Jurisdiction J Part B News for Friday 10/20/17

Jurisdiction J (JJ) Welcome Letter

Attention Jurisdiction J (JJ) Providers. Palmetto GBA mailed the JJ Welcome Letter to providers on October 17, 2017. This letter includes very important information about the JJ A/B MAC transition. For your convenience, we have included a sample copy of this letter on our website to view. Please review this information and share it with your staff.

Navigating Palmetto GBA’s Event Registration Portal

This article lists the steps to take to register for an event advertised on the Event Registration Portal. Please review this information and share it with your staff.

Register Today for the Jurisdiction J (JJ) Welcome to Palmetto GBA Part A Transition Workshop Series

We are pleased to announce our Welcome to Palmetto GBA transition workshop series. These Part A workshops are designed to introduce our providers in the states of Alabama, Georgia and Tennessee to us, their new Medicare Administrative Contractor (MAC).

Register Today for the Jurisdiction J (JJ) Welcome to Palmetto GBA Part B Transition Workshop Series

We are pleased to announce our Welcome to Palmetto GBA transition workshop series. These Part B workshops are designed to introduce our providers in the states of Alabama, Georgia and Tennessee to us, their new Medicare Administrative Contractor (MAC).


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Jurisdiction J Part A News for Friday 10/20/17

Jurisdiction J (JJ) Welcome Letter

Attention Jurisdiction J (JJ) Providers. Palmetto GBA mailed the JJ Welcome Letter to providers on October 17, 2017. This letter includes very important information about the JJ A/B MAC transition. For your convenience, we have included a sample copy of this letter on our website to view. Please review this information and share it with your staff.

Navigating Palmetto GBA’s Event Registration Portal

This article lists the steps to take to register for an event advertised on the Event Registration Portal. Please review this information and share it with your staff.

Register Today for the Jurisdiction J (JJ) Welcome to Palmetto GBA Part A Transition Workshop Series

We are pleased to announce our Welcome to Palmetto GBA transition workshop series. These Part A workshops are designed to introduce our providers in the states of Alabama, Georgia and Tennessee to us, their new Medicare Administrative Contractor (MAC).

Register Today for the Jurisdiction J (JJ) Welcome to Palmetto GBA Part B Transition Workshop Series

We are pleased to announce our Welcome to Palmetto GBA transition workshop series. These Part B workshops are designed to introduce our providers in the states of Alabama, Georgia and Tennessee to us, their new Medicare Administrative Contractor (MAC).


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Railroad Medicare Provider News for Friday 10/20/17

Prohibition on Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program

Medicare providers may not bill QMB individuals for Medicare cost-sharing, regardless of whether the State reimburses providers for the full Medicare cost-sharing amounts. Further, all original Medicare and MA providers–not only those that accept Medicaid–must refrain from charging QMB individuals for Medicare cost-sharing. Providers who inappropriately bill QMB individuals are subject to sanctions.

Medicare Fee-for-Service (FFS) Response to the 2017 California Wildfires

On October 17, 2017, 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 October 8, 2017 for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of wildfires. Make sure your staff is aware.


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Jurisdiction M Part B News for Friday 10/20/17

Prohibition on Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program

Medicare providers may not bill QMB individuals for Medicare cost-sharing, regardless of whether the State reimburses providers for the full Medicare cost-sharing amounts. Further, all original Medicare and MA providers–not only those that accept Medicaid–must refrain from charging QMB individuals for Medicare cost-sharing. Providers who inappropriately bill QMB individuals are subject to sanctions.

Ask the Contractor Teleconference: Choosing Immediate Offset of Demanded Overpayments: November 16

Join Palmetto GBA on November 16, 2017, at 10 am, ET for the next Jurisdiction M Part B Ask the Contractor Teleconference (ACT). On this ACT call, Palmetto GBA will present the benefits of using Immediate Offset to collect Medicare overpayments. Also, we will walk through the options available for submitting Immediate Offset requests as well as the ways these requests can be submitted. Please share with appropriate staff.


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Jurisdiction M Part A News for Friday 10/20/17

Prohibition on Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program

Medicare providers may not bill QMB individuals for Medicare cost-sharing, regardless of whether the State reimburses providers for the full Medicare cost-sharing amounts. Further, all original Medicare and MA providers–not only those that accept Medicaid–must refrain from charging QMB individuals for Medicare cost-sharing. Providers who inappropriately bill QMB individuals are subject to sanctions.


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Jurisdiction J Part B News for Thursday 10/19/17

Jurisdiction J EDI Submitter Letter

The Palmetto GBA EDI Team has mailed the attached letter to electronic submitters currently submitting Medicare claims to Cahaba Government Benefit Administrators, LLC (Cahaba GBA). The information included in this letter will assist you in transitioning your EDI transactions to Palmetto GBA.


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Jurisdiction J Part A News for Thursday 10/19/17

Jurisdiction J EDI Submitter Letter

The Palmetto GBA EDI Team has mailed the attached letter to electronic submitters currently submitting Medicare claims to Cahaba Government Benefit Administrators, LLC (Cahaba GBA). The information included in this letter will assist you in transitioning your EDI transactions to Palmetto GBA.


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Railroad Medicare Provider News for Wednesday 10/18/17

Clinical Laboratory Fee Schedule Not Otherwise Classified, Not Otherwise Specified or Unlisted Service or Procedure Code Data Collection

Change Request (CR) 10232 instructs MACs to assure that providers submit private payor data on unique tests currently being paid as a Not Otherwise Classified (NOC) code, Not Otherwise Specified (NOS) code, or Unlisted Service or Procedure code. Make your billing staff aware of this change.

E/M Weekly Tip: 1995 Examination (Combining)

For the 1995 Examination component, you may either use body areas or organ systems. You cannot combine both examinations to determine the appropriate level. Please share with appropriate staff.

Don’t Let Denials Increase Your Claims Processing Times

Palmetto GBA would like to remind providers that it is imperative to review Smart Edits returned on your 277CA. Smart Edits set before claims enter the adjudication processing system to alert providers that your claim is likely to deny if processed. Smart Edits have been put in place to assist you and we want you to receive the maximum benefit from this tool. Making necessary corrections before resubmitting a claim can reduce denials and time spent requesting reopenings or filing redeterminations and help ensure claims are correctly coded upon submission.

ICD-10 Editing

Palmetto GBA has been notified of an issue where some ranges of ICD-10 diagnosis codes were not read correctly by the system when the new ICD 10 file was loaded. As a result, some claims were incorrectly denied when the claims contained a valid diagnosis. Additionally, some claims may have paid when they contained a diagnosis code that was not valid. The system issue impacted a small number of claims processed on August 25, 2017. The system self corrected on August 26, 2017 during the next cycle. Palmetto GBA will perform adjustments on affected claims. Please share with appropriate staff.

Skilled Nursing Facility Consolidated Billing – Moderate Sedation Codes

CMS determined that certain moderate sedation codes were overlooked when the 2017 annual Skilled Nursing Facility (SNF) Common Working File (CWF) coding files were created. This issue may have affected some claims for dates of service January 1, 2017 and the article outlines the codes.


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Jurisdiction J Part B News for Wednesday 10/18/17

Jurisdiction J (JJ) Welcome Letter

Attention Jurisdiction J (JJ) Providers. Palmetto GBA mailed the JJ Welcome Letter to providers on October 17, 2017. This letter includes very important information about the JJ A/B MAC transition. For your convenience, we have included a sample copy of this letter on our website to view. Please review this information and share it with your staff.


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