Railroad Medicare Provider News for Monday 5/22/17

Palmetto GBA Website to Undergo Maintenance Sunday, May 21, 2017

Due to scheduled maintenance, www.palmettogba.com users may experience an interruption in service beginning at approximately 4 p.m. ET on Sunday, May 21, 2017. Please read this article to learn more.

E/M Weekly Tip: History of Present Illness (HPI) – Multiple Complaints

A patient may present with more than one complaint, sign or symptom. They may use the most descriptive under the History of Present Illness (HPI) and additional information may be used under review of systems (ROS). Please share with appropriate staff.

Lack of Documentation is the #1 reason for Claims Denial!

Lack of documentation in the medical record is the #1 reason for claims being denied for payment. Providers can fix this by documenting the information in this article. Please share with appropriate staff.


Want to get these updates automatically?

Sign up for our Daily Listerv or Subscribe to our RSS Feed

Jurisdiction M Home Health & Hospice News for Monday 5/22/17

There is Still Time to Evaluate Our Services!

There is still time to share your experiences about the services we provide. Please complete the MAC Satisfaction Indicator (MSI) survey. These survey results will help us find ways to better serve you.

Open Draft Local Coverage Determination (LCD) Meetings: June 5, 2017

Palmetto GBA JM A/B Medicare Administrative Contractor (MAC) has scheduled an Open Draft Local Coverage Determination (LCD) Meeting on June 5, 2017, in order to allow for the submission of information related to the proposed LCDs. A listing of LCDs under discussion is now available. The general public is invited to submit information for Palmetto GBA’s consideration. Please share with appropriate staff.

Palmetto GBA Website to Undergo Maintenance Sunday, May 21, 2017

Due to scheduled maintenance, www.palmettogba.com users may experience an interruption in service beginning at approximately 4 p.m. ET on Sunday, May 21, 2017. Please read this article to learn more.

Home Health Tip: Diagnosis

If there is a new onset or acute exacerbation of diagnosis for home health services, document the information. Articles such as ‘Focus on a Plan of Care’ give documentation tips that can help your agency. Please share with appropriate staff.

Hospice Tip: Palliative Care

The individual’s or representative’s (as applicable) acknowledgment that the individual has been given a full understanding of hospice care, particularly the palliative rather than curative nature of treatment, must be documented.

Lack of Documentation is the #1 reason for Claims Denial!

Lack of documentation in the medical record is the #1 reason for claims being denied for payment. Providers can fix this by documenting the information in this article. Please share with appropriate staff.


Want to get these updates automatically?

Sign up for our Daily Listerv or Subscribe to our RSS Feed

This post applies to: JM HHH

Jurisdiction M Part B News for Monday 5/22/17

Open Draft Local Coverage Determination (LCD) Meetings: June 5, 2017

Palmetto GBA JM A/B Medicare Administrative Contractor (MAC) has scheduled an Open Draft Local Coverage Determination (LCD) Meeting on June 5, 2017, in order to allow for the submission of information related to the proposed LCDs. A listing of LCDs under discussion is now available. The general public is invited to submit information for Palmetto GBA’s consideration. Please share with appropriate staff.

Palmetto GBA Website to Undergo Maintenance Sunday, May 21, 2017

Due to scheduled maintenance, www.palmettogba.com users may experience an interruption in service beginning at approximately 4 p.m. ET on Sunday, May 21, 2017. Please read this article to learn more.

There is Still Time to Evaluate Our Services!

There is still time to share your experiences about the services we provide. Please complete the MAC Satisfaction Indicator (MSI) survey. These survey results will help us find ways to better serve you.

E/M Weekly Tip: History of Present Illness (HPI) – Multiple Complaints

A patient may present with more than one complaint, sign or symptom. They may use the most descriptive under the History of Present Illness (HPI) and additional information may be used under review of systems (ROS). Please share with appropriate staff.

Lack of Documentation is the #1 reason for Claims Denial!

Lack of documentation in the medical record is the #1 reason for claims being denied for payment. Providers can fix this by documenting the information in this article. Please share with appropriate staff.


Want to get these updates automatically?

Sign up for our Daily Listerv or Subscribe to our RSS Feed

Jurisdiction M Part A News for Monday 5/22/17

Open Draft Local Coverage Determination (LCD) Meetings: June 5, 2017

Palmetto GBA JM A/B Medicare Administrative Contractor (MAC) has scheduled an Open Draft Local Coverage Determination (LCD) Meeting on June 5, 2017, in order to allow for the submission of information related to the proposed LCDs. A listing of LCDs under discussion is now available. The general public is invited to submit information for Palmetto GBA’s consideration. Please share with appropriate staff.

