Fwd: WPS Medicare Part B MAC eNews for Monday, May 9, 2011

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Date: Mon, May 9, 2011 at 2:39 PMSubject: WPS Medicare Part B MAC eNews for Monday, May 9, 2011To: RONALDJEDWARDS@...********************************************************************

WPS Medicare Part B MAC eNews for Monday, May 9, 2011***********************************************************************MEDICARE TIP OF THE WEEK***Annual Wellness Visit (AWV) Codes Added to C-SNAP

WPS Medicare is pleased to let you know that G0438 (initial AWV) and G0439 (subsequent AWV) are now displayed in CMS Secure Network Access Portal (C-SNAP). The codes are located on the Preventive Service Eligibility Function.

For more information on the AWV, please refer to the Questions and Answer document located at http://www.wpsmedicare.com/j5macpartb/resources/provider_types/awv-faq.shtml

********************************************************************TABLE OF CONTENTSWPS ARTICLESI.      Cardiology, Family Practice, Internal Medicine, and Nurse Practitioner Focused Education Audio Files Now Available!

II.     Comprehensive Error Rate Testing (CERT) - Documentation Contractor UpdateIII.    Enrollment Application Status Inquiry (EASI)IV.     New Audiology Frequently Asked Question (FAQ)V.      Should I Bill Medicare When the Primary Insurer Paid in Full?

VI.     Unprocessable Claim Rejections Do Not Have Appeal or Reopening RightsCMS ARTICLESVII.    CMS Learnresource MessagesVIII.   CMS MLN Matters Articles********************************************************************

I.      CARDIOLOGY, FAMILY PRACTICE, INTERNAL MEDICINE, AND NURSE PRACTITIONER FOCUSED EDUCATION AUDIO FILES NOW AVAILABLE!WPS Medicare is pleased to announce the posting of the audio files and additional resources for the April 18, 2011 Family Practice Focused Education and Internal Medicine Focused Education Teleconferences and the April 25, 2011 Cardiology Focused Education and Nurse Practitioner Focused Education Teleconferences. To access these, please refer to the following web pages:

Cardiology: http://www.wpsmedicare.com/j5macpartb/training/on_demand/cardiology.shtmlFamily Practice: http://www.wpsmedicare.com/j5macpartb/training/on_demand/family-practice.shtml.

Internal Medicine: http://www.wpsmedicare.com/j5macpartb/training/on_demand/internal-medicine.shtmlNurse Practitioner: http://www.wpsmedicare.com/j5macpartb/training/on_demand/nurse-practitioner.shtml

********************************************************************II.     COMPREHENSIVE ERROR RATE TESTING (CERT) - DOCUMENTATION CONTRACTOR UPDATEThe CERT Documentation Contractor (CDC) makes every effort to obtain complete medical record documentation from providers in order to conduct a fair review. We are sharing information and recommendations recently received from the CDC to assist you in responding to CERT medical records requests and related follow-up inquiries. Please read the full article at http://www.wpsmedicare.com/j5macpartb/departments/cert/cert-documentation-update.shtml for information on the following topics:

*       Faxing of documentation*       Legibility of images*       Requests for contractor numbers*       CERT related recoupment questions********************************************************************

III.    ENROLLMENT APPLICATION STATUS INQUIRY (EASI)In late May 2011, our Provider Enrollment unit will be adding a new process to confirm receipt of new applications via e-mail. We will also provide the internal control number we have assigned to the application and a website link for you to check the status of that application at any time, as it moves through the various processing stages.

The different processing statuses you may see are:*       Completed*       Pending*       Returned*       EFT response*       Additional information requestedConfirmation of completion of the application and assignment of new Provider Transaction Access Numbers (PTANs) will continue to be sent via regular mail.

PLEASE BE CERTAIN TO PROVIDE YOUR CURRENT E-MAIL ADDRESS IN THE CONTACT PERSON SECTION OF ALL APPLICATIONS TO ENSURE THAT THE RECEIPT CONFIRMATION E-MAIL WITH TRACKING CONTROL NUMBER CAN BE PROPERLY SENT TO YOU.

********************************************************************IV.     NEW AUDIOLOGY FREQUENTLY ASKED QUESTION (FAQ)Question: Is an audiologist required to file claims under their own National Provider Identifier (NPI) for services rendered in an office setting?

Answer: Yes, an audiologist must use his/her own NPI when filing claims. As stated in the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 12 , Physicians/Nonphysician Practitioners, Audiology Services, Section 30.3, A.2:

Audiologists must be enrolled and use their NPI on claims for services they render in office settings on or after October 1, 2008 (for additional information about enrollment, refer to IOM Pub. 100-08, Medicare Program Integrity Manual, Chapter 15). Before October 1, 2008, the services of audiologists who were not yet enrolled in Medicare were billed by a physician or group who employed the audiologist. Audiologists shall use the billing instructions in the Medicare manuals.

Additional information regarding services provided by an audiologist can be found in the Claims Processing Manual at http://www.cms.gov/manuals/downloads/clm104c12.pdf.

