anticipated duration of this activity, there will be one “gray” day occurring on Thursday, April 3, 2014, and two “dark” days on Friday, April 4, 2014 and Saturday, April 5, 2014.

Below is a list of scheduled events for the release:

  • CWF Hosts will implement the Out of Service Area (OSA) drop for 03/31/14 through 04/04/14.
  • CWF Hosts will not perform any XREF or Health Insurance Correction Record (HICR) transactions from 03/31/14 through 04/06/14. 
  • 04/03/14 will be considered a “Gray” day for the CWF Hosts. This means the CWF online Health Insurance Master Record (HIMR) inquiry and the Beneficiary Data Streamlining (BDS) transaction will be available for all MACs. In addition, CWF Hosts will process In Sector Area (ISA) claims during the day on 04/03/14 and deliver response files back to the MACs in the old format for 04/03/14 night’s processing.
  • CWF Hosts will hold the claims received from MACs on 04/03/14 and 04/04/14. 
  • 04/04/14 and 04/05/14 will be a “Dark” day for CWF Hosts with no on lines available, which means, no access to the HIMR inquiry and BDS transaction. 
  • CWF Host will install the CWF April quarterly release on 04/04/14. 
  • CWF Host will run the CWF SSM conversion and combine the held 04/03/14 and 04/04/14 MAC files on 04/07/14 and will send the combined files to the Fraud Prevention System (FPS) in the new version. 
  • 04/07/14, the on lines are available for CWF Host under the new version. CWF Host will receive responses from the FPS by the afternoon of 04/07/14. The FPS response files will be loaded for CWF ISA processing on the night of 04/07/14. Response files will be sent to MACs in the new version for 04/08/14 night’s processing

Medicare Part A-Pathway for SGR Reform Act of 2013


Pathway for SGR Reform Act of 2013 – FY 2014 Low Volume 412.101 Applications

Section 1105 - Extension of Medicare Inpatient Hospital Payment Adjustment for Low-Volume Hospitals - The Affordable Care Act 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. This provision extends the payment adjustment through March 31, 2014, retroactive to October 1, 2013. For information can be found by clicking here.

Medicare Part B News- Customer Contact Training Schedule

Customer Contact Center Training Schedule for April 2014

The Customer Contact Centers will close for training on Friday, April 4th and thereafter Thursday afternoons in the month of April. Please visit our Holiday and Training webpage for all of the dates and times.

Medicare Part B News- Medicare Insights Podcast

Don't miss this week's Medicare Insights Weekly Podcast Interview with Medial Affairs

We wrap up our podcast series on Local Coverage Determinations with an interview with a representative from Medical Affairs. If you haven't listened to our podcasts, this is the time to start!

Information on podcast subscription can be found by clicking here.

Medicare Part B News-Submitting Medical Records by Disc

Submitting Medical Records by Disc (CD or DVD)

We are receiving encrypted CD's without passwords- or they are defective or not readable. Failure to obtain the password from you will impact access to the medical records and may have a negative impact on your claim. Please review bulletin, Submitting Medical Records by DISC (CD or DVD) located in the bulletin section of our website.


Medicare Part A News-"Ask-the-Contractor Teleconference"

JH Part A Teleconference Handout: "Ask-the-Contractor Teleconference" 
March 19, 2014 (10:00am-11:00am CT)

Join us for our Jurisdiction H Part A "Ask-the-Contractor Teleconference" on March 19, 2014 at 10:00am CT.

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.

To participate in the teleconference, please register by clicking here.

Medicare Part A News- MLN Matters Articles


Medicare Learning Network (MLN) Matters Articles from CMS

Medicare Part A- JH Top Claim Submission Errors 2/14


JH Part A Top Claim Submission Errors - February 2014

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

JH MAC Local Coverage Determination

The following JH MAC Local Coverage Determination (LCD) is posted for notice and will become effective for dates of service on or after May 1, 2014:

The following JH MAC Local Coverage Determinations (LCDs) have been revised:

The following JH MAC Local Coverage Determination (LCD) has been retired effective for dates of service on and after 11/01/2013.

Medicare Part B-MLN Connects, Weekly Provider News

CMS MLN Connects Provider e-News

The March 13, 2014 edition of the MLN Connects Provider e-News is now available. Subscribe to the newsletter by clicking here.

