April 1, 2010, Home Health & Hospice Medicare A Newsline - CGS

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Additionally, since there is potential for crossover between compliance and enforcement and fraud, waste,and abuse work, the MEDICs will continue to work collaboratively and refer issues to one another asappropriate.This should be a seamless transition for the Medicare beneficiaries as well who will still be able to contactthe MEDIC toll free number from anywhere in the United States to report concerns pertaining to MedicareParts C and D program fraud, waste, and abuse. Any Medicare beneficiary who suspects fraud should callthe Benefit Integrity (BI) MEDIC at 1-877-7SafeRx or 1-877-772-3379 or their local Senior MedicarePatrol (SMP). Those with concerns about plan sponsor compliance or agent/broker misconduct can call 1-800-Medicare, their local State Health Insurance Counseling and Assistance Program (SHIP) or theirDepartment of Insurance (DOI).Anyone with Medicare who finds that someone is inappropriately using their personal information shouldcontact: 1-877-7SafeRx (1-877-772-3379) and the Federal Trade Commission’s ID Theft hotline at 1-877-438-4338 to make a report (TTY users should call 1-866-653-4261). For more information about ID theftprotection, visit www.FTC.gov/idtheft.As always, beneficiaries who feel in danger for any reason should call their local police departmentimmediately.For further information about the MEDICs, please visit our Web sites:Health Integrity, Benefit Integrity (BI) MEDIC: www.healthintegrity.org/SafeGuard Services, LLC Compliance and Enforcement (C&E) MEDIC: www.edssafeguardservices.edsgov.com/Availability of the Provider Contact Center (PCC)Medicare is a continuously changing program, and it is important that we provide correct and accurateanswers to your questions. To better serve the provider community, the Centers for Medicare & MedicaidServices (CMS) allows the provider contact centers the opportunity to offer training to our customer servicerepresentatives (CSRs). Listed below are the date and time the home health and hospice PCC (1-877-299-4500 and 1-866-539-5592) will be closed for training. We will continue to notify you of future CSRtraining dates in the Home Health & Hospice Medicare A Newsline.CSR Training DateApril 13, 2010May 11, 2010June 8, 2010July 13, 2010Time8:20—10:40 a.m. Central Time8:20—10:40 a.m. Central Time8:20—10:40 a.m. Central Time8:20—10:40 a.m. Central TimeHome Health & Hospice April 1, 2010 39Medicare A Newsline Vol. 17, No. 7
Medicare Credit Balance Quarterly ReminderThis is to remind you to submit the Quarterly Medicare Credit Balance Report. The next report is due in ouroffice postmarked by April 30, 2010, for the quarter ending March 31, 2010.The Medicare Credit Balance Report (CMS-838) and certification must be postmarked by the date indicatedabove. If the information is received with a postmark date later than the date indicated above, we arerequired to withhold 100 percent of all payments being sent to your facility. This withholding will remainin effect until the reporting requirements are met. If no credit balance exists for your facility during aquarter, a signed Medicare Credit Balance Report certification is still required. Please include yourMedicare provider number on the certification form.To ensure timely receipt and processing, please send the report to the following address:Attention: Credit Balance, Sta. 210Provider Audit and ReimbursementCahaba GBAP.O. Box 14537Des Moines, IA 50306-3537If sending overnight:Attention: Credit Balance, Sta. 210Provider Audit and ReimbursementCahaba GBA400 E Court AveDes Moines, IA 50309-2019For additional information, refer to the “Credit Balance Report” Web page. If you have any questions, or ifyou need a paper copy of the CMS-838 form, please contact the Medicare Credit Balance telephone line at515-471-7444.News from Cahaba for Home Health ProvidersNew Fiscal Intermediary Standard System (FISS) Inquiry Menu Screen for HomeHealth ProvidersThe Change Request 6759, “Limitation on Home Health Prospective Payment System (HH PPS) OutlierPayments”, explains that effective January 1, 2010, outlier payments made to each home health agency aresubject to an annual limitation. As a result, the new FISS Inquiry Menu screen, Home Health Pymt Totals(Map 1B41), was developed to allow you to track your outlier and HH PPS payment totals to ensure thatoutlier payments comprise no more than 10 percent of the HHA’s total HH PPS payments for the year.Data for up to three years will be available, beginning with calendar year 2010 HH PPS payment totals andoutlier payments. When each HH PPS claim is processed, FISS will compare these two amounts anddetermine whether the 10 percent has currently been met.Home Health & Hospice April 1, 2010 40Medicare A Newsline Vol. 17, No. 7
Page 1 and 2: Home Health & HospiceMedicare A New
Page 3 and 4: H1N1 Influenza ImmunizationsMedicar
Page 5 and 6: Revised Medicare Physician Fee Sche
Page 7 and 8: classified (NOC) drug pricing files
Page 9 and 10: DisclaimerThis article was prepared
Page 11 and 12: BCTransfer From AnotherHome Health
Page 13 and 14: BackgroundWhen the National Uniform
Page 15 and 16: Key OPPS Updates for April 20101. P
Page 17 and 18: carrier or A/B MAC cannot provide a
Page 19 and 20: Note: Medicare contractors may adju
Page 21 and 22: Additional InformationFor complete
Page 23 and 24: Implementation of Home Health Agenc
Page 25 and 26: Provider Types AffectedThis article
Page 27 and 28: A. CMS has alerted MAC audit staff
Page 29 and 30: interpretation is billed and no E/M
Page 31 and 32: The provider may not bill the patie
Page 33 and 34: Claims in the “S MXXXX” status/
Page 35 and 36: In addition, the provider will also
Page 37 and 38: For more detailed information about
Page 39: Can Cahaba provide guidance to us r
Page 43 and 44: MAP1B41 CAHABA GBA - RHHI ACPFAT01
Page 45 and 46: Resolving Reason Code U538FThe Caha
Page 47 and 48: A2. Yes, you are correct. The langu
Page 49 and 50: medical director of the hospice or
Page 51 and 52: Cahaba GBA Learning Corner‣ “Cl

April 1, 2010, Home Health & Hospice Medicare A Newsline - CGS

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