Palmetto GBA Website to Undergo Maintenance Sunday, May 21, 2017

Due to scheduled maintenance, www.palmettogba.com users may experience an interruption in service beginning at approximately 4 p.m. ET on Sunday, May 21, 2017. Please read this article to learn more.

Mass Adjustment to Correct Underpayments on CAH Method II Claims

Change Request (CR) 9134 implemented a Physician Quality Reporting System (PQRS) Negative Payment Adjustment for Critical Access Hospital (CAH) Method II caused an underpayment on certain claims. CAH Method II claims submitted with revenue codes 0963 and/or 0964 were not reimbursed for that revenue line. A mass adjustment will be initiated within 90 days for CAH Method II claims that meet the criteria outlined.

There is Still Time to Evaluate Our Services!

There is still time to share your experiences about the services we provide. Please complete the MAC Satisfaction Indicator (MSI) survey. These survey results will help us find ways to better serve you.

Update FISS Editing to Include All Three Patient Reason for Visit Code Fields

Change Request (CR) 9672 makes changes that update logic in the Fiscal Intermediary Standard System (FISS) (Medicare’s system for processing institutional claims) to allow editing of the expanded Patient Reason for Visit (PRV) fields. CR9672 requires updating of FISS to ensure that all of the National Coverage Determination (NCD) edits within Reason Code ranges 3xxxx and 59xxx that are tied to the diagnosis code fields include all three PRV fields for outpatient hospital claims on Types of Bills (TOB) 013x and 085x. CR9672 makes no policy changes.

Lack of Documentation is the #1 reason for Claims Denial!

Lack of documentation in the medical record is the #1 reason for claims being denied for payment. Providers can fix this by documenting the information in this article. Please share with appropriate staff.


Want to get these updates automatically?

Sign up for our Daily Listerv or Subscribe to our RSS Feed

Railroad Medicare Provider News for Friday 5/19/17

Screening for Hepatitis B Virus (HBV) Infection

Change Request (CR) 9859 provides that the Centers for Medicare & Medicaid Services (CMS) has determined that, effective September 28, 2016, Medicare will cover screening for Hepatitis B Virus (HBV) infection when performed with the appropriate U.S. Food and Drug Administration (FDA) approved/cleared laboratory tests, used consistent with FDA-approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations. Medicare coinsurance and the Part B deductible are waived for this additional preventive service. You should ensure that your billing staffs are aware of this coverage change.


Want to get these updates automatically?

Sign up for our Daily Listerv or Subscribe to our RSS Feed

Jurisdiction M Home Health & Hospice News for Friday 5/19/17

Prepayment Service Specific Probe Results for, The Health Insurance Prospective Payment System (HIPPS) Codes For Claims Utilizing the 1CHN* HIPPS Code in Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina and Tennessee

Palmetto GBA performed service-specific pre-payment probe medical review on Home Health claims for HIPPS code 1CHN*. There were 13 edits set for specific states within the Palmetto GBA A/B MAC Home Health jurisdiction: Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina and Tennessee, for claims processed between November, 2016 and March 2017 are presented here.

Prepayment Service Specific Probe Results for, The Health Insurance Prospective Payment System (HIPPS) Codes For Claims Utilizing the 3CHP* HIPPS Code in Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina and Tennessee

Palmetto GBA performed service-specific pre-payment probe medical review on Home Health claims for HIPPS code 3CHP*. There were 13 edits set for specific states within the Palmetto GBA A/B MAC Home Health jurisdiction: Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina and Tennessee. The results for Alabama, Louisiana, Oklahoma, and Tennessee, for claims processed between November 2016 and March 2017, are presented here. Results for other states will be released at a later date.

Prepayment Service Specific Probe Results for the Health Insurance Prospective Payment System (HIPPS) Codes For Claims Utilizing the 1BGM* HIPPS Code in Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, Ohio, and Tennessee

Palmetto GBA performed service-specific pre-payment probe medical review on Home Health claims for HIPPS code 1BGM*. There were 13 edits set for specific states within the Palmetto GBA A/B MAC Home Health jurisdiction: Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina and Tennessee. The results for Alabama, Arkansas, New Mexico, Oklahoma and South Carolina, will be delivered in a separate article. The article for the remaining 8 states, for claims processed between November, 2016 and March 2017 are presented in this article.

Prepayment Service Specific Probe Results for, The Health Insurance Prospective Payment System (HIPPS) Codes For Claims Utilizing the 1BGK* HIPPS Code in Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina and Tennessee

Palmetto GBA performed service-specific pre-payment probe medical review on Home Health claims for HIPPS code 1BGK*. There were 13 edits set for specific states within the Palmetto GBA A/B MAC Home Health jurisdiction: Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina and Tennessee. The results for the 13 probe edits, for claims processed between November 2016 and March 2017, are presented in this article.