Wednesday, March 19, 2014

Medicare Part B- Avoiding Claim Delays

Avoid Claim Delays - Start using the New CMS-1500 (02-12) Claim Form Today! 
 
As of April 1, 2014, we will no longer accept the CMS-1500 (08-05) claim form. Please begin using the new CMS-1500 (02-12) claim form now. Read the full article by clicking here.




Tuesday, March 18, 2014

Medicare Part B - Reduce your wait time by using the IVR

As you may be aware, Novitas has been experiencing longer than usual wait times for our Customer Service units and we apologize for the inconvenience. Please be assured that we are working diligently to improve our service times. Many of our calls are for items that can be obtained through the use of our Self Service Tools and Interactive Voice Response Unit (IVR) and we would like to encourage our customers to use these automated tools to obtain information. Using these resources will allow us to streamline and route more difficult requests directly to a Customer Service Representative. Also, please note that it is a CMS requirement to use the IVR if the answer can be obtained within one of the options, and we are required to transfer callers back to the IVR if the information can be obtained using that tool.

To avoid the long wait times on the phone, please use the self-service tools and the IVR to obtain automated information. We appreciate your assistance as we work towards resolving the long wait times for the Customer Service units.

Part B IVR
Click here for Step by Step instructions on how to navigate the IVR
Click here for our IVR Quick Reference Guide

We have created a dedicated IVR link on the left side bar of our website for easier access of resources. As a reminder, below is a list of the items that can be obtained through the IVR:

General Information:
  • Claim Status 
  • Beneficiary Eligibility 
  • Beneficiary Deductible Amount 
  • Beneficiary Preventive Service Dates 
  • Patient Account Number Information 
  • Status of My Check 
  • Provider Summary Information 
  • Order a Duplicate Remittance 
  • Fee Schedule Pricing 
  • Fax a Copy of Your Provider Summary 
  • Fax a List of Your Pending Claims 
  • Fax a List of Your Finalized Claims 

Claims Correction:
  • Correct a Previously Processed Claim 

Provider Enrollment:
  • Status of 855 or 588 Enrollment Forms

Medicare Part A - Reduce your wait time by using the IVR

As you may be aware, Novitas has been experiencing longer than usual wait times for our Customer Service units and we apologize for the inconvenience. Please be assured that we are working diligently to improve our service times. Many of our calls are for items that can be obtained through the use of our Self Service Tools and Interactive Voice Response Unit (IVR) and we would like to encourage our customers to use these automated tools to obtain information. Using these resources will allow us to streamline and route more difficult requests directly to a Customer Service Representative. Also, please note that it is a CMS requirement to use the IVR if the answer can be obtained within one of the options, and we are required to transfer callers back to the IVR if the information can be obtained using that tool.

To avoid the long wait times on the phone, please use the self-service tools and the IVR to obtain automated information. We appreciate your assistance as we work towards resolving the long wait times for the Customer Service units.


Part A IVR
Click here for Step by Step instructions on how to navigate the IVR
Click here for our IVR Quick Reference Guide

We have created a dedicated IVR link on the left side bar of our website for easier access of resources. As a reminder, below is a list of the items that can be obtained through the IVR:

General Information:
  • Claim Status 
  • Beneficiary Eligibility 
  • Beneficiary deductible amount 
  • Beneficiary Preventive Service Dates 
  • Overlapping Claims Information 
  • Patient Discharge Status Information 
  • Home Health Episode of Care 
  • Check Status 
  • Remittance Information 
Provider Enrollment:
  • Status of 855 or 588 Enrollment Forms

Free AgriSafe Webinar: Respiratory Program Adapted for Agriculture


The primary goal of this webinar is to highlight the components of an effective respiratory protection program for the agricultural workplace. The intended audience for this presentation includes healthcare professionals who provide care in agricultural communities, business owners, managers, and workers in production agriculture.

Participants will learn to:
  • Recognize the diverse respiratory hazards unique to agricultural and the justification for a comprehensive respiratory program. 
  • Identify the OSHA respirator standards that apply to an agricultural setting. 
  • Understand key components of an effective respiratory protection program 
  • Access resources, templates, medical evaluations, and further trainings to effectively implement a respiratory program.
The webinar will be held on March 26th, 2014, from 12:00pm-1:00pm. Event details and registration information can be found by clicking here.

CDPHE Community Forums on Health Information Technology

The Colorado Department of Public Health and Environment will be hosting two community forums on Health Information Technology, Clinic Quality Measurement, and Population Health.

