no notes wps gha spring payer panel ppt.…– wps gha portal enhancements – medicare day of...
TRANSCRIPT
03/22/2018
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wpsgha.litmos.com
6th Annual Spring Payer PanelMarch 29, 2018
Agenda
• Program News and Announcements
– New Medicare Cards
–WPS GHA Portal Enhancements
–Medicare Day of Learning
– CMS Electronic Cost Report Submission Portal
– Outpatient Therapy News
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Agenda
• Clinical News and Reviews
– Targeted Probe and Educate (TPE)
– CMS Review Reason Codes
• MAC Satisfaction Indicator (MSI)
• Resources
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Program News and Announcements
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New Medicare Cards
Replacing Health Insurance Claim (HIC) Numbers
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Medicare Beneficiary Identifier
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Where:
C – Numeric 1 thru 9
A – Alphabetic Character (A...Z); Excluding (S, L, O, I, B, Z)
N – Numeric 0 thru 9
AN – Either A or N
***NOTE: Alphabetic characters are Upper Case ONLY
Position 1 – numeric values 1 thru 9
Position 2 – alphabetic values Athru Z (minus S, L, O, I, B, Z)
Position 3 – alpha-numeric values 0 thru 9 and A thru Z
(minus S, L, O, I, B, Z)Position 4 – numeric values 0 thru 9
Position 5 – alphabetic values Athru Z (minus S, L, O, I, B, Z)
Position 6 – alpha-numeric values 0 thru 9 and A thru Z
(minus S, L, O, I, B, Z)
Position 7 – numeric values 0 thru 9
Position 8 – alphabetic values A thru Z (minus S, L, O, I, B, Z)
Position 9 – alphabetic values A thru Z (minus S, L, O, I, B, Z)Position 10 – numeric values 0 thru 9
Position 11 – numeric values 0 thru 9
Transition Timeline
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Look-Up Tool
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Social
Security Number
First
and last
name
Date of
birth
New Card Mailing Schedule
Wave States Included Cards Mailing
1Delaware, District of Columbia, Maryland,
Pennsylvania, Virginia, West VirginiaApril – June 2018
2Alaska, American Samoa, California, Guam, Hawaii,
Northern Mariana Islands, OregonApril – June 2018
3Arkansas, Illinois, Indiana, Iowa, Kansas, Minnesota,
Nebraska, North Dakota, Oklahoma, South Dakota,
Wisconsin
After June 2018
4Connecticut, Maine, Massachusetts, New Hampshire,
New Jersey, New York, Rhode Island, VermontAfter June 2018
5Alabama, Florida, Georgia, North Carolina, South
CarolinaAfter June 2018
6Arizona, Colorado, Idaho, Montana, Nevada, New
Mexico, Texas, Utah, Washington, WyomingAfter June 2018
7Kentucky, Louisiana, Michigan, Mississippi, Missouri,
Ohio, Puerto Rico, Tennessee, Virgin IslandsAfter June 2018
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Help Spread the Word
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Portal Enhancements
Improving Provider Self-Service Tools
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More Info
Claim Detail
• Access line-specific detail
• Information on related claims
• Recommended actions
• Link to associated policy
• Verify enrollment
• View other insurance
• Details regarding duplicate and overlapping claims
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Code Lookup
• Claim Adjustment Reason Code (CARC)
• Remittance Advice Reason Code (RARC)
• Part A Reason Code
• Search by CPT/HCPCS – coming soon!