Prepayment Service Specific Probe Results for the Health Insurance Prospective Payment System (HIPPS) Codes For Claims Utilizing the 1CHK* HIPPS Code in Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina and Tennessee

Palmetto GBA performed service-specific pre-payment probe medical review on Home Health claims for HIPPS code 1CHK*. There were 13 edits set for specific states within the Palmetto GBA A/B MAC Home Health jurisdiction: Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina and Tennessee. The results for the probe edits, for claims processed between November, 2016 and March 2017 are presented in this article.

Prepayment Service Specific Probe Results for the Health Insurance Prospective Payment System (HIPPS) Codes For Claims Utilizing the 1CHM* HIPPS Code in Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, Ohio, Oklahoma, South Carolina and Tennessee

Palmetto GBA performed service-specific pre-payment probe medical review on Home Health claims for HIPPS code 1CHM*. There were 13 edits set for specific states within the Palmetto GBA A/B MAC Home Health jurisdiction: Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina and Tennessee. New Mexico’s results will be delivered in a separate article. The articles for the remaining 12 states, for claims processed between November, 2016 and March 2017 are presented in this article.

Active Medical Reviews

This article provides a listing of active medical reviews being conducted by Palmetto GBA. Please share with appropriate staff.


Want to get these updates automatically?

Sign up for our Daily Listerv or Subscribe to our RSS Feed

This post applies to: JM HHH

Jurisdiction M Part B News for Friday 5/19/17

Active Medical Reviews

This article provides a listing of active medical reviews being conducted by Palmetto GBA. Please share with appropriate staff.

Screening for Hepatitis B Virus (HBV) Infection

Change Request (CR) 9859 provides that the Centers for Medicare & Medicaid Services (CMS) has determined that, effective September 28, 2016, Medicare will cover screening for Hepatitis B Virus (HBV) infection when performed with the appropriate U.S. Food and Drug Administration (FDA) approved/cleared laboratory tests, used consistent with FDA-approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations. Medicare coinsurance and the Part B deductible are waived for this additional preventive service. You should ensure that your billing staffs are aware of this coverage change.

Local Coverage Determination (LCD) Updates Part B

The comment period for the Chiropractic Services DL37387 and Vertebroplasty/Kyphoplasty DL33473 JM Part B LCD(s) will begin on June 5, 2017. The Implantable Infusion Pump L33461 JM Part B LCDs was revised. Please share with appropriate staff.

Local Coverage Determination (LCD) Update: Part A and Part B

The comment period for the Echocardiography DL37379 and Noncovered Category III CPT Codes DL34555 JM A/B MAC LCDs will begin on June 5, 2017. The Retroperitoneal Ultrasound L34577 A/B MAC LCDs begins its notice period May 18, 2017. The following A/B MAC LCDs were revised: Application of Skin Substitutes L36466, Cataract Surgery, Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy L34454, Corneal Pachymetry L34512, Nerve Conduction Studies and Electromyography L35048, and Rituximab (Rituxan®) L35026. Please share with appropriate staff.


Want to get these updates automatically?

Sign up for our Daily Listerv or Subscribe to our RSS Feed

Jurisdiction M Part A News for Friday 5/19/17

Active Medical Reviews

This article provides a listing of active medical reviews being conducted by Palmetto GBA. Please share with appropriate staff.

Screening for Hepatitis B Virus (HBV) Infection

Change Request (CR) 9859 provides that the Centers for Medicare & Medicaid Services (CMS) has determined that, effective September 28, 2016, Medicare will cover screening for Hepatitis B Virus (HBV) infection when performed with the appropriate U.S. Food and Drug Administration (FDA) approved/cleared laboratory tests, used consistent with FDA-approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations. Medicare coinsurance and the Part B deductible are waived for this additional preventive service. You should ensure that your billing staffs are aware of this coverage change.

Local Coverage Determination (LCD) Update: Part A and Part B

The comment period for the Echocardiography DL37379 and Noncovered Category III CPT Codes DL34555 JM A/B MAC LCDs will begin on June 5, 2017. The Retroperitoneal Ultrasound L34577 A/B MAC LCDs begins its notice period May 18, 2017. The following A/B MAC LCDs were revised: Application of Skin Substitutes L36466, Cataract Surgery, Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy L34454, Corneal Pachymetry L34512, Nerve Conduction Studies and Electromyography L35048, and Rituximab (Rituxan®) L35026. Please share with appropriate staff.


