Railroad Medicare Provider News for Tuesday 11/21/17

Medicare Secondary Payer Inquiry Form

As a reminder, A Medicare Secondary Payer Inquiry Form is available in the Medicare Secondary Payer forms section of our website. To ensure timely processing of your request, this form should be used for any Medicare Secondary Payer (MSP) request pertaining to Primary or Secondary payment of claims. Please share with appropriate staff.

Respond to all CERT Requests

Failure to respond to a CERT request for additional information will result in a denied claim and a CERT error assigned to your facility. There is an easy fix; submit the documentation within the timeframe indicated in the CERT letter.

Website Provider Focus Group: Survey and Teleconference

Are you a frequent visitor to the Palmetto GBA website? If so, we need your feedback! Join us for the Palmetto GBA Website Provider Focus Group on December 6, 2017, at 11 a.m. ET by calling 877-789-3907 and reference conference ID # 5487539. This is your opportunity to share with us your feedback and help us make improvements to our website. Prior to the call please take a short seven question survey. We look forward to hearing from each of you!

ICD-10 Coding Revisions to National Coverage Determinations (NCDs)

Change Request (CR) 10318 constitutes a maintenance update of the International Code of Diseases, Tenth Revision (ICD-10) conversions and other coding updates specific to National Coverage Determinations (NCDs). These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. Make sure your staff is aware.

E/M Weekly Tip: Discharge Services-Patient Expired

Only the physician who personally performs the pronouncement of death may bill for the face-to-face hospital discharge service. The date of the pronouncement must reflect the calendar date of service on the day it was performed even if the paperwork is delayed to a subsequent date. Please share with appropriate staff.

Emergency Ambulance Services: Regulations and Required Documentation Webcast: December 12

Join us on December 12, 2017, at 2 p.m. ET for a live webcast focused on the Medicare benefit for Emergency Ambulance Transports. In this informative session, we will explore Medicare benefit policies, medical necessity, and supporting documentation requirements. We will also discuss how to respond to a Medical Review documentation request, provide helpful resources, and give you the chance to ask questions related to this topic. Please plan to attend.

December 2017 Railroad Medicare News

The December 2017 Railroad Medicare News is now available. Please review this issue for the latest Medicare updates and upcoming provider education opportunities. Please remember to share this information with your staff.


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Jurisdiction J Part B News for Tuesday 11/21/17

2018 Part B Ask the Contractor Teleconference (ACT) Schedule

The 2018 JJ Part B ACT Schedule is now available. Please review this schedule and instructions on how to attend this teleconference. Please share this information with your staff.

Part A JJ Provider Cost Report Submission Instructions Upon Transition

Effective January 29, 2018, the date when Part A providers transition to Palmetto GBA, you can submit your cost report package electronically through our portal at www.palmettogba.com/eservices. You will still need to mail the signature page. Or you can mail the cost report package to the appropriate addresses noted in this article.


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Jurisdiction J Part A News for Tuesday 11/21/17

2018 Part B Ask the Contractor Teleconference (ACT) Schedule

The 2018 JJ Part B ACT Schedule is now available. Please review this schedule and instructions on how to attend this teleconference. Please share this information with your staff.

Part A JJ Provider Cost Report Submission Instructions Upon Transition

Effective January 29, 2018, the date when Part A providers transition to Palmetto GBA, you can submit your cost report package electronically through our portal at www.palmettogba.com/eservices. You will still need to mail the signature page. Or you can mail the cost report package to the appropriate addresses noted in this article.


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Railroad Medicare Provider News for Friday 11/17/17

Anesthesia for Extensive Spine and Spinal Cord Procedures

Railroad Medicare’s Medical Review (MR) unit is conducting a service-specific review of anesthesia services for extensive spine and spinal cord procedures (such as spinal instrumentation or vascular procedures). Our MR unit selected this code based on internal data analysis. At the conclusion of this review, we will publish our findings on our website.

Anesthesia for Lower Intestinal Endoscopic Procedures: Endoscope Introduced Distal to Duodenum

Railroad Medicare’s Medical Review (MR) unit is conducting a service-specific review of anesthesia services for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum. Our MR unit selected this code based on internal data analysis. At the conclusion of this review, we will publish our findings on our website.

Active Medical Reviews

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

Medical Review of Non-Emergency BLS Transport

Railroad Medicare’s Medical Review (MR) unit is conducting a service-specific review for HCPCS code A0428, ambulance service, Basic Life Support, non-emergency transport, (BLS – Non-Emergency). This code was selected based on internal data analysis. At the conclusion of this review, we will publish our findings on our website.

