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Medicare Part A - Additional InformationWebsites You Need to KnowWPS Medicare http://www.wpsmedicare.comCMS http://www.cms.govLet Your Voice Shape WPS Medicare’s Website and Education!There are several opportunities to provide feedback to WPS Medicare ForeSee survey Educational event surveysWPS Medicare values your opinion. Please take the opportunity to complete a surveywhenever you see a link.WPS Medicare eNews!The WPS Medicare eNews is now offered through Constant Contact. Constant Contact offersimproved features such as quick, easy registration and subscription management, HTML eNewspresented in an attractive and easy-to-read format, a linkable table of contents and immediatecommunication of eNews to subscribers. You can contact today’s presenter or go tohttp://www.wpsmedicare.com and click on eNewsOpen Payments Mobile ApplicationsCMS has developed two mobile applications (apps) to help physicians and health care industryusers track their payments and other transfers of value that manufacturers and GroupPurchasing Organizations (GPOs) may need for successful Open Payments reporting. One appis targeted specifically to physicians (Open Payments Mobile for Physicians) and the other oneis for industry, including manufacturers and GPOs (Open Payments Mobile for Industry). Bothapps are compatible with the iOS (Apple ) and Android platforms; they are available fordownload free through the iOS Apple Store and Google Play Store.For more information on Open Payments and the mobile app, please see the program websiteat: http://go.cms.gov/openpaymentsICD-10The Centers for Medicare & Medicaid Services is examining the implications of the ICD-10provision in the recently enacted Protecting Access to Medicare Act of 2014 and will provideguidance to providers and other stakeholders soon. Until that time, Medicare will not beannouncing the participants selected for the planned July 2014 end-to-end testing.http://www.wpsmedicare.com/Updated: 04/23/141
For detailed timelines and checklists for activities that all providers need to carry out to preparefor ICD-10, visit the CMS ICD-10web page dicare/Coding/ICD10/index.htmlThere is an On-line Implementation Guide, designed especially for small and medium practices,large provider practices, small hospitals and payers. These guides are available at:https://implementicd10.noblis.org/To help WPS Medicare determine the readiness of our provider community for implementationof the ICD-10 codes, please complete a brief survey wefakhqqqm79v/startThe survey is also posted on the ICD-10 page of the WPS Medicare website and can also beaccessed on the ICD-10 page of the WPS Medicare website. Iowa, Kansas, Missouri and ms/icd-10/ Indiana and ms/icd-10/Provider Contact CenterWPS Medicare’s Provider Contact Center (PCC) is the first point of contact for providers whohave additional questions.MAC RegionContact NumberJ5 & J5 National MAC A(866) 518-3285J8 MAC A(866) 234-7331CMS Secure Net Access Portal (C-SNAP)WPS Medicare, in partnership with CMS, offers providers a FREE self-service portal as yourcomprehensive, secured website to be used as your primary Medicare information source forpatient eligibility, claim status information and duplicate remittance notices. C-SNAP isavailable to you 24 hours a day 7 days a week. For more information on C-SNAP go to: J5 MAC and J5 National Part ms-tools/csnap/index.shtml J8 MAC Part ms-tools/csnap/index.shtml2
Comprehensive Error Rate Testing (CERT) Programhttp://www.wpsmedicare.comCMS uses the CERT program to measure and improve the quality and accuracy of Medicareclaims submission, processing and payment. WPS Medicare uses the error rate information toensure that our education will address and prevent the most common billing errors and claimdenials. For more information on the CERT program go to: J5 MAC and J5 National Part /cert/index.shtml J8 MAC Part /cert/index.shtmlWPS Medicare Interactive Voice Response Unit (IVR)The Interactive Voice Response (IVR) offers easy access to Medicare information 24 hours aday. Simply call toll-free to obtain Medicare claims information, patient eligibility and much more!What is Available on the IVR?Eligibility, Claim Status, ChecksRemittance Advice and Overlapping Claim InformationRegionContact NumberJ5 & J5 National MAC A(866) 590-6702J8 MAC A(877) 567-7201HIPAA Eligibility Transaction