– Find any associated policy/coverage article
– Similar to former “crosswalk”
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Multi-Factor Authentication
• Secure access required by CMS
• Must enter a unique, temporary code
– Sent by email, phone or app
• Code valid for 8 hours
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Medicare Day of Learning
Bringing the Payer and Providers Together
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The Particulars
• Who:
– All providers in Jurisdiction 5
• What:
–Multiple breakout sessions
• Topics related to Part A and Part B
• Billing and clinical
– Guest speakers
– Question & Answer forum
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The Particulars
• When:
– August 7, 2018
• Where:
– Ankeny, IA
• Why:
– Understand billing and coverage criteria
– Receive proper reimbursement
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Additional Dates
• April 24, 2018
– St. Charles, MO
• July 17, 2018
– Grand Island, NE
• July 19, 2018
– Olathe, KS
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CMS Electronic Cost Report Submission Portal
More Efficient Acceptance and Tentative Settlement
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MCReF Coming Soon
• Medicare Cost Report Electronic Filing
– Same website currently used for PS&R data
• Use not mandatory but encouraged
• Easier to submit documentation
• More efficient acceptance and tentative settlement
• No need for separate hardcopy settlement page
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Outpatient Therapy News
Changes and Updates
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Outpatient Therapy Updates
• Bipartisan Budget Act of 2018
– Section 50202
• Repeals financial limitation (therapy caps)
– Retains cap amounts (OT & PT/SLP)
• Eliminates waiting for notification
– Exception process and review threshold
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Exceptions and Review Updates
• KX Modifier still required
– Attests to need for continued therapy
• Services above $2,010 (updated annually)
• Medical review threshold
– Therapy in excess of $3,000
• Rate in effect until 2028
– Targeted rather than mandatory
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Clinical News and Reviews
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Targeted Probe and Educate
Aiming to Improve the Claim Review Process
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Focus of TPE
• Specific provider/supplier that bill a particular item or service
–Highest claim denial rates
– Billing practices that vary significantly from their peers
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Identification
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Notification
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The Review
• Dedicated Nurse Analyst
• 20-40 claims per provider/service
– Per item or service
– Per round
• Up to 3 rounds
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Getting Results
• Individual Claim Review (ICR) issued
– Uploaded to WPS GHA Portal
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Education
• Ongoing to prevent errors
• 1:1 session offered
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Next Step
Remove
(next) Round
Refer
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Current Part A Topics
• Hyperbaric Oxygen Therapy
– G0277 and 99183
• Skilled Nursing Facility (SNF) RUG Utilization
• Diagnostic Related Group (DRG) Validation
• Inpatient Rehabilitation Facility or Unit (IRF/IRU)
• Non-Emergent Ambulance Transports
– Dialysis Services (Modifier “J”)
• Facilities Billing Emergency Room Services
– 99281-99285
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Current Part B Topics
• Hyperbaric Oxygen Therapy
– G0277 and 99183
• Non-Emergent Ambulance Transports
– Dialysis Services (Modifier “J”)
• Emergency Department Visits
– 99281-99285
• Outpatient Evaluation and Management Services
– 99211-99215
• Inpatient Evaluation and Management Services
– 99221-99223
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Submitting Documentation
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Methods for Submission
• Upload to WPS GHA Portal
• Mail paper records
• Fax documentation
• Send a password-protected CD
• Via Electronic Submission of Medical Records (esMD)
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CMS Review Reason Codes
Promoting Continuity and Understanding
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Standardized Review Codes
• Review contractors develop denial codes and messages
–MAC, RAC, SMRC may all be different
• CMS implemented codes and statements
– Contain common language from existing
– Alleviate confusion
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Generic Codes and Statements
• Part A
• Part B
• Durable Medical Equipment
• Power Mobility Devices
• Non-Emergent Ambulance Transport
• Non Emergent Hyperbaric Oxygen
• Home Health Services
• Inpatient Rehabilitation Facilities (IRF)
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MAC Satisfaction Indicator (MSI)
Evaluate WPS GHA
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Evaluate your MAC
• Take the MSI survey
• Opportunity to share your experience with CMS
• Honest feedback is encouraged
• Promotes awareness of areas to implement improvements
• Link on our Portal
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Resources
Get More Information
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Resources
• New Medicare Card
– CMS webpage -https://www.cms.gov/Medicare/New-Medicare-Card
– Fact sheet - https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TransitiontoNewMedicareNumbersandCards-909365.pdf
– Outreach materials -https://productordering.cms.hhs.gov
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Resources
• WPS GHA Portal User Manual
– https://www.wpsgha.com/wps/wcm/connect/mac/9916b093-2279-4d42-955b-27e44f269c72/transactional-portal-user-manual.pdf
• WPS GHA Learning Center
– https://wpsgha.litmos.com/online-courses
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Resources
• Targeted Probe and Educate
– https://www.cms.gov/Research-Statistics-Data-and-Systems/Research-Statistics-Data-and-Systems.html
– Change Request 10249 -https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R1919OTN.pdf
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Resources
• CMS Review Reason Codes and Statements
– https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/ESMD/Review-Reason-Codes-and-Statements.html
• MAC Satisfaction Indicator (MSI)
– https://www.wpsgha.com/wps/portal/mac/site/training/news-and-updates/msi-evaluate-our-services/
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Disclaimer
This program was designed for informational purposes only. The current Medicare regulations will always prevail. The provider alone is responsible for correct submission of claims. The official Medicare Program provisions change frequently and are contained in the relevant laws, regulations and rulings and can be found on the Centers for Medicare & Medicaid Services (CMS) website at www.cms.gov. Recording is not allowed; this includes audio, video, or photographic capture of educational material by any electronic or digital means, either original or copied/shared.
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