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Jurisdiction 6 – Part A
2017 AAHAM/HFMA Payer Panel
National Government Services, Inc.
March 14, 2017
www.NGSMedicare.com
Jurisdiction 6 – Part A
Today’s Presenter
Jean Roberts, RN, BSN, CPC
J6 Provider Outreach & Education Consultant
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Jurisdiction 6 – Part A
Disclaimer
National Government Services, Inc. has produced this material as an
informational reference for providers furnishing services in our contract
jurisdiction. National Government Services employees, agents, and staff
make no representation, warranty, or guarantee that this compilation of
Medicare information is error-free and will bear no responsibility or
liability for the results or consequences of the use of this material.
Although every reasonable effort has been made to assure the accuracy
of the information within these pages at the time of publication, the
Medicare Program is constantly changing, and it is the responsibility of
each provider to remain abreast of the Medicare Program requirements.
Any regulations, policies and/or guidelines cited in this publication are
subject to change without further notice. Current Medicare regulations
can be found on the CMS website at https://www.cms.gov.
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https://www.cms.gov/
Jurisdiction 6 – Part A
No Recording
Attendees/providers are never permitted to
record (tape record or any other method) our
educational events
This applies to our webinars, teleconferences, live events
and any other type of National Government Services
educational events
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Jurisdiction 6 – Part A
Acronyms
Acronyms used in this presentation can be
viewed on the NGSMedicare.com website. On
the Welcome page, click on Provider
Resources > Acronyms.
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Jurisdiction 6 – Part A
Agenda
Presubmitted Questions
General
Specific for J6 NGS/Medicare
Updates
CERT
Wrap Up
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Jurisdiction 6 – Part A
FYI:March is National Kidney Month!
More information is available on the National Institute of Diabetes and Digestive and Kidney Diseases web site: https://www.niddk.nih.gov/health-information/health-communication-programs/nkdep/get-involved/kidney-month/Pages/kidney-month.aspx?utm_source=AND&utm_campaign=2017NKM&utm_medium=Newsletter
National Kidney Foundation
https://www.kidney.org/patients/medicare
2017 World Kidney Disease Theme is Kidney Disease & Obesity
http://www.worldkidneyday.org/2017-campaign/2017-wkd-theme/
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Jurisdiction 6 – Part A
FYI:March: Colorectal Cancer Awareness Month
Centers for Disease Control and Preventive (CDC)
https://www.cdc.gov/cancer/colorectal/sfl/index.htm
Medicare Preventive Services Quick Reference Chart
Interactive Online Version
https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html
Text Only Version
https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS-QuickReferenceChart-1TextOnly.pdf
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Jurisdiction 6 – Part A
General Presubmitted Questions
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Jurisdiction 6 – Part A
General Question #1
1. Question: There seems to be long hold times when calling into payers. What are payers doing to address these long hold times? This is across all payers, however has been noted for some upwards of 40-50 minutes.
Answer: National Government Services average speed of answering an initial call placed to the J6 Provider Contact Center (PCC) is currently less than 1 minute
PCC – telephone # 877-702-0990
Interactive Voice Response (IVR) System: telephone # 877-309-4290
For additional information: www.NGSMedicare.com > Contact US (Directly below search bar)
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Jurisdiction 6 – Part A
General Question #2
2. Question: What is your preferred method of refunding overpayments for a UB04 and 1500 professional claims?
Do you prefer to receive a Corrected or cancellation claim?
Do you have a specific Recoupment form that should be used?
Do you prefer a refund check?
Answer: When an adjusted/corrected/cancel claim will resolve the issue, that is a preferred method. Otherwise, NGS offers several methods to refund an overpayment.
The preferred method is to use the standardized “Immediate recoupment” process. This process allows the avoidance of interest to accrue.
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Jurisdiction 6 – Part A
General Question #2
Submit your request by fax, or by using the Immediate Recoupment Request - Electronic/Email Form.
To request an immediate recoupment by fax, you must complete the Immediate Recoupment Request Form.
A request for immediate offset must be received no later than the 16th day from the date of the initial demand letter.