System (HETS)In the future, CMS plans to discontinue access to the Common Working File (CWF) queriesthrough the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE). Medicareproviders and their agents that currently access the CWF queries through the FISS screens willneed to modify their business processes to use HETS to access Medicare beneficiary eligibilityinformation.HETS allows Medicare providers and their agents to submit and receive X12N 270/271 eligibilityrequest and response files over a secure connection. Many Medicare providers and their agentsare already receiving eligibility information from HETS. For more information about HETS andhow to obtain access to the system, refer to the CMS HETS Help web page etConnectedHETS270271.htmlMore information may also be found in the following MedLearn (MLN) Matters wnloads/SE1249.pdf3
Detection of Duplicate Claimshttp://www.wpsmedicare.comThe claims processing systems contain edits which identify duplicate claims and suspectedduplicate claims. All exact duplicate claims or claim lines are auto-denied or rejected (absentappropriate modifiers). Suspect duplicate claims and claim lines are suspended and reviewedby WPS Medicare to make a determination to pay or deny the claim or claim line.Some claims that appear to be duplicates are actually claims or claim lines that contain an itemor service, or multiple instances of an item or service, for which Medicare payment may bemade. Correct coding rules applicable to all billers of health care claims encourage theappropriate use of condition codes or modifiers to identify claims that may appear to beduplicates, but are in fact not.Patterns of duplicate claim submission will be analyzed to determine whether certain providersare responsible for duplicates, and if so, those facilities will be identified. Education will beprovided to those providers to reduce the number of duplicates. Should these providerscontinue to submit duplicate claims, WPS Medicare will initiate program integrity action.More information may also be found in the following MLN Matters wnloads/MM8121.pdfRemittance Advice (RA) InformationAre you still receiving paper RAs and/or paper checks? If so, GO GREEN!It’s FREE! For information on Electronic Data Interchange (EDI) go to:http://www.wpsic.com/edi/edi contact.shtmlTo gain a better understanding of the RA and the resources available, providers can access theRemittance Advice Information Fact Sheet t-Advice-Overview-Fact-Sheet-ICN908325.pdfand the Remittance Advice Resources t-Advice-Resources-Fact-Sheet-ICN908329.pdfNeed more information on your Remittance Advice Remark Codes (RARCs) and ClaimAdjustment Reason Codes (CARCs)? Just look here:http://www.wpc-edi.com/referenceIn DDE – choose option 16 and then 68Fraud and Abuse PreventionCMS has produced two fraud and abuse prevention training modules available on theMedscape website at http://www.medscape.com “Reducing Medicare and Medicaid Fraud and Abuse: Protecting Practices and Patients” oProvides health care professionals with actionable ideas for working with CMSand other agencies that investigate suspected fraud and ��How CMS Is Fighting Fraud: Major Program Integrity Initiatives”4
oIncreases awareness amongst providers about strategies CMS has undertakento detect and preventfraud and abuse in the Medicare and Medicaid scape.org/viewarticle/764791Appeals NavigatorHave an appeal, but do not know which form to submit? We have a new tool available to helpyou navigate through the appeal process. The Appeals Navigator will guide you by asking aseries of questions about your request and lead you to the correct form and department. Usingthe correct form and submitting it to the correct department will expedite the processing of yourrequest. All forms are available on our website under the Forms tab or you may link directly tothem from the Appeals Navigator: J5 MAC and J5 National Part Ao s/appeals-formselector.shtml J8 MAC Part Ao s/appeals-formselector.shtml5