Want to get these updates automatically?

Sign up for our Daily Listerv or Subscribe to our RSS Feed

Railroad Medicare Provider News for Thursday 5/18/17

eServices Unavailable due to Scheduled Maintenance Saturday, May 20, 2017

Due to scheduled maintenance, eServices users may experience an interruption in service beginning at approximately 8 a.m. ET on Saturday, May 20, 2017. Please read this article to learn more.

Updated Manual Guidelines for Electronic Funds Transfer (EFT) Payments and Change of Ownership (CHOW)

Special Edition article SE17012 clarifies language in Chapter 15, Section 15.7.7.1.5 of the ‘Medicare Program Integrity Manual’ related to Electronic Funds Transfer (EFT) Payments and Changes of Ownership (CHOWs). Please make sure your staffs are aware of this update.

Understanding the Railroad Medicare Medical Review Program Webcast: June 13

Have questions about the Railroad Medicare Medical Review program? We have answers! Join us June 13, 2017, for a live webinar covering the basics of the Medical Review program. We will discuss why we conduct reviews, the different types of reviews we conduct, and your role in the medical review process. We will share helpful resources and answer frequently asked questions.

What to Know, Where to Go, and What’s New Webcast: May 23

Join us on May 23, 2017, as we address frequently asked questions about Railroad Medicare. In this updated webcast, we will discuss many of our top telephone inquiries and answer common questions about Railroad Medicare enrollment, claims submission, appeals, eServices and more, with emphasis on the website resources and self-service tools that can help you succeed with Railroad Medicare. Please plan to attend.


Want to get these updates automatically?

Sign up for our Daily Listerv or Subscribe to our RSS Feed

Jurisdiction M Home Health & Hospice News for Thursday 5/18/17

There is Still Time to Evaluate Our Services!

There is still time to share your experiences about the services we provide. Please complete the MAC Satisfaction Indicator (MSI) survey. These survey results will help us find ways to better serve you.

Prepayment Service Specific Probe Results for the Health Insurance Prospective Payment System (HIPPS) Codes For Claims Utilizing the 2CHL* HIPPS Code in Alabama and Tennessee

Palmetto GBA performed service-specific pre-payment probe medical review on Home Health claims for HIPPS code 2CHL*. There were 13 edits set for specific states within the Palmetto GBA A/B MAC Home Health jurisdiction: Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina and Tennessee. The results for Alabama and Tennessee for claims processed between November 2016 and March 2017 are presented in this article. Results for remaining 11 states will be released at a later date.

Prepayment Service Specific Probe Results for, the Health Insurance Prospective Payment System (HIPPS) Codes For Claims Utilizing the 3BGP* HIPPS Code in Louisiana and Oklahoma

Palmetto GBA performed service-specific pre-payment probe medical review on Home Health claims for HIPPS code 3BGP*. There were 13 edits set for specific states within the Palmetto GBA A/B MAC Home Health jurisdiction: Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina and Tennessee. The results for Louisiana and Oklahoma for claims processed between November 2016 and March 2017 are presented in this articles.

NPI Crosswalk Issue: Claims Editing with Reason Code 32103/ Direct Data Entry (DDE) System Access Issues/Claim DCNs Suffix XXX

Certain providers are receiving reason code 32103 for all their claims, having DDE access issues and claim DCNs getting assigned the suffix of XXX. This is due to a Medicare crosswalk issue. The reason code explains that NPI/Oscar (PTAN) number pair on the claim is not present on the Medicare NPI crosswalk file. Other MACs are experiencing the same issue. Palmetto GBA is suspending the claims that receive reason code 32103 instead of having them return to provider (RTP). The issue is being researched and has been reported to CMS. No provider action is required at this time. Please share with appropriate staff.

eServices Unavailable due to Scheduled Maintenance Saturday, May 20, 2017

Due to scheduled maintenance, eServices users may experience an interruption in service beginning at approximately 8 a.m. ET on Saturday, May 20, 2017. Please read this article to learn more.

Prepayment Service Specific Probe Results for the Health Insurance Prospective Payment System (HIPPS) Codes For Claims Utilizing the 3BGM* HIPPS Code in Louisiana

Palmetto GBA performed service-specific pre-payment probe medical review on Home Health claims for HIPPS code 3BGM*. There were 13 edits set for specific states within the Palmetto GBA A/B MAC Home Health jurisdiction: Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina and Tennessee. The results for Louisiana for claims processed between November, 2016 and March 2017 are presented in this article. The results for the 12 remaining states will be delivered in a separate article.


Want to get these updates automatically?

Sign up for our Daily Listerv or Subscribe to our RSS Feed

This post applies to: JM HHH