If you have already submitted a request for all future recoupments, you no longer need to request an immediate recoupment for each demand letter you receive.
Please Note: You can terminate the immediate recoupment process at any time; however, the request to terminate must be in writing.
Additional Information: www.NGSMedicare.com > Overpayment
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Jurisdiction 6 – Part A
General Question #3
3. Question: Does each facility have a specific provider representative that we can go to with complicated issues that are not resolved by the initial contact with the provider call centers? If so, who do we contact to get the name of our provider representative? If not, can we get one?
Answer: NGS does not assign a specific Provider Outreach Education (POE) representative to a facility. Per CMS requirements you must make all initial inquiries via self-service technology, the Interactive Voice Response (IVR) system, or the Provider Contact Center.
www.NGSMedicare.com > Contact Us (under search bar)
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Jurisdiction 6 – Part A
General Question #3
If at least 30 days have elapsed since contact with the Provider Customer Care Department and you either have not received a response or are dissatisfied with the response, please contact the Provider Outreach Department at J6.Provider.Training@anthem.com with:
Question/Description of issue and include any reason codes involved
Activity number assigned by Customer Care
Date you opened the request
Your facility’s Medicare legacy provider number
What you have been told by Customer Care
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Jurisdiction 6 – Part A
General Question #4
4. When a previously submitted claim denies requiring medical notes or an EOB (Explanation of Benefits) it requires the Provider to submit the additional documentation to adjudicate the claim, but since there are no occurrence codes to add no additional changes can be add on the UB04 claim form. Due to no changes being made on the UB04 claim form some Insurance payers require an appeal/adjustment claim form to be completed and that documentation is either mailed or faxed in for reprocessing of the claim manually. The occurrence code could be a useful tool for the provider to add an occurrence code on the UB04 claim (additional documentation) to enable the provider to submit a replacement claim using the MN AUC form to comply with the necessary documentation needed to adjudicate the claim vs. writing up an appeal/adjustment claim form and submitting either snail mail or faxing.
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Jurisdiction 6 – Part A
General Question #4
NGS articles:
www.NGSMedicare.com > Claims & Appeals > About Appeals > select article title from side
“Submit an Adjustment to Correct Claims Partially Denied by Automated LCD/NCD Denials”
Process only applies to line items denied for 55A00, 55A01, 52NCD, 53NCD, 54NCD
“Reopenings for Minor Errors and Omissions”
Clerical error/omission reopenings are granted at the discretion of the contractor
Note: If the above articles do not apply you will need to file an appeal via NGSConnex (preferred method); eSMD; or hard copy
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Jurisdiction 6 – Part A
General Question #55. When insurance companies send out new cards we are noting that not all cards
contain the EDI number. This is a very helpful item to have on the card for us to be able to identify where the claim needs to go. And to ensure the correct coverage is selected. We even scan a copy of the card and attach it in our system.
Will payors consider ensuring this is on the cards? Some payers are not sending new cards when coverages have changed – so
the patient continues to carry the OLD card which creates an issue if anything has changed (from the group number to the discount logos etc). Short of having to look up every patient on a website, this is creating some concerns. And the use of digital copies (a picture of the card on a patient’s phone) is very difficult for us to save a copy of the card.
Is it just the cost savings of printing and mailing the cards that is prompting these changes?
What suggestions would the payers have to overcome some of these difficulties?
Answer: Does not apply to Medicare
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Jurisdiction 6 – Part A
Your Presubmitted Questions for NGS
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Jurisdiction 6 – Part A
Presubmitted NGS Question 1: MSP
Question: MSP claims-particularly no-fault claims. We follow the MSP Billing and Adjustment guide – Process A-J from your website, which is very helpful. There is one billing scenario that does not seem to apply to any of the Process flows:a) The patient supplies the MVA billing information and claim
number to the provider. The claim(s) are billed. The issues starts when the patient does not provide the insurer with the necessary paperwork that is required. This can go on for a very long time. Numerous letters are sent to the patient by the MVA payer and by the provider.
b) The provider has no denial. The MSP record shows a No-Fault carrier. What process would we follow to bill Medicare – and what Value Code(s) and Remark code would be appropriate?