Bone Mass Measurements (BMM) Services

Railroad Medicare’s Medical Review (MR) unit is conducting a service-specific review of dual-energy X-ray absorptiometry (DXA) bone density study. Our MR unit selected this code based on internal data analysis. At the conclusion of this review, we will publish our findings on our website.

Diagnostic Radiology: Chest X-Ray Services

Railroad Medicare’s Medical Review (MR) unit is conducting a service-specific review of Chest X-rays. Our MR unit selected this code based on internal data analysis. At the conclusion of this review, we will publish our findings on our website.


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Railroad Medicare Provider News for Thursday 11/16/17

Medical Review of Emergency ALS Transports

Railroad Medicare’s Medical Review (MR) unit is conducting a service-specific review for HCPCS code A0427, ambulance service, Advanced Life Support, emergency transport, (ALS – Emergency). Our MR unit selected this code based on internal data analysis. At the conclusion of this review, we will publish our findings on our website.


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Jurisdiction J Part B News for Thursday 11/16/17

Jurisdiction J (JJ) Transition Frequently Asked Questions (FAQs): Updated November 15, 2017

Palmetto GBA updated the Jurisdiction (JJ) Frequently Asked Questions (FAQs) on November 15, 2017. Please review this information and share it with your staff.

Palmetto GBA Workshop Speaker Request Form

Associations and Medical Societies requesting the Palmetto GBA workshop series are asked to complete all sections of this form and fax it to Palmetto GBA. Please review the information about the form and instructions for submitting this form. Remember to share this information with your staff.


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Jurisdiction J Part A News for Thursday 11/16/17

Jurisdiction J (JJ) Transition Frequently Asked Questions (FAQs): Updated November 15, 2017

Palmetto GBA updated the Jurisdiction (JJ) Frequently Asked Questions (FAQs) on November 15, 2017. Please review this information and share it with your staff.

Palmetto GBA Workshop Speaker Request Form

Associations and Medical Societies requesting the Palmetto GBA workshop series are asked to complete all sections of this form and fax it to Palmetto GBA. Please review the information about the form and instructions for submitting this form. Remember to share this information with your staff.


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Railroad Medicare Provider News for Wednesday 11/15/17

Annual Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement

Change Request (CR) 10308 provides the 2018 annual update to the list of Healthcare Common Procedure Coding System (HCPCS) codes used by Medicare systems to enforce consolidated billing of home health services. Make sure your billing staffs are aware of these updates.

Claim Status Category and Claim Status Codes Update

Change Request (CR) 10271 informs MACs about system changes to update, as needed, the Claim Status Codes and Claim Status Category Codes used for the Accredited Standards Committee (ASC) X12 276/277 Health Care Claim Status Request and Response and ASC X12 277 Health Care Claim Acknowledgment transactions. Make sure your billing staffs are aware of these changes.

Implement Operating Rules -Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): CORE 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule -Update from Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE)

Change Request (CR) 10268 instructs MACs and Shared System Maintainers (SSMs) to update systems based on the CORE 360 Uniform Use of Claims Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC), and Claim Adjustment Group Code (CAGC) Rule publication. These system updates are based on the Committee on Operating Rules for Information Exchange (CORE) Code Combination List to be published on or about February 1, 2018. Make sure that your billing staff is aware of these changes.

Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update

Change Request (CR) 10270 updates the Remittance Advice Remark Codes (RARC) and Claims Adjustment Reason Code (CARC) lists and instructs Medicare Shared System Maintainers (SSMs) to update Medicare Remit Easy Print (MREP) and PC Print. Be sure your staffs are aware of these changes and obtain the updated MREP and PC Print software if they use that software.

Revision of PWK (Paperwork) Fax/Mail Cover Sheets

Change Request (CR) 10124 alerts providers that their MAC will provide revised fax/mail cover sheets via hardcopy and/or electronic download. These revised documents are attached to CR10124. There are three paperwork (PWK) attachments to CR10124: (1) Medicare Part A Fax/Mail Cover Sheet (2) Medicare Part B Fax/Mail Cover Sheet and (3) Medicare DME MAC Fax/Mail Cover Sheet.

Therapy Cap Values for Calendar Year (CY) 2018

Change Request (CR) 10341 provides the amounts for outpatient therapy caps for Calendar Year (CY) 2018. For physical therapy and speech-language pathology combined, the CY 2018 cap is $2,010. For occupational therapy, the CY 2018 cap is $2,010. Make sure that your billing staffs are aware of these therapy cap value updates.

