Railroad Medicare Provider News for 11/16/2018

January 2019 ‘Dark Days’ Release for the Common Working File (CWF) Hosts

For the upcoming January 2019 Release, CWF will be observing ‘Dark Days’ starting Friday, January 4, 2019, through the Sunday, January 6, 2019 to accommodate the anticipated duration of this activity and to ensure the completion of weekly/monthly/quarterly processing and the installation of the January 2019 Release. Please share with appropriate staff.

Medicare Fee-for-Service (FFS) Response to the 2018 California Wildfires

On November 13, 2018, the Administrator of the Centers for Medicare & Medicaid Services (CMS) authorized waivers under §1812(f) of the Social Security Act for the State of California retroactive to November 8, 2018, for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of the wildfires. Under Section 1135 or 1812(f) of the Social Security Act, CMS has issued several blanket waivers in the impacted geographical areas of the State of California. These waivers will prevent gaps in access to care for beneficiaries impacted by the emergency. Providers do not need to apply for an individual waiver if a blanket waiver has been issued. Please share with appropriate staff.

Provider Customer Service Center Training and Closure Dates

The Provider Contact Center (PCC) training will be held on December 5, 2018, from 10:45 a.m. to 12:45 p.m. ET. It will also be held from 2:30 p.m. to 4:30 p.m. ET on November 29, December 6, 13 and 20, 2018. Please be sure to share this update with your staff.

Widespread Review of Evaluation/Management Claims for Emergency Department Visit, with High Complexity Medical Decision Making: Fourth Quarter of FY 2018

Palmetto GBA Railroad Medicare has completed a widespread Charge Denial Rate (CDR) review of specified Evaluation/Management (E/M) service claims submitted from July 2018 through September 2018. Please review this information and share it with your staff.

Widespread Review of Evaluation/Management Claims for Initial Hospital Inpatient Care Services: Fourth Quarter of FY 2018

Palmetto GBA Railroad Medicare has completed a widespread Charge Denial Rate (CDR) review of specified Evaluation/Management (E/M) service claims submitted from July 2018 through September 2018. Please review this information and share it with your staff.

Widespread Review of Evaluation/Management Claims for Subsequent Hospital Inpatient Care, Typically 25 Minutes: Fourth Quarter of FY 2018

Palmetto GBA Railroad Medicare has completed a widespread Charge Denial Rate (CDR) review of specified Evaluation/Management (E/M) service claims submitted from July 2018 through September 2018. Please review this information and share it with your staff.

Widespread Review of Select Bone Mass Measurements (BMM) Services: Fourth Quarter of FY 2018

Palmetto GBA Railroad Medicare has completed a widespread Charge Denial Rate (CDR) review of specified DXA bone density service claims submitted from July 2018 through September 2018. Please review this information and share it with your staff.


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Jurisdiction M Home Health & Hospice News for 11/16/2018

January 2019 ‘Dark Days’ Release for the Common Working File (CWF) Hosts

For the upcoming January 2019 Release, CWF will be observing ‘Dark Days’ starting Friday, January 4, 2019, through the Sunday, January 6, 2019 to accommodate the anticipated duration of this activity and to ensure the completion of weekly/monthly/quarterly processing and the installation of the January 2019 Release. Please share with appropriate staff.

Why isn’t Mary Receiving the Home Health Care Her Physician Ordered?

Submitting appropriate documentation when requested to do so will ensure the HHA can receive appropriate Medicare payment and your patient’s care will not be interrupted or discontinued. Please review and share with your staff.

Hospice Claims Editing for Reason Code U5181

Hospices are reporting claims to the Provider Contact Center that did edit correctly for reason code U5181. Some claims are incorrectly returning to provider (RTP) for reason code U5181, stating there are issues with occurrence code OC 27 (missing, incorrect date, outside the dates of service{DOS}, etc.). Most, if not all, of the affected claims have Occurrence Span Code (OSC) 77 (Provider Liability) and dates within the DOS. Please share with your staff.

Credit Balance Reports Due October 30, 2018, Are Now Past Due: Please Submit Now

Palmetto GBA mailed letters to over 600 providers whose September 30, 2018 credit balance reports are past due. Please ensure your credit balance reports are submitted timely. eServices is the most efficient and Palmetto GBA’s preferred method of submission of Credit Balance reports. Please share with appropriate staff.


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This post applies to: JM HHH

Jurisdiction M Part B News for 11/16/2018

January 2019 ‘Dark Days’ Release for the Common Working File (CWF) Hosts

For the upcoming January 2019 Release, CWF will be observing ‘Dark Days’ starting Friday, January 4, 2019, through the Sunday, January 6, 2019 to accommodate the anticipated duration of this activity and to ensure the completion of weekly/monthly/quarterly processing and the installation of the January 2019 Release. Please share with appropriate staff.