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Jurisdiction 6 – Part A
Answer to Presubmitted NGS Question 1: MSP
Answer: a) CMS IOM Pub 100-05, Medicare Secondary Payer Manual, Chapter 5, Section 40.6.2 states:
“Note: Individuals are not required to file a claim with a liability insurer or required to cooperate with a provider in filing such a claim. However, beneficiaries are required to cooperate in the filing of no-fault and workers’ compensation claims. If the beneficiary refuses to cooperate in filing of no-fault or workers’ compensation claims Medicare does not pay. Conditional benefits are not payable if payment cannot be made under no-fault insurance because the provider or the beneficiary failed to file a proper claim. (See Chapter 1, §20, for definition.) Exception: When failure to file a proper claim is due to mental or physical incapacity of the beneficiary, and the provider could not have known that a no-fault claim was involved, this rule does not apply.”
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Jurisdiction 6 – Part A
Answer to Presubmitted NGS Question 1: MSP
CMS IOM 100-05, Chapter 1, Section 10 states: “When Medicare is the secondary payer, the provider, physician, or other supplier, or beneficiary must first submit the claim to the primary payer.” Therefore: If the beneficiary was involved in an accident and no-fault
insurance is available, the beneficiary is responsible for filing a claim with the no-fault insurer.
If the beneficiary has filed a claim with the no-fault insurer, and has given the provider the name, address and necessary information regarding the no-fault insurer, then the beneficiary is being cooperative.
However, if the no-fault insurer is requesting additional information from the beneficiary and the beneficiary is not responding to those requests, the provider may opt to go
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Jurisdiction 6 – Part A
Answer to Presubmitted NGS Question 1: MSP
ahead and submit a conditional claim to Medicare, as long as 120 days have passed since the provider first billed the no-fault insurer. The provider should use an explanation code of ‘DA’ in the Remarks field along with the date the no-fault was billed.
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Jurisdiction 6 – Part A
Answer to Presubmitted Question 1: MSP
b) In this situation: If the provider billed but did not receive information from the
beneficiary regarding the no-fault insurer, the provider can go ahead and submit a claim to the no-fault insurer.
If the beneficiary has not provided information, but the provider finds sufficient information on the beneficiary’s MSP record at the common working file (CWF), the provider can submit a claim to the no-fault insurer.
If 120 days have passed and no payment or denial has been received, the provider can go ahead and submit a conditional claim to Medicare, using the 14 value code with zero amount, the 02 occurrence code with date of accident, a ‘C’ payer code with the name of the no-fault insurer, and a ‘DA’ explanation code along with the date the no-fault insurer was billed in the Remarks field.
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Jurisdiction 6 – Part A
MSP Resources www.NGSMedicare.com > Claims & Appeals > Claims> Medicare
Secondary Payer
CMS IOM Pub 100-05, Medicare Secondary Payer Manual, Chapter 5, Section 40.6.2
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/msp105c05.pdf
CMS IOM Pub 100-05, Medicare Secondary Payer Manual, Chapter 1, Section 10 and 20
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/msp105c01.pdf
CMS Fact Sheet: Medicare Secondary Payer for Providers, Physicians, Other Suppliers, and Billing Staff, ICN 006903 https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MSP_Fact_Sheet.pdf
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Jurisdiction 6 – Part A
Presubmitted NGS Question 2: Crossover
Question: Why does Medicare crossover to more than one payer? This creates credit balances for the provider.