Medicare Part B - Current UpdatesMay 2014DisclaimerEvery reasonable effort has been made to ensure the accuracy of this information. However, theprovider has the ultimate responsibility for compliance with Medicare rules and regulations.WPS Medicare bears no liability for the results or consequences of the misuse of thisinformation. The official Medicare Program provisions are contained in the relevant laws,regulations, and rulings.ICD-10 Compliance Date DelayedThe Centers for Medicare & Medicaid Services is examining the implications of the ICD-10provision in the recently enacted Protecting Access to Medicare Act of 2014 and will provideguidance to providers and other stakeholders soon. Until that time, Medicare will not beannouncing the participants selected for the planned July 2014 end-to-end testing.As additional information becomes available from CMS, we will publish that information in theweekly eNews. To sign up for eNews, click on the eNews tab found at the top right on the WPSMedicare page and complete the information anage/optin/ea?v 001B5adRlY4IqajYzHtZeaOuQ%3D%3DSingle Point of ContactOn February 3, 2014, WPS Medicare implemented a single point of contact phone number toreach Customer Service, Part A Appeals, Part B Reopenings, Provider Enrollment or EDI. Asingle number will reach any of these areas; and following the prompts will connect you to theappropriate staff to assist you. Please note: It is very important that you provide allinformation requested so you will be routed to the appropriate area.Iowa, Kansas, Missouri, and NebraskaCall (866) 518-3285. For additional useful information on the changes, go s/customer service/single-poc.shtmlIndiana and MichiganCall (866) 234-7331. For additional useful information on the changes, go s/customer service/single-poc.shtmlUpdated 04/16/141http://www.wpsmedicare.com/
CMS 1500 Claim Form Revised- Version 02/12http://www.wpsmedicare.comEffective April 1, 2014, Medicare will no longer accept paper claims submitted on the CMS 1500form with the date of 8-05 in the lower right hand corner. The revised CMS-1500 has the date02-12 in the lower right hand corner. Qualifiers to identify an ordering, referring, or supervisingrole should be entered to the left of the dotted vertical line on item 17. Providers are required touse this revised form in accordance with Change Request 8509.Additional information is found in MLN MM8509 article ds/MM8509.pdfInformation for ordering CMS 1500 claim forms can be found on the WPS website at:Iowa, Kansas, Missouri, and ms/submission/b 1500.shtmlIndiana and ms/submission/b 1500.shtmlComprehensive Error Rate Testing (CERT) ProgramCMS uses the CERT program to measure and improve the quality and accuracy of Medicareclaims submission, processing, and payment. WPS Medicare uses the error rate information toensure education will address and prevent the most common billing errors and claim denials.CMS Comprehensive Error Rate Testing (CERT) Program web d-Systems/MonitoringPrograms/CERT/index.htmlIowa, Kansas, Missouri, and rtments/cert/Indiana and rtments/cert/Revalidation of Medicare Provider Enrollment InformationSection 6401(a) of the Affordable Care Act established the requirement for providers andsuppliers to revalidate their Medicare enrollment information under new enrollment screeningcriteria.This requirement applies to providers and suppliers enrolled in Medicare prior to March 25,2011. Providers and suppliers who submitted their Medicare enrollment on or after March 25,2011, are not impacted.2
Medicare Contractors will send out revalidation notices to the providers and suppliers by March2015. Providers and suppliers mustwait to submit revalidation until after they are asked to dohttp://www.wpsmedicare.comso by their Medicare Contractors.Get easy access to the revalidation process by scanning the Quick Response (QR) code withyour smartphone or visit: /SE1126.pdfInternet-based Provider Enrollment, Chain and Ownership System (PECOS)Submit your Medicare Enrollment Application Using Internet-based PECOSDo you need to enroll in the Medicare program? Change or add a practice location? Orrevalidate? PECOS is the fastest, easiest way to enroll in the Medicare program or update yourMedicare enrollment record.Get easy access to Internet-based PECOS by scanning the Quick Response (QR) code withyour smartphone or visit: asedPECOS.htmlInternet-based PECOS Education AvailableCMS has available an informative 14 page CMS publication (ICN 903767), entitled "The Basicsof Internet-based Provider Enrollment, Chain and Ownership System (PECOS) for Provider andSupplier Organizations” to help you use internet-based PECOS. You can download it dEnroll PECOS ProviderSup FactSheet ICN903767.pdfCMS has available an informative 12 page CMS publication (ICN 903764), entitled "The Basicsof Internet-based Provider Enrollment, Chain and Ownership System (PECOS) for Physiciansand Non-Physician Practitioners” to help you use internet-based PECOS. You can download ithere: ll Pecos PhysNonPhys FactSheet ICN903764.pdf3