Appropriate Usage of the Modifier for a Distinct Procedural Service, Other Than E/M Services

This article explains when to use the modifier to identify procedures/services, other than E/M services, that are not normally reported together but are appropriate under the circumstances. Please share with appropriate staff.

Why isn’t Mary Receiving the Home Health Care Her Physician Ordered?

Submitting appropriate documentation when requested to do so will ensure the HHA can receive appropriate Medicare payment and your patient’s care will not be interrupted or discontinued. Please review and share with your staff.


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Jurisdiction M Part A News for 11/16/2018

January 2019 ‘Dark Days’ Release for the Common Working File (CWF) Hosts

For the upcoming January 2019 Release, CWF will be observing ‘Dark Days’ starting Friday, January 4, 2019, through the Sunday, January 6, 2019 to accommodate the anticipated duration of this activity and to ensure the completion of weekly/monthly/quarterly processing and the installation of the January 2019 Release. Please share with appropriate staff.

Patient Discharge Status Codes Matter

The CERT Task Force has released an educational article for Part A providers emphasizing the importance of using correct patient discharge status codes. Please review this information and share it with your staff.

What conditions will contractors allow for exceptions to and extension of timely filing requirements?

This article explains what conditions contractors will allow for exceptions to and extension of timely filing requirements. Please share with appropriate staff.

Why isn’t Mary Receiving the Home Health Care Her Physician Ordered?

Submitting appropriate documentation when requested to do so will ensure the HHA can receive appropriate Medicare payment and your patient’s care will not be interrupted or discontinued. Please review and share with your staff.

Credit Balance Reports Due October 30, 2018, Are Now Past Due: Please Submit Now

Palmetto GBA mailed letters to over 600 providers whose September 30, 2018 credit balance reports are past due. Please ensure your credit balance reports are submitted timely. eServices is the most efficient and Palmetto GBA’s preferred method of submission of Credit Balance reports. Please share with appropriate staff.


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Jurisdiction J Part B News for 11/16/2018

January 2019 ‘Dark Days’ Release for the Common Working File (CWF) Hosts

For the upcoming January 2019 Release, CWF will be observing ‘Dark Days’ starting Friday, January 4, 2019, through the Sunday, January 6, 2019 to accommodate the anticipated duration of this activity and to ensure the completion of weekly/monthly/quarterly processing and the installation of the January 2019 Release. Please share with appropriate staff.

Appropriate Usage of the Modifier for a Distinct Procedural Service, Other Than E/M Services

This article explains when to use the modifier to identify procedures/services, other than E/M services, that are not normally reported together but are appropriate under the circumstances. Please share with appropriate staff.

Why isn’t Mary Receiving the Home Health Care Her Physician Ordered?

Submitting appropriate documentation when requested to do so will ensure the HHA can receive appropriate Medicare payment and your patient’s care will not be interrupted or discontinued. Please review and share with your staff.


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Jurisdiction J Part A News for 11/16/2018

January 2019 ‘Dark Days’ Release for the Common Working File (CWF) Hosts

For the upcoming January 2019 Release, CWF will be observing ‘Dark Days’ starting Friday, January 4, 2019, through the Sunday, January 6, 2019 to accommodate the anticipated duration of this activity and to ensure the completion of weekly/monthly/quarterly processing and the installation of the January 2019 Release. Please share with appropriate staff.

Patient Discharge Status Codes Matter

The CERT Task Force has released an educational article for Part A providers emphasizing the importance of using correct patient discharge status codes. Please review this information and share it with your staff.

What conditions will contractors allow for exceptions to and extension of timely filing requirements?

This article explains what conditions contractors will allow for exceptions to and extension of timely filing requirements. Please share with appropriate staff.

Why isn’t Mary Receiving the Home Health Care Her Physician Ordered?

Submitting appropriate documentation when requested to do so will ensure the HHA can receive appropriate Medicare payment and your patient’s care will not be interrupted or discontinued. Please review and share with your staff.


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Railroad Medicare Provider News for 11/15/2018

Widespread Review of ALS Emergency Ambulance Services: Fourth Quarter of FY 2018

Palmetto GBA Railroad Medicare has completed a widespread Charge Denial Rate (CDR) review of specified ambulance service claims submitted from July 2018 through September 2018. The review sample included HCPCS code A0427. The overall CDR based on the dollar amount billed for services involved in this sampling was 32.5 percent. Of the 5,287 reviewed, 1,713 were denied, and 3,574 were allowed. An analysis of the results is provided in this article.