Answer: The Coordination of Benefits Agreement (COBA) Program established a standard contract between CMS and other health insurance organizations that defines the criteria for transmitting enrollee eligibility data and Medicare adjudicated claim data for the purposes of coordinating benefits. In 2006, CMS consolidated the automatic or eligibility file-based crossover process under the Medicare Benefits Coordination and Recovery Center (BCRC). Medicare will cross over to all identified payers, with a cross-over agreement, to ensure that all Medicare claims are properly adjudicated for each beneficiary across all eligible payers
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0909.pdf
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Jurisdiction 6 – Part A
Crossover Resources
CMS Coordination of Benefits Agreement web page https://www.cms.gov/Medicare/Coordination-of-Benefits-and-
Recovery/COBA-Trading-Partners/Coordination-of-Benefits-
Agreements/Coordination-of-Benefits-Agreement-page.html
CMS Special Edition article SE0909 “Important Information
Regarding the Centers for Medicare & Medicaid Services
(CMS) National Claims Crossover Process”
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-
Network-MLN/MLNMattersArticles/downloads/SE0909.pdf
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Jurisdiction 6 – Part A
Presubmitted NGS Question 3: PO Modifier
Question: We have off-site provider based clinics. Do services ordered at an off-site provider based clinic but are performed at our hospital require a PO modifier? For example blood drawn at off-site clinic and sent to hospital lab to perform the actual test.
Answer: The determinative factor is whether or not the item or service is being paid through the OPPS. If an item or service is being provided by an applicable provider and is being paid through the OPPS, then the PO modifier should be applied.
For instance, a drug with an OPPS status indicator of “K” or a laboratory test that is packaged into an OPPS service should have the PO modifier applied.
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Jurisdiction 6 – Part A
Answer to Presubmitted NGS Question 3: PO Modifier
Answer, continued:
If a service is not paid through the OPPS, such as a laboratory test paid separately through the Clinical Laboratory Fee Schedule, it should not have the PO modifier applied.
Note that the Medicare Claims Processing Manual Chapter 4 20.6.11 was updated in July 2015 to read: “This modifier is to be reported with every HCPCS code for all outpatient hospital items and services furnished in an off-campus provider-based department a hospital.”
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Jurisdiction 6 – Part A
PO Modifier Resources
When service is not bundled Check Status Indicator (SI) for specific HCPCS code: https://www.cms.gov/Medicare/Medicare-Fee-For-Service-Payment/HospitalOutpatientpps/Addendum-A-and-Addendum-B-Updates.html
SI A = Services furnished to a hospital outpatient that are paid under a fee schedule or payment system other than OPPS, for example: Clinical Diagnostic Laboratory Services
• CMS FAQs https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/PO-Modifier-FAQ-1-19-2016.pdf
• CMS IOM 100-04, Medicare Claims Processing Manual, Chapter 4, Section 20.6.11: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/PO-Modifier-FAQ-1-19-2016.pdf
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https://www.cms.gov/Medicare/Medicare-Fee-For-Service-Payment/HospitalOutpatientpps/Addendum-A-and-Addendum-B-Updates.html
Jurisdiction 6 – Part A
Updates
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Jurisdiction 6 – Part A
CMS Medicare Administrative Contractors and New Recovery Audit Contractors
Medicare Administrative Contractors (MACs)
https://www.cms.gov/Medicare/Medicare-
Contracting/Medicare-Administrative-Contractors/Who-are-
the-MACs.html
Recovery Audit Contractors:
https://www.cms.gov/Research-Statistics-Data-and-
Systems/Monitoring-Programs/Medicare-FFS-Compliance-
Programs/Recovery-Audit-Program/index.html
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Jurisdiction 6 – Part A
Recovery Audit Contractor Regions
https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Downloads/Medicare-FFS-RAC-map-November-2016-clean.pdf
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Jurisdiction 6 – Part A
J6 Region Recovery Audit Contractor
Cotiviti, LLC
Awarded 10/31/2016
States: IL, MN, WI, NE, IA, KS, MO, CO, NM, TX, OK, AR,
LA, and MS
Website: http://www.cotiviti.com/RAC/Welcome
• http://www.cotiviti.com/cotiviti-healthcare/cms-rac-provider-resources
• Slides from recent educational sessions:
http://www.cotiviti.com/sites/default/files/docs/cms/workingwithcotiviti
-01072017.pdf
Email: RACInfo@Cotiviti.com
Telephone Number: 1‐866-360-2507
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Jurisdiction 6 – Part A
Region 5: Durable Medical Equipment and Home Health/Hospice Recovery Audit Program
Performant Recovery, Inc.