Provider Enrollment Email Communications

For many years it has been our practice to send Provider Enrollment communications via email. Effective November 13, 2017, our email communication process will be streamlined with the implementation of new email addresses specific to Provider Enrollment Additional Development Requests (ADRs) and final application completion letters. Please share with appropriate staff.

Controlled Substances and Drugs of Abuse Screenings family, Presumptive and Definitive Tests

Railroad Medicare’s Medical Review (MR) unit is conducting a service-specific review of HCPCS codes G0477, G0478, G0479 (presumptive test), and HCPCS codes G0480, G0481, G0482, and G0483 (definitive test) from the Controlled Substances and Drugs of Abuse Screenings family. Presumptive and/or definitive drug testing methods are used to detect usage of controlled substances and illicit drugs. Our MR unit selected this code based on internal data analysis. At the conclusion of this review, we will publish our findings on our website.

Evaluation and Management Code, Initial Hospital Inpatient Care, typically 70 minutes

Railroad Medicare’s Medical Review (MR) unit is conducting a service-specific review of Evaluation and Management (E/M) code, initial hospital inpatient care, typically 70 minutes. This code should be used for the admitting physician to report the first hospital encounter with the patient. Our MR unit selected this code based on internal data analysis. At the conclusion of this review, we will publish our findings on our website.

Evaluation and Management New Patient, Office or other Outpatient Visit: Typically 60 minutes

Railroad Medicare’s Medical Review (MR) unit is conducting a service-specific review of Evaluation and Management (E/M) code, new patient office or other outpatient visit, typically 60 minutes. Our MR unit selected this code based on internal data analysis. At the conclusion of this review, we will publish our findings on our website.

Evaluation and Management: Emergency Department Visit, with Highly Complex Medical Decision Making

Railroad Medicare’s Medical Review (MR) unit is conducting a service-specific review of Evaluation and Management (E/M) code, emergency department visit, requiring highly complex medical decision making. Evaluation and management emergency codes should be used for reporting care provided in the emergency department. Our MR unit selected this code based on internal data analysis. At the conclusion of this review, we will publish our findings on our website.

Evaluation and Management: Subsequent Inpatient Hospital Care, Typically 25 minutes

Railroad Medicare’s Medical Review (MR) unit is conducting a service-specific review of Evaluation and Management (E/M) code, subsequent hospital inpatient care, typically 25 minutes. Our MR unit selected this code based on internal data analysis. At the conclusion of this review, we will publish our findings on our website.

Provider Customer Service Center Training and Closure Dates

The Provider Contact Center (PCC) will be closed for the Thanksgiving Holiday on November 23-24. The PCC will reopen on November 27. Please be sure to share with your staff.

Subsequent Nursing Facility Care, Typically 15 or 25 Minutes

Railroad Medicare’s Medical Review (MR) unit is conducting a service-specific review of subsequent nursing facility care, typically 15 minutes per day, and subsequent Nursing Facility Care, typically 25 minutes per day. Our MR unit selected this code based on internal data analysis. At the conclusion of this review, we will publish our findings on our website.


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Railroad Medicare Provider News for Tuesday 11/14/17

Medicare Secondary Payer Inquiry Form

As a reminder, A Medicare Secondary Payer Inquiry Form is available in the Medicare Secondary Payer forms section of our website. To ensure timely processing of your request, this form should be used for any Medicare Secondary Payer (MSP) request pertaining to Primary or Secondary payment of claims. Please share with appropriate staff.

Emergency Ambulance Services: Regulations and Required Documentation Webcast: December 12

Join us on December 12, 2017, at 2 p.m. ET for a live webcast focused on the Medicare benefit for Emergency Ambulance Transports. In this informative session, we will explore Medicare benefit policies, medical necessity, and supporting documentation requirements. We will also discuss how to respond to a Medical Review documentation request, provide helpful resources, and give you the chance to ask questions related to this topic. Please plan to attend.


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Railroad Medicare Provider News for Monday 11/13/17

January 2018 Release ‘Dark Days’ for the Common Working File (CWF) Hosts

In anticipation of the January 2018 Release, the CWF Hosts will not process claims beginning Friday, December 29, 2017 through Sunday, December 31, 2017. During this period, which is commonly referred to as ‘dark days,’ the CWF Hosts will install the January 2018 Release, complete weekly/monthly/quarterly processing activities, and perform scheduled data center maintenance. Note: On Monday, January 1, 2018, the onlines will be available for HIMR, BDS and the MBI/HICN crosswalk, but no CWF cycles will be run. This means Medicare Administrative Contractors (MACs) will not have access to the Health Insurance Master Record (HIMR) and Beneficiary Data Streamlining (BDS) transactions. Eligibility information in HIQA and HIQH will also not be available to providers.


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