Widespread Review of BLS Non-Emergency Ambulance Services: Fourth Quarter of FY 2018

Palmetto GBA Railroad Medicare has completed a widespread Charge Denial Rate (CDR) review of specified ambulance service claims submitted from July 2018 through September 2018. The review sample included HCPCS code A0428. The overall CDR based on the dollar amount billed for services involved in this sampling was 38.4 percent. Of the 5,100 reviewed, 1,942 were denied, and 3,158 were allowed. An analysis of the results is provided in this article.

Widespread Review of Diagnostic Radiology: Chest X-Ray Services: Fourth Quarter of FY 2018

Palmetto GBA/Railroad Medicare has completed a widespread Charge Denial Rate (CDR) review of claims submitted for specified chest X-ray codes from July 2018 through September 2018. Please review this information and share it with your staff.

Widespread Review of Evaluation/Management Claims for New Patient Office or other Outpatient Services: Fourth Quarter of FY 2018

Palmetto GBA Railroad Medicare has completed a widespread Charge Denial Rate (CDR) review of specified Evaluation/Management (E/M) service claims submitted from July 2018 through September 2018. Please review this information and share it with your staff.

Widespread Review of Evaluation/Management Claims of Skilled Nursing Facility (SNF) Services: Fourth Quarter of FY 2018

Palmetto GBA Railroad Medicare has completed a widespread, Charge Denial Rate (CDR), review of specified Evaluation/Management (E/M) service claims submitted from July 2018 through September 2018. The review sample included subsequent nursing facility care, typically 15 minutes and subsequent nursing facility care, typically 25 minutes. The overall charge denial rate based on the dollar amount billed for services involved in this sampling was 51.6 percent. Of the 3,480 reviewed, 1,789 were denied, and 1,691 were allowed. An analysis of the results is provided in this article.


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Jurisdiction M Home Health & Hospice News for 11/15/2018

Common Working File (CWF) Provider Queries National Provider Identifier (NPI) and Submitter Identification (ID) Verification

Change Request (CR) 10983 announces that the Common Working File (CWF) will require verification of the National Provider Identifier (NPI) and Submitter Identification (ID) similar to the Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS) when Medicare Part A providers request Medicare beneficiary eligibility and entitlement data via the CWF provider inquiry screens. Make sure your billing staffs are aware of this update.

User CR: Fiscal Intermediary Shared System (FISS) – Implementation of the Molecular Diagnostic Services (MolDX)

Change Request (CR) 10760 adds a Molecular Diagnostic Services (MolDX) test identification (ID) field to FISS. The MolDX program requires that providers be able to input a unique test ID into their claims at the detail line level. Providers will now be able to manually enter or correct the MolDX test ID field through Direct Data Entry (DDE) processing. This will assist the Medicare Administrative Contractors (MACs) in more accurate adjudication of Part A claims involved with the MolDX program. This feature will be available on April 1, 2019. Make sure your billing staff is aware of this change.


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This post applies to: JM HHH

Jurisdiction M Part B News for 11/15/2018

eUtilization: See Who Has Been Using Your NPI

Electronic Utilization (eUtilization) reports are now available in the eServices portal. eUtilization reports provide rendering providers and ordering and referring providers access to their personal data. This data can be reviewed to ensure providers are aware of when and by whom their NPI is being used for billing Medicare services and when their NPI is entered on a Medicare claim as the ordering referring physician.

Gain Insight Into Your Billing Patterns and Utilization Services: Use Electronic Comparative Billing Reports (eCBRs)

Palmetto GBA uses electronic Comparative Billing Reports (eCBRs) as an educational tool for providers to use in order to provide insight into your billing patterns and utilization of services in comparison to your peers. eCBR will provide you with the ability to view and download your individual CBR online.


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Jurisdiction M Part A News for 11/15/2018

Common Working File (CWF) Provider Queries National Provider Identifier (NPI) and Submitter Identification (ID) Verification

Change Request (CR) 10983 announces that the Common Working File (CWF) will require verification of the National Provider Identifier (NPI) and Submitter Identification (ID) similar to the Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS) when Medicare Part A providers request Medicare beneficiary eligibility and entitlement data via the CWF provider inquiry screens. Make sure your billing staffs are aware of this update.

User CR: Fiscal Intermediary Shared System (FISS) – Implementation of the Molecular Diagnostic Services (MolDX)

Change Request (CR) 10760 adds a Molecular Diagnostic Services (MolDX) test identification (ID) field to FISS. The MolDX program requires that providers be able to input a unique test ID into their claims at the detail line level. Providers will now be able to manually enter or correct the MolDX test ID field through Direct Data Entry (DDE) processing. This will assist the Medicare Administrative Contractors (MACs) in more accurate adjudication of Part A claims involved with the MolDX program. This feature will be available on April 1, 2019. Make sure your billing staff is aware of this change.

Part A Credit Balance Survey

We would like your input regarding the credit balance process. Please complete our credit balance survey via the link provided. The survey will be available until November 30, 2018. Please share with your staff.


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