Awarded 10/31/2016
Nationwide for DMEPOS/HHA/Hospice
Website:
https://www.performantrac.com/PROVIDERPORTAL.aspx
Email: info@Performantrac.com
Telephone: 1‐866‐201‐0580
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Jurisdiction 6 – Part A
Upcoming Education Opportunities
J6 Part A Ask The Contractor (ACT) call
March 30, 2017 at 12 Noon CT (no preregistration)
• You may submit questions in advance; deadline: March 16
J6 Virtual Conference (must preregister)
May 2, 2017
Next In-person seminar: SNF CB
Tentative Date and location
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Jurisdiction 6 – Part A
Enhanced NGS Tool: Reason Code Look Up
New! Redesigned and expanded self-service
tool on www.NGSMedicare.com
Starting with Part A top 20 denial, RTP, reject reason codes
Will expand to cover most/all denial, RTPs, reject reason
codes
• Reason Code, Description, Provider Action to Correct, Tips to Avoid
Error, Related Resources
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http://www.ngsmedicare.com/
Jurisdiction 6 – Part A
Enhanced NGS Tool: Reason Code Look Up
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Jurisdiction 6 – Part A38
Enhanced NGS Tool:
NGS CERT Denial Reason Finder
Jurisdiction 6 – Part A
NGS Tools:
Reason Code Look Up & NGS CERT Denial Reason Finder
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Jurisdiction 6 – Part A
Coming Soon – “Look and Feel” Upgrade
When is this happening?
Estimated launch: 1st quarter 2017
What isn't changing?
Functionality
What will you see?
Refreshed visual design
Simplified, intuitive and consistent navigation
Revised logout process
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Jurisdiction 6 – Part A
Multifactor Authentication What is MFA?
Who is impacted?
All providers who utilize NGSConnex
When is this happening?
Estimated launch: 1st quarter 2017
What do you need to do now?
Verify User Profile email address
Email address must be unique to you
If applicable, update email address
My User Profile tab
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Jurisdiction 6 – Part A
Provider Enrollment Revalidation
Who All providers five years after initial enrollment or last revalidation
When Only when notified and before due date
Notices are mailed 2-3 months prior to due date
Unsolicited revalidation applications returned if received more than 6 months prior due date
What Verify entire Medicare enrollment record
Why Avoid payment hold or deactivation of Medicare billing privileges by
responding promptly
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Jurisdiction 6 – Part A
Provider Enrollment Revalidation
Check PECOS https://pecos.cms.hhs.gov/pecos/login.do
Check CMS website Information: https://go.cms.gov/MedicareRevalidation
Medicare Revalidation Look Up Tool: https://data.cms.gov/revalidation
Due date will display or “TBD” (To Be Determined) if not currently due
MLN Matters article SE1211
MLN Matters article SE1605
MLN Matters article SE1126
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Jurisdiction 6 – Part A
NGS You Tube Channel
https://www.youtube.com/user/NGSMedicare
Many helpful videos available: Examples Using Multi-Factor Authentication (MFA) in NGSConnex
Coming Soon - New and Improved NGSConnex
The New Medical Policy Center Experience
NGSConnex: How to Register a New User Account
NGSConnex: Credit Balance Reporting (Part A Only)
NGSConnex: How to check MSP Records
What is an Advance Beneficiary Notice of Noncoverage (ABN)?
The Usage of an Advance Beneficiary Notice of Noncoverage (ABN)
Includes links to “CMS Provider Minute” videos
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Jurisdiction 6 – Part A
CMS ICD-10 Resources
CMS has merged all up-to-date content from our
Road to 10 website to our main ICD-10 site:
cms.gov/ICD10 is your one-stop site for official
CMS ICD-10 resources
The Road to 10 site is being phased out with an
anticipated completion date of April 3.