The forum held in Greeley, CO will take place on Wednesday, April 16th, 2014 from 12pm-1pm, and the flyer for event details can be found by clicking here.

The forum held in Pueblo, CO will take place on Wednesday, April 30th, 2014 from 12pm-1pm, and the flyer for event details can be found by clicking here.

Issuing Guidelines for Geriatric EDs

ENA joins groups in issuing guidelines for geriatric EDs

In response to the proliferation of geriatric EDs geared specifically to patients ages 65 and older, the Emergency Nurses Association, American College of Emergency Physicians, American Geriatrics Society and Society for Academic Emergency Medicine have issued a comprehensive set of geriatric ED guidelines covering everything from staffing to education to handling common problems of aging, such as falls, delirium and dementia. Click here to read the full article posted March 5, 2014 at Nurse.com.

Hospital Patient Satisfaction

5 straightforward ways to improve patient satisfaction in hospitals

Patient satisfaction and improving the hospital experience is being discussed in hospital boardrooms across the country. Now that financial reimbursements are directly tied to HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey scores, there is a significant incentive to do so. A multitude of ideas are being put forward into how this can be achieved, and hospitals are investing heavily to get tangible results. Many involve complicated and expensive methods that unfortunately border on being a bit gimmicky. Examples include reorganization of medical floors and staff, computer-based solutions, pamphlets, and other free “treats.” Click here to read the full article by Suneel Dhand, MD, February 19, 2014.

RHC Billing and Cost Reporting Seminar


RHC Billing and Cost Reporting Seminar 

Clanton, Alabama
March 28, 2014

I will be speaking on cost reporting at the AMS Software RHC Billing and Cost Reporting Seminar on March 28, 2014 in Clanton, Alabama. The billing speaker will be Charles James, Jr. who will conduct the morning session and I will present on cost reports and annual evaluations in the afternoon session. To find out more check out the AMS website at:

http://www.ams-software.com/

For more information, email Matt Kannan at matt@ams-software.com or call Paul Samia or Matt Kannan at 800-440-6949.



RHC Billing Series-Session 2-More Advanced Topics

RHC Billing Series - Session 2 - More Advanced Topics


Please register for RHC Billing Series - Session 2 - More Advanced Topics on Apr 30, 2014 12:00 PM EDT at: 


In this second webinar on Billing, we will discuss commingling, preventive services, global billing for surgeries, specialists, non-rhc time, transitional care management, hospice, and a number of more complex billing issues.

After registering, you will receive a confirmation email containing information about joining the webinar.

RHC Billing Series-Session 1- The Basics of Medicare Billing


RHC Billing Series - Session 1 - The basics of Medicare Billing 


Please register for RHC Billing Series - Session 1 - The basics of Medicare Billing on Apr 17, 2014 12:00 PM EDT at: 


In this session we will review the basics of RHC billing starting with definition of a visit, where to find information, laboratory billing, technical components, hospital visits, Incident to, revenue codes and other basics of RHC billing.

After registering, you will receive a confirmation email containing information about joining the webinar.

RHC Annual Evaluation Webinar


Annual Evaluation Webinar 

Please register for Annual Evaluations - Why they are required and how to conduct one on Apr 9, 2014 12:00 PM EDT at: 



In this webinar, you will learn why the annual evaluation is required in RHCs and how to conduct an annual evaluation. We will go though the entire process and how to cost effectively conduct an annual evaluation. You will be provided tools to help you conduct the annual evaluation including a Word Template and forms to help conduct the evaluation.

After registering, you will receive a confirmation email containing information about joining the webinar.

Thursday, March 13, 2014

MLN Connects-eNews


For those interested in viewing the Medicare Learning Network's enewsletter, click here for weekly provider news. Be sure to subscribe to get the most up-to-date information.

Applications for Indian Health Services

Indian Health Services Provider Enrollment Applications- Development Requests for Additional Information

Please read this important article about development requests for additional information on your Provider Enrollment applications. We are noticing trends in missing data on the various CMS 855 enrollment applications, and it is causing delays in processing your application. Did you miss one of these required items?

Novitas Provider Enrollment Status Inquiry

What Is The Status of My Enrollment Application?