eNewshttp://www.wpsmedicare.comWPS Medicare publishes our eNews Listserv three times a week. The eNews sent on Mondaycontains the most current and vital information Medicare providers need to know. This weeklyeNews contains policy updates, all current Medicare information, and changes as they happen.A second eNews sent out on Wednesday contains educational opportunities. The third eNewssent on Thursday is a publication of a CMS Listserv. To sign up, visit the WPS Medicarewebsite and select “eNews” in the upper right corner. We encourage all individuals at aprovider’s office to subscribe, as there are no restrictions on how many individuals cansubscribe.Get easy access to the sign-up website by scanning the Quick Response (QR) code above withyour smartphone or visit: icareListservUserWelcomeLoadAction.doSign up for Medicare Learning NetworkThe Medicare Learning Network (MLN) is the brand name for official CMS national providereducational products. These products are designed to share up-to-date educational informationand accompany the release of new or revised Medicare program policies. These educationaltools are available through various mechanisms such as National Educational Articles,Brochures, Fact Sheets, Web-Based Training Courses, Videos and Podcasts.For more details, please S Secure Net Access Portal (C-SNAP)For C-SNAP Technical Support assistance, please reference the C-SNAP On Demand trainingslisted below. The training may provide you with the answer to your question. Also, review ournew feature “Help Center.”4
Iowa, Kansas, Missouri, and ning/on iana and ning/on demand/csnap-od.shtmlIf you have questions that cannot be resolved after reviewing the C-SNAP On Demand Training,please contact Medicare Customer Service atIowa, Kansas, Missouri, and NebraskaCall (866) 518-3285.Indiana and MichiganCall (866) 234-7331.Get easy access to C-SNAP by scanning the Quick Response (QR) code above with yoursmartphone or visiting: http://medicareinfo.comCustomer Satisfaction SurveyWPS Medicare strives to continue to improve our website to meet our providers’ needs. We usethe ForeSee Customer Satisfaction Survey as a primary means to gather your feedback andinput and gauge your satisfaction with our website. Please take time to complete the WebsiteSatisfaction Survey that pops up when visiting the WPS Medicare website.Medicare Quarterly Provider Compliance NewsletterThe Medicare Learning Network (MLN) Products Provider Compliance page containseducational products that inform Medicare Fee-For-Service (FFS) providers about how to avoidcommon billing errors and other improper activities when dealing with the Medicare Program.Since 1996, CMS has implemented several initiatives to prevent improper payments before aclaim is processed and to identify and recoup improper payments after the claim is processed.The overall goal of CMS' claim review programs is to reduce payment error by identifying andaddressing billing errors concerning coverage and coding made by providers.To learn more, visit the CMS Provider Compliance liance.htmlPlace of Service (POS) Coding Instructions - Revised and ClarifiedCMS revised and clarified POS coding instructions. Instructions are provided regarding theassignment of POS for all services paid under the Medicare Physician Fee Schedule and forcertain services provided by independent labs. To learn more visit:5
Internet - Only Manual (IOM) Publication 100-04, Medicare Claims Process Manual, Chapter 26,Sections 10.5 and /clm104c26.pdfChange Request (CR) dance/Transmittals/Downloads//R2679CP.pdfMLN Matters Article downloads/MM7631.pdfMLN Matters Article (SE oads/SE1104.pdfWPS Medicare Resources Web PageWPS Medicare offers a wide range of resources to assist providers. We regularly develop andimprove our online resources to decrease providers’ costs and time spent contacting WPSMedicare. Information regarding self-service tools is available 24 hours a day, 7 days a week, ata time most suitable to providers’ schedules. The tools allow the user quick and easy access tothe most current Medicare information.Visit the WPS Medicare Resource Web Page:Iowa, Kansas, Missouri, and urces/Indiana and urces/Medicare Remit Easy Print (MREP)Are you still receiving paper Remit Notices? MREP enables providers and suppliers to view andprint 835 files, saves time and money, generates several useful reports, makes remittanceseasy to navigate and view.Get easy Access to MREP by scanning the Quick Response (QR) codeabove with your smartphone or visiting the WPS Medicare website below.Iowa, Kansas, Missouri, and rtments/edi /mrep.shtmlFor assistance, please call (866) 518-3285 and follow the prompts for EDI assistance.Indiana and rtments/edi /mrep.shtmlFor assistance, please call (866) 234-7331 and follow the prompts for EDI assistance.6