********************************************************************V.      SHOULD I BILL MEDICARE WHEN THE PRIMARY INSURER PAID IN FULL?Question: My patient provided primary insurance information and the insurance company paid in full. Do I still need to submit a claim to Medicare?

Answer: Medicare recommends you submit the claim for secondary benefits even though there is no outstanding balance. The reasons for this include application of the patient's deductible for allowed services, notification of certain once in a lifetime benefits, recording of certain time restricted services, and allowing Medicare to keep the claim on file. This last one becomes vitally important when the primary insurance company requests the payment back.

The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-05, Chapter 3, Section 10.5 indicates that a primary insurance take back alone does not constitute good cause to waive the 1 year filing limit. However, if we already have the claim on file, we may be able to perform a reopening. You can find more information on good cause for waiving the file limit and reopening on the " Appeals " and " Claims " departmental areas of our website:

http://www.wpsmedicare.com/j5macpartb/departments/appeals/http://www.wpsmedicare.com/j5macpartb/departments/claims/

********************************************************************VI.     UNPROCESSABLE CLAIM REJECTIONS DO NOT HAVE APPEAL OR REOPENING RIGHTSA claim with the Remittance Advice Remark Code (RARC) of MA130 does not have appeal rights. We frequently receive requests for redeterminations that must be transferred to another area for response. Please look at the Remittance Advice to determine the reason for the claim rejection and correct the problem. For more information, please see the following article on the WPS Medicare website:

http://www.wpsmedicare.com/j5macpartb/departments/appeals/appeal-rights.shtml********************************************************************

VII.    CMS LEARNRESOURCE MESSAGESThe Centers for Medicare & Medicaid Services (CMS) released the following Learnresource articles this week. Visit the WPS Medicare website at the addresses listed below for more information on the topics.

*       2011 Physician Quality Reporting System & Electronic Prescribing Incentive Program National Provider Call with Question & Answer Session       http://www.wpsmedicare.com/j5macpartb/publications/news/current/2011-0509-call-session.shtml

*       CMS Announces National Version 5010 Testing Day - Wednesday, June 15, 2011       http://www.wpsmedicare.com/j5macpartb/publications/news/archived/2011-0505-5010-testing.shtml

*       CMS ICD-10 Conversion Activities National Provider Teleconference - Including a Lab Case Study       http://www.wpsmedicare.com/j5macpartb/publications/news/archived/2011-0505-icd10-conversion.shtml

*       Healthcare Common Procedure Coding System (HCPCS) Public Meeting Agendas for Orthotics & Prosthetics       http://www.wpsmedicare.com/j5macpartb/publications/news/archived/2011-0505-hcpcs-agenda.shtml

*       HIPAA 5010 & D.0 Implementation Calendar and Important Reminders for May 2011       http://www.wpsmedicare.com/j5macpartb/publications/news/current/2011-0509-implement-calendar.shtml

*       Medicare Part B Average Sales Price - Payments for Wilate and Flulaval       http://www.wpsmedicare.com/j5macpartb/publications/news/current/2011-0509-avg-price.shtml

*       National Provider Call on the Medicare and Medicaid EHR Incentive Programs: Understanding Meaningful Use       http://www.wpsmedicare.com/j5macpartb/publications/news/current/2011-0509-understand-npc.shtml

*       National Women’s Health Week and National Women’s Checkup Day       http://www.wpsmedicare.com/j5macpartb/publications/news/archived/2011-0505-womens-health.shtml

*       New FAQs on CMS EHR Incentive Programs       http://www.wpsmedicare.com/j5macpartb/publications/news/archived/2011-0505-faqs-ehr.shtml

*       Physician Quality Reporting System & Electronic Prescribing Incentive Program Announcement       http://www.wpsmedicare.com/j5macpartb/publications/news/current/2011-0509-pqr-erx-announce.shtml

*       Save the Date: Medicare and Medicaid EHR Incentive Programs: Understanding Meaningful Use       http://www.wpsmedicare.com/j5macpartb/publications/news/current/2011-0509-ehr-call.shtml

*       Save the Date: National Provider Call on Medicare FFS Implementation of HIPAA Version 5010 and D.0 Transactions       http://www.wpsmedicare.com/j5macpartb/publications/news/archived/2011-0505-ffs-hipaa.shtml

*       Special Open Door Forum: 2011 Physician Quality Reporting System and Electronic Prescribing (eRx) Incentive Programs       http://www.wpsmedicare.com/j5macpartb/publications/news/archived/2011-0505-pqr-odf.shtml

*       Two New State Medicaid Incentive Programs Launched       http://www.wpsmedicare.com/j5macpartb/publications/news/archived/2011-0505-state-prgms.shtml

*       Updates From the Medicare Learning Network       http://www.wpsmedicare.com/j5macpartb/publications/news/archived/2011-0505-mln-updates.shtml

********************************************************************VIII.   CMS MLN MATTERS ARTICLESThe Centers for Medicare & Medicaid Services (CMS) released the following MLN Matters articles this week. Visit the CMS website at the addresses listed below for more information on the topics.

Power Mobility Device Face-to-Face Examination Checklisthttp://www.cms.gov/MLNMattersArticles/Downloads/SE1112.pdf********************************************************************

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