Novitas has been receiving many calls requesting the status of applications that were recently sent to us for processing. As a reminder, Novitas has a Provider Enrollment Status Inquiry Tool that provides the status history of all Part A and Part B Internet-based Provider Enrollment, Chain and Ownership System (PECOS) or paper submitted CMS 855/588 (EFT) applications. Using the dropdown menu in the field next to “Select”, you have the ability search using the following criteria: 
  • Document Control Number (DCN) 
  • National Provider Identifier (NPI) 
  • Internet based PECOS Tracking ID Number 
  • Legal Business Name 
  • First/Last Name 

Once you have entered your search criteria, click on “Submit Query”; do not hit the enter key. Search results are based on EXACT matches between the input search criteria and the information we record directly from the application. Only one search criteria can be selected at a time. If you submit multiple applications to Novitas, you may receive more than one exact match in the search results. If this occurs, click on the DCN associated to the application you would like to view. If you would like to go back to the search results screen to view another DCN, click “Return to Multiple Results Page.”

To check the status of an application, please use the applicable links below:
Provider Enrollment Status Inquiry Tool

Please keep in mind that CMS has defined specific timeframes for processing CMS-855 forms. To learn more about those timeframes, please reference Chapter link below and go to the section titled “Processing Timeframes”: Enrollment Guide: Chapter 5 - Other Requirements and Timeliness Standards

Top Claim Submission Errors


JH Part B Claim Submission Errors

The Top Claim Submission Errors and their resolutions for January 2014 are now available. Please take some time to review these errors and avoid them on future claim submissions.
Part B Webinar Handout: "Evaluation and Management Score Sheet: Part Three-Using the Score Sheet"

March 20, 2014 (11:00-12:00pm ET, 10:00am-11:00am CT)

Join us for "Part Three-Understanding the Score Sheet" of the Four Part Series on Evaluation and Management Score Sheet. This four part series was developed to increase your understanding of evaluation and management services. The complete series will be presented every month with one part each week. It is recommended to take the entire series in order to maximize your understanding. However, if you miss any part of the series, it will be presented again the following month in the same order.

The series will consist of the following:
  • Week One-Part One- Understanding the Key components of Evaluation and Management. 
  • Week Two-Part Two- Introduction to the Score Sheet, 
  • Week Three- Part Three- Using the Score Sheet 
  • Week Four- Part Four- Scoring Medical Records Using the Score Sheet 
If you are new to documenting and/or scoring evaluation and management services, this webinar event is for you. You must attend this event.

Register for this event by clicking here.

Medicare Part B News - JH System Alerts


Codes 76937 & 76942 denied when performed by a Physician Assistant or Nurse Practitioner

UPDATED: (3/12/14 @ 8:45AM):
The mass adjustment project is scheduled for March 14, and claims that may have denied in error will be adjusted.

ISSUED: (2/27/2014)
Beginning August 2, 2013 Novitas Solutions incorrectly denied Current Procedural Terminology (CPT) codes 76937 and 76942 when performed by a Physician Assistant (PA) or Nurse Practitioner (NP) in Jurisdiction H States. We have updated our processing system to allow payment for these two codes as of February 28, 2014. A mass adjustment project is being initiated to automatically adjust claims that may have been denied in error. No provider action is necessary to request adjustment of services previously denied.

Social Determinants and Health Equity Workshop



Social Determinants and Health Equity: Widening the Lens of Health Promotion


Grand Junction, CO: 6/2-6/3/14

Alamosa, CO: 6/24-6/25/14

This two-day course will examine the effects of social determinants of health such as economic status, stigma, homophobia, racism and other social and political issues on risk, prevalence and access to services. A model and continuum of approaches will be introduced to assist prevention and care providers with implementation strategies to address these concerns. Participants will become familiar with strategies for improving health equity so that individuals are more empowered to make healthy choices regardless of their living condition, income, sexual orientation or ethnic background.

Course Objectives:

1. Define terms related to social determinants of health
2. Explain how the values of social and personal responsibility may influence people’s understanding of health outcomes
3. Explain the relationship between social determinants and population health outcomes
4. Describe health disparities as demonstrated by current epidemiological data
5. Describe how social determinants affect an individual’s health seeking behaviors
6. Describe how social determinants can explain disparities in disease prevalence
7. Select ways to integrate a social-determinants-of-health perspective into current health promotion and prevention work


Register for the Grand Junction workshop by clicking here.

Register for the Alamosa workshop by clicking here.