Be sure to update all your bookmarks and links for
Roadto10.org to point to cms.gov/ICD10
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Jurisdiction 6 – Part A
National Uniform Billing Committee (NUBC)
• The Official UB-04 Data Specifications Manual is
available directly from the NUBC Web site at
http://www.nubc.org– The National Uniform Billing Committee (NUBC) maintains the
codes needed to complete the Form CMS-1450 (UB-04 claim)
and compliant X12N 837 institutional claim
– The NUBC is responsible for the design and printing of the UB-
04 form. The NUBC is a voluntary, multidisciplinary committee
that develops data elements for claims and claim-related
transactions, and is composed of all major national provider
and payer organizations (including Medicare)
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Jurisdiction 6 – Part A
Reminder: RARC & CARC Code Updates
Remittance Advice Remark Code (RARC) and
Claim Adjustment Reason Code (CARC) lists
Code updates are published three times per year: around
March 1, July 1, and November 1
• CARC and RARC lists are made available on the
Washington Publishing Company (WPC) website
http://www.wpc-edi.com/reference/
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Jurisdiction 6 – Part A
CERT A/B MAC Outreach & Education Task Force
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Jurisdiction 6 – Part A
CERT A/B MAC Outreach & Education Task Force
The goal of the A/B MAC Outreach & Education Task Force is to ensure consistent communication and education to reduce the Medicare Part A and Part B error rates.
A joint collaboration of the A/B MACs to communicate national issues of concern regarding improper payments to the Medicare Program.
Partnership to educate Medicare providers on widespread topics affecting most providers and complement ongoing efforts of CMS, the MLN and the MACs individual error-reduction activities within its jurisdictions
Disclaimer: The CERT A/B MAC Outreach & Education Task Force is independent from the CMS CERT team and CERT contractors, which are responsible for calculation of the Medicare fee-for-service improper payment rate.
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Jurisdiction 6 – Part A
CERT A/B MAC Outreach & Education Task Force
CMS works closely with the CERT A/B MAC Task Force and the CERT DME MAC Outreach & Education Task Force CMS has a web page dedicated to education developed by the CERT
A/B MAC Outreach & Education Task Force
• https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/CERT-Outreach-and-Education-Task-Force.html
NGS CERT Task Force Web Page Go to our website, https://www.NGSMedicare.com; in the About Me
drop down box, select your provider type and applicable state, click on Next, accept the Attestation. Choose the Medical Policy & Review tab, then choose CERT, the CERT Task Force link is located to the right of the web page.
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https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/CERT-Outreach-and-Education-Task-Force.htmlhttp://www.ngsmedicare.com/
Jurisdiction 6 – Part A
www.NGSMedicare.com > Medical Policy & Review > CERT >
CERT Task Force
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Jurisdiction 6 – Part A
https://www.cms.gov/outreach-and-education/medicare-
learning-network-mln/mlnproducts/providercompliance.html
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Jurisdiction 6 – Part A
Email Updates
53
Subscribe to receive the latest Medicare information.
Jurisdiction 6 – Part A
Website Survey
This is your chance to have your voice heard—
click on “Yes, I’ll give feedback” when you see
this pop-up so NGS can make your job easier!
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Jurisdiction 6 – Part A
Medicare University
Interactive online system available 24/7
Educational opportunities available
Computer-based training courses
Teleconferences, webinars, live seminars/face-to-face
training
Self-report attendance
Website
http://www.MedicareUniversity.com
55
http://www.medicareuniversity.com/
Jurisdiction 6 – Part A
Medicare University Self-Reporting Instructions
Log on to National Government Services’ Medicare
University
http://www.MedicareUniversity.com
• Topic = MN AAHAM/HFMA Meeting
• Medicare University Credits (MUCs) = 1
• Catalog Number = AA-C-03774
• Course Code = 17073OAJMR1
Visit our website for step-by-step self-reporting instructions
Click on the Education tab, then the Medicare University
Course List tab, click on the Get Credit link. This will open
the Get Credit for Completed Courses web page
56
http://www.medicareuniversity.com/
Jurisdiction 6 – Part A
Continuing Education Credits
All National Government Services Part A and Part B
Provider Outreach and Education attendees can
now receive one CEU from AAPC for every hour of
National Government Services education received.
If you are accredited with a professional
organization other than AAPC, and you plan to
request continuing education credit, please contact
your organization not National Government
Services with your questions concerning CEUs.
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Jurisdiction 6 – Part A
Thank You!
Questions?
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