Medicare Incentive Programshttp://www.wpsmedicare.comIncentive payments are available to eligible professionals who meet the eligibility and reportingrequirements for each program. In 2014, eligible professionals may choose to participate in thefollowing payment incentive programs.1. Physician Quality Reporting System – Medicare eligible professionals who satisfactoryreport data on quality measures for covered professional services furnished to Medicarebeneficiaries.Find more information on the Physician Quality Reporting System program on the CMSwebsite: tient-AssessmentInstruments/PQRS/index.html2. Electronic Health Records (EHR) – Medicare eligible professionals, hospitals, and criticalaccess hospitals for the “meaningful use” of certified EHR technology. Medicare eligibleprofessionals may not earn incentives under the eRX and Electronic Health Recordsincentive programs at the same time.Find more information on the EHR Incentive Program on the CMS ty and Resource Use Reports (QRUR)QRUR reports provide confidential information about the quality of care providers furnish, theresources they use to care for their Medicare-fee-for-service patients and provide comparativeinformation so physicians can see their quality of care compared to physicians / practices insimilar specialties.In mid-September 2013, CMS made available the PY 2012 QRURs for groups nationally thatconsisted of 25 or more eligible professionals. The implementation of the Value Based Modifierin 2015 will be based on a 2013 performance period and will impact medical practice groupsrather than individual physicians. QRURs for individual physicians will not be produced in 2013.Information regarding the QRUR, value-based modifier and the Physician Feedback Programcan be found on the Physician Feedback Program page of the CMS website ail questions about the physician feedback program to QRUR@cms.hhs.govCMS National Physician Payment Transparency Program: Open PaymentsTraining Module for ProvidersCMS has produced a training module called "Are You Ready for the National PhysicianPayment Transparency Program?" Accessible via 0?src cmsaca) physicians can receive a maximumof 1.00 AMA PRA Category 1 Credit by participating in the activity and receiving a minimum7
score of 70% on the post-test. Through the activity, participants will learn more about OPENPAYMENTS, the steps involvedhttp://www.wpsmedicare.comin collecting and reporting physician data, key dates forimplementation, and actions they can take to verify their information in advance of websitepublication. Please note that this training is valid for credit through 3/26/14.The module features Dr. Peter Budetti, Deputy Administrator and Director of the Center forProgram Integrity and Dr. Shantanu Agrawal, Medical Director of the Center for ProgramIntegrity and Director of the Data Sharing and Partnership Group.Medscape accounts are free and users do not have to be health care professionals to register.Registration is on the landing page of http://www.medscape.comCMS offers Free Mobile Applications (apps) to track payments under OpenPaymentsIn July 2012, the Centers for Medicare & Medicaid Services (CMS) introduced two free mobileapplications (apps) to help physicians and health care industry users track their payments andother transfers of value that applicable manufacturers and applicable Group PurchasingOrganizations (GPOs) will report under Open Payments. Created by a provision of theAffordable Care Act, Open Payments creates greater public transparency about the financialtransactions among physicians, teaching hospitals, and drug and device manufacturers.These apps are available to facilitate accurate reporting of required information, which will beavailable to the public and