Questions?
Contact Katie.Langland@dhha.org or 303.602.3620



Webinar: Care Transitions and Health Information Exchanges

Care Transitions and Health Information Exchanges

Webinar: March 19th, 12:00-1:00 MT

Join Pamela Russell from the Colorado Regional Health Information Exchange for an update on HIE progress in the state, including which hospitals, labs, and long-term and post-acute care organizations are participating. Learn about Direct messaging and how it's being used to improve care transitions from skilled nursing homes to an Emergency Department in one community up north. 

Hosted by the Center for Improving Value in Health Care

Attend this free webinar and learn how you can strengthen care transitions and reduce readmissions!

Click Here for Free Registration



Patient Navigator Facilitation Skills Workshop in Telluride


Facilitation Skills for Group-Level Health Promotion Interventions
Telluride, CO
Date: 4/23-24/14

The primary goal of this two-day training is to enhance participants’ facilitation skills relevant to Patient Navigators delivering group-level interventions. This course will focus on the development of new skills as well as the enhancement of existing skills. This course is appropriate for an audience of varying experience. Participants will have the opportunity to assess their own facilitation skills and understand their strengths and how to fortify their skills.


Course Objectives

1. Explain the different roles that small groups play in prevention interventions
2. Describe the differences between facilitation, education and presentation styles
3. Explain why incorporating different learning styles into group facilitation creates a richer learning environment
4. Practice effective verbal and non-verbal facilitation skills
5. Practice skills to help address challenges in a group process
6. Discuss how co-facilitation skills can affect group facilitation
7. Construct a quality assurance plan for small group prevention efforts


To register by clicking here:





New Accountable Care Collaborative Video


New Video about the Accountable Care Collaborative

The Department has just released a new animated video about the Accountable Care Collaborative. Check out our new video here that helps to explain what the ACC is and how it helps Medicaid clients get connected to the right services, in the right setting, at the right time.

PQRS Call with CMS

Register for the National Provider Call on March 18 to Learn About Reporting Once for 2014 Medicare Quality Reporting Programs

Join CMS on March 18 from 1:30 to 3:00 pm ET for a National Provider Call about reporting across Medicare quality reporting programs in 2014.

This call will provide an overview of how to report across various 2014 Medicare quality reporting programs, including the Physician Quality Reporting System (PQRS), Electronic Health Record (EHR) Incentive Programs, Value-Based Payment Modifier (VM), and Accountable Care Organizations (ACOs).

CMS subject matter experts will guide providers who wish to report quality measures one time during the 2014 program year to maximize their participation in the various Medicare reporting programs.

Agenda
  • During the call, individual eligible professionals, group practices, and ACOs will learn how to: 
  • Become incentive eligible for the 2014 PQRS program 
  • Avoid the 2016 PQRS payment adjustment 
  • Satisfy the clinical quality measure (CQM) component of the Medicare EHR Incentive Program 
  • Satisfy requirements for the 2016 VM adjustment, if applicable 

A link to the slide presentation will be posted prior to the call.

Registration Information
To register for this National Provider Call, please visit the CMS MLN Connects Upcoming Calls registration website.

Medicare Insights Weekly Podcast on Local Coverage Determination

This news is brought to you by Novitas Solutions, INC.:

Have you reviewed a local coverage determination and wanted a change? In this week's Medicare Insights Weekly podcast, we discuss the Local Coverage Determination reconsideration process. Listen to this podcast to know when and how to ask Novitas to change a local coverage determination.

QualityNet Secure Portal: Webinar

National Provider Webcast scheduled for Tuesday, March 18, 2014. The webcast will be presented by Bob Dickerson, MSHSA, RRT, Lead Health Informatics Solution Coordinator, Telligen.

This presentation will review the QualityNet Secure Portal and the Portal registration process. For more information see the attached flyer.

The webcast will be offered at: 11:00 p.m. ET and at 3:00 p.m. ET. To register for each event, please use the information below:

For the 11:00-12:00 p.m. ET session, register by clicking here.

For the 3:00-4:00 p.m. ET session, register by clicking here.




QHi Back to Basics Session: Webinar

Please join us for our next QHi Back to Basics Session scheduled for Tuesday, March 25 from 2:00 to 3:00 Central Time. After a quick review of updates to the site and to measures, we will walk through the live site demonstrating how to select measures, add users, enter data and run reports. All QHi users are invited to participate on this free webinar. Following the demonstration, we will open the lines for discussion, so bring questions of your peers.

