June 2013 - Cahaba GBA

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Update to Chapter 15 of the Program Integrity Manual (PIM)MLN Matters® MM8222Provider Types AffectedThis MLN Matters® Article is intended for physicians, providers and suppliers submitting claims toMedicare contractors (carriers, Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs),and A/B Medicare Administrative Contractors (MACs)) for services to Medicare beneficiaries.What You Need to KnowThis article is based on Change Request (CR) 8222, which makes several revisions to Chapter 15 of theCenters for Medicare & Medicaid Services (CMS) "Medicare Program Integrity Manual." The keyclarification is as follows:Sections 15.25.1.2 and 15.25.2.2 (Reconsideration Requests) are revised as follows: Consistent with42 CFR 498.24(a), the provider, the supplier, or the Medicare contractor may submit corrected, new,or previously omitted documentation or other facts in support of its reconsideration request of aprovider enrollment denial or revocation at any time prior to the Hearing Officer's (HO’s) decision.The HO must determine whether the denial or revocation is warranted based on all of the evidencepresented. This includes:o The initial determination itself,o The findings on which the initial determination was based,o The evidence considered in making the initial determination, ando Any other written evidence submitted under 42 CFR 498.24(a), taking into account factsrelating to the status of the provider or supplier subsequent to the initial determination.Additional InformationThe official instruction, CR8222 issued to your FI, RHHI, carrier, or A/B MAC regarding this change maybe viewed at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R461PI.pdf on the CMS website.Medicare A Newsline April 2013 26
Phase III Electronic Remittance Advice (ERA) Enrollment Operating RulesMLN Matters® MM8223Provider Types AffectedThis MLN Matters® Article is intended for physicians, providers and suppliers enrolling for ElectronicRemittance Advice (ERA) with Medicare contractors (Fiscal Intermediaries (FIs), carriers, Regional HomeHealth Intermediaries (RHHI), A/B Medicare Administrative Contractors (MACs) and Durable MedicalEquipment (DME MACs)).What You Need to KnowThis article is based on Change Request (CR) 8223, which instructs Medicare contractors on the steps theymust take to come into compliance with Phase III ERA Enrollment Operating Rule requirements by October1, 2013. Contractors must have paper-based ERA enrollment forms in compliance with Attachment 1 of CR8223 no later than July 1, 2014.Medicare contractors must update their Electronic Remittance Advice (ERA) Enrollment forms for newenrollments to comply with Attachment 1 of CR 8223. The contractors must comply with the followingrequirements:1. Identify a maximum set of standard data elements to be requested from providers for enrollment toreceive Electronic Remittance Advice (ERA).2. Apply “controlled vocabulary” – predefined and authorized terms- for use when referring to thesame data element.3. Use standard data elements to appear on paper enrollment form in a standard format and flow, usingconsistent data elements and vocabulary as on the electronic form.4. Use specific information or instruction to providers to assist in manual paper-based ERA enrollment.5. Offer electronic ERA enrollment.Make sure that your billing staffs are aware of these updates to the ERA Enrollment Operating Rules.BackgroundSection 1104 of the Affordable Care Act requires the Secretary of Health and Human Services to adopt andregularly update standards, implementation specifications, and operating rules for the electronic exchangeand use of health information for the purpose of financial and administrative transaction.What You Need to Know about the ERA Enrollment FormProviders who have a signed ERA Enrollment Form on file with a particular Medicare contractor orCommon Electronic Data Interchange (CEDI) are not required to submit a new signed ERA EnrollmentForm to the same Medicare contractor or CEDI each time they change their method of electronic billing orbegin to use another type of electronic data interchange (EDI) transaction, e.g., changing from directsubmission to submission through a clearinghouse or changing from one billing agent to another.Medicare A Newsline April 2013 27
Page 1 and 2: June 2013This bulletin should be sh
Page 3 and 4: News from Cahaba GBA for All Part A
Page 6 and 7: Cahaba GBA’s Email Notification S
Page 8 and 9: LCD - Finalized Local Coverage Dete
Page 10: Calendar Year 2013 Update to the Am
Page 13 and 14: ICD-10 Implementation DateThe ICD-1
Page 15 and 16: News from CMS for Part A ProvidersO
Page 17 and 18: Key Points of CR8121Exact Duplicate
Page 19 and 20: Data Reporting on Home Health Prosp
Page 21 and 22: Recovery of Annual Wellness Visit (
Page 23: New Healthcare Common Procedure Cod
Page 28 and 29: Additionally, providers are not req
Page 30 and 31: Professional claim lines for 0256T,
Page 32 and 33: Reporting End-Stage Renal Disease (
Page 34 and 35: 3) If the provider states that the
Page 36 and 37: Applying Multiple Procedure Payment
Page 38 and 39: New Codes - CARC: NoneModified Code
Page 40 and 41: Quarterly Healthcare Common Procedu
Page 42: Medicare A Newsline Quality SurveyP

June 2013 - Cahaba GBA

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