will be published annually on the Open Payments website. Themobile apps allow both industry and physician users to track payments and other transfers ofvalue in real-time. One app is targeted specifically to physicians (Open Payments Mobile forPhysicians) and the other one is for industry, including applicable manufacturers and applicableGPOs (Open Payments Mobile for Industry).The mobile applications can be downloaded and used easily and conveniently on a mobiledevice. Both apps are compatible with the iOS (Apple ) and Android platforms; they areavailable free through the iOS Apple Store and Google Play Store.For more information on Open Payments and the mobile app, please see the program websiteat http://go.cms.gov/openpaymentsFor more information regarding the enhancements made to the mobile apps based upon userfeedback, please use the MLN Matters article on the topic. The article can be found online s/SE1402.pdf.Advance Beneficiary Notice of Noncoverage (ABN), FORM- R-131 UpdatesHome Health Agency (HHA): As of December 9, 2013, Home Health Agencies (HHA) arerequired to use the Advance Beneficiary Notice of Noncoverage (ABN) CMS Form CMS-R-131in certain situations. The Home Health Advance Beneficiary Notice of Noncoverage (HHABN)CMS Form CMS-R-296 will no longer be recognized for option 1. The CMS Internet-Only8
Manual (IOM) Publication 100-04, Chapter 30, Section 50.15.4 gives examples of when an ABNis required and how to completeit for HHAs.http://www.wpsmedicare.comOutpatient Therapy Services:The American Taxpayer Relief Act (ATRA) provides liability protection for the beneficiary;therefore, providers will be required to give patients an ABN when services are over theMedicare Therapy Cap. CMS suggests using language similar to:"You have met your physical therapy goals, and physical therapy is no longer medicallynecessary. Medicare doesn't pay for physical therapy services that aren't medically reasonableand necessary."CMS doesn't require an ABN if the therapy service is medically necessary. In such a case, theprovider should continue to append the KX modifier on claims submitted.The CMS Internet-Only Manual (IOM) Publication 100-04, Chapter 30, Section 50.15.5 providesclarification on the use of the ABN for outpatient therapy services.To find more information on using the ABN form, visit the CMS idance/Manuals/Downloads/clm104c30.pdfTo Download the CMS-ABN-R-131 form and General-Information/BNI/ABN.htmlReference the article "Advance Beneficiary Notice of Noncoverage (ABN)" found on the WPSMedicare website at:Iowa, Kansas, Missouri, and ms/submission/abn.shtmlIndiana and ms/submission/abn.shtmlCMS Medicare Billing Certificate ProgramLearn about the Medicare Program, master the specifics of billing for your provider type, andreceive a certificate in Medicare billing from CMS for successful completion. Completion of theprogram includes: required web-based training courses and readings and a 75% or higher scoreon the post-assessment. To participate in either the Part A and/or Part B program, or browsethe entire list of CMS prepared web-based training courses, refer to the Related Links posted onthe CMS Web-Based Training (WBT) web page, located at htmlManual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient RehabilitationFacility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant toJimmo vs. Sebelius9
In accordance with the Jimmo v. Sebelius Settlement Agreement, the Centers for Medicare &Medicaid Services (CMS) has agreedto issue revised portions of the relevant program manualshttp://www.wpsmedicare.comused by Medicare contractors, in order to clarify that coverage of skilled nursing and skilledtherapy services “ does not turn on the presence or absence of a beneficiary’s potential forimprovement, but rather on the beneficiary’s need for skilled care.” Skilled care may benecessary to improve a patient’s current condition, to maintain the patient’s current condition, orto prevent or slow further deterioration of the patient’s condition. For more information, pleasesee MLN Matters article MM 8458 at MM8458.pdf10
WPS Medicare Interactive Voice Response Unit (IVR) The Interactive Voice Response (IVR) offers easy access to Medicare information 24 hours a day. Simply call toll-free to obtain Medicare claims information, patient eligibility and much more! What is Available on the IVR? Eligibility, Claim Status, Checks