Event: QHi Back to Basics 3/25/14 2:00 CT
Location: Webinar/conference call
Starts At: 2014-03-25 14:00
Ends At: 2014-03-25 15:00

Go to https://cc.readytalk.com/r/r724jmw2i4xn&eom to register for the session.

Friday, March 7, 2014

CDPHE iCARE Participants Reimbursements?


CDPHE iCARE Participants receive reimbursement for registration fees, lodging, and mileage for Forum!

CDPHE iCARE participants can send two representatives from their facility and receive reimbursement for 1) Registration fees 2) Lodging and 3) Mileage. Not sure if your facility is a CDPHE iCARE participant?  Check out this informational flyer for further details.

Funding For Certified RHC attendance to Forum


Certified Rural Health Clinics can receive up to $1,000 when attending 2014 Forum

To receive funds each Certified RHC participant IS REQUIRED to attend BOTH emergency preparedness sessions offered at the Forum. Attendees will be provided with an attendance verification form during each session. Funds will be allocated following the conference and after attendance is verified. This opportunity is available to any Certified RHC Staff attending the Forum. Each clinic may register up to two attendees; clinics wishing to register more than two attendees must be pre-approved as funds are limited (contact Bridgette at bo@coruralhealth.org to request registering more than two attendees). Click here for informational flyer.

14th Anual Forum Conference


Don’t miss this year’s Forum conference! Register Today

The 14th Annual Forum will be held April 9-11, 2014 at the Sheraton Denver West in Lakewood, bringing together participants from all over Colorado and the surrounding states. The Forum serves as an essential educational, training, and networking conference for all safety net clinics and other interested parties.  Register Today!  Member rate is $295.  Non-members rate is $450.

Thursday, March 6, 2014

March 18th, ICD-10 PCS Coding Webinar #4

Please register your ICD-10 Implementation Team for this meeting here.


Meeting Description:
Please join us on Tuesday, March 18, 2014, from 12:00pm - 1:30 pm for the 4th webinar in this series of procedural coding for CAHs and Rural PPS hospitals -- so you and your small rural hospital will be ready for October 1, 2014.

March 13th ICD-10 impementation Webinar #6

Please register your ICD-10 Implementation Team for this meeting here.

Meeting Description:


Please join us Thursday, March 13, 2013, from 12:00pm - 1:15pm to continue this step by step journey toward a successful ICD-10 Implementation on October 1, 2014

Wednesday, March 5, 2014

Level 2 Patient Navigator

Registration open for a Level 2 Patient Navigator online course, Emotional and Social Aspects of Disease.


The Patient Navigator Training Collaborative has opened registration for a Level 2 online course, Emotional and Social Aspects of Disease.


COURSE DESCRIPTION: Chronic diseases affect our physical bodies, but they also have an emotional, social and psychological impact. This course explains how chronic disease affects patients and their families and the role of navigators in helping patients.


DATES: Tuesday, April 1 - Friday, May 16, 2014 (7 weeks)



COST: Free for Colorado patient navigators, $400 for navigators outside Colorado



COURSE FORMAT: This is an online course. ALL course activities take place via the internet (there are no face-to-face meetings). You will login to a course “website” to complete activities. Course activities include readings, online tutorials, videos, quizzes and online discussions. This course is not self-paced. Activities are required each week. There are no “live” meeting times or webinar meetings. You will complete all activities independently and use the discussion tool to interact with other students. Online discussions are similar to email: you will post your response to a question or case study early in the week (using the discussion tool) and check back a minimum of three times per week to read and respond to messages left by other students. Please review the registration page for more details regarding time commitment.

 

Register and learn more at: https://publichealthpractice.org/civicrm/event/info?id=235&reset=1


We hope to see you online!


 Patient Navigator Training Collaborative www.patientnavigatortraining.org

Board Training Webinars



CRHC is pleased to announce a three-part Board Training webinar series with presenter Bill Charney from Charney Associates. Click on the links below for more information and to register. We hope you and your boards will join us for these webinars.


Part I  I’m on the Board: Now What’s My Job?
Thursday March 13th 4:30-6:00 MST

CLICK HERE to register



Part II
Leading With One Voice
Thursday, March 20th 4:30-6:00 MST
CLICK HERE to register

 

Part III
Chairs and CEOs: Who Leads What?
Thursday, March 27th 4:30-6:00 MST

CLICK HERE to register