NY Chapter NASW March 16, 2018

Disclaimer No recording please National Government Services, Inc. has produced this material as an informational reference for providers furnishing services in our contract jurisdiction. National Government Services employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this material. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of publication, the Medicare Program is constantly changing, and it is the responsibility of each provider to remain abreast of the Medicare Program requirements. Any regulations, policies and/or guidelines cited in this publication are subject to change without further notice. Current Medicare regulations can be found on the Centers for Medicare & Medicaid Services (CMS) website at http://www.cms.gov.

2018 Agenda topics New Medicare Card Provider Enrollment and tips for Revalidation Billing Medicare changes in 2018 Medicare Basics for Clinical Social Workers Impact of legislative changes – 2016 PQRS and QPP going forward

New Medicare Card MACRA requires that CMS mail out new Medicare cards with a new Medicare Number starting in April 2018 – April 2019 Does not affect Medicare benefits There will be geographical waves of successive mailings. People with Medicare can start using their new Medicare cards right away The Medicare Beneficiary Identifier (MBI) is confidential like the SSN and should be protected as Personally Identifiable Information

New Medicare Card Your systems and business processes must be ready to accept the new Medicare number (MBI) by April 2018 for transactions, such as billing, claim status, eligibility status, and interactions with NGS contact centers. There will be a transition period when you can use either the HICN or the MBI to exchange data and information with us Transition period will start 4/1/18 and run through 12/31/19 Your systems must be ready however, for people who are new to Medicare in April 2018 and later as they will only receive a card with the MBI The patient’s MBI will be returned on every electronic RA for claims you submit with a valid and active HICN

New Medicare Card Characteristics of the MBI Prepare for this change: 11 characters in length (no special characters) Randomly generated Contains numbers (0-9) Uppercase letters (A-Z) Except for S, L, O, I, B, and Z No special characters Prepare for this change: Contact your vendors to discuss system changes No end-to-end testing Use the transition period as a live test

New Medicare Card Work to help your Medicare patients with MBI changes Must have a valid address Beneficiaries will not receive a new card if their address isn’t correct Record correction Social Security Administration at 1-800-772-1213 Electronically changing address online at: https://www.ssa.gov/myaccount/

What You Can Do to Get Ready CMS mailings will include instructions about a secure provider look-up tool Check with your billing vendors System changes Order or print the new poster (#12009-P) and tear- off sheets Display in your offices and waiting rooms Follow the Medicare Learning Network and look on www.cms.gov/newcard for the latest information about new Medicare cards

Provider Enrollment

Provider Enrollment Application Process Timeline All required information available Internet based PECOS application target is 45 days CMS 855 paper application target is 60 days An acknowledgment notice with a case number (faxed, mailed or emailed) to the contact from PEDoNotReply@anthem.com If necessary, additional documentation request will be faxed, mailed or emailed with a 30 days return date Obtainable Status Interactive Voice Response System Application Status Inquiry Tool Response letters may take up to 7 days to receive after the finalized application All Medicare Administrative Contractors (MACs) including National Governments Services (NGS) have a goal to finalize an internet based PECOS application within 45 days and a CMS 855 paper application within 60 days, if all required information is available. About the process: An acknowledgment notice with a case number will be mailed or emailed (PEDoNotReply@anthem.com) to the contact on the submitted application. If additional documentation is needed, a request will be mailed or emailed to the contact giving 30 days to respond. When all information is available, application will go through a series of steps before the final step of completion. The contact can follow the status of the application by calling the Interactive Voice Response System (IVR) or link to the Application Status Inquiry Tool. Please allow up to 7 days after the application has finalized for the response letter to be received by mail or email.

Provider Enrollment Revalidation Check PECOS https://pecos.cms.hhs.gov/pecos/login.do Check CMS website https://go.cms.gov/MedicareRevalidation https://data.cms.gov/revalidation (Medicare Revalidation Look Up Tool) Due date will display or “TBD” (To Be Determined) if not currently due MLN Matters article SE1211  MLN Matters article SE1605 MLN Matters article SE1126 You can also determine if you need to revalidate by using PECOS or the CMS Medicare Revalidation Look Up Tool . In PECOS under your enrollment record look for a date in the “Revalidation Mailed Date” field.   CMS Medicare Revalidation Look Up Tool will give your revalidation due date or will indicate “TBD” (to be determined), this tool is updated monthly. You can review the MLN Matters SE1211 article for additional details on the Fraud Prevention Program and automated screenings. MLN Matters SE1605 for updated changes to this current 5 year cycle.   MLN Matters article SE1126 for the initial 5 year round of revalidation.

Provider Enrollment Revalidation Who All providers five years after initial enrollment or about last revalidation When Only when notified and before due date Notices are mailed 2 - 3 months prior to due date Unsolicited revalidation applications returned if received more than 6 months prior due date What Verify entire Medicare enrollment record Why Avoid payment hold or deactivation of Medicare billing privileges by responding promptly Revalidation is mandated under Section 6401(a) of the Affordable Care Act.    Revalidation is intended to verify all information on file for existing Medicare providers to ensure that providers meet current program requirements and is a key component of the National Fraud Prevention Program.  National Government Services will send revalidation notifications 2 to 3 months before revalidation due date to providers/suppliers that are requested to revalidate. Submit complete revalidation application before due date and  no more than 6 months prior.  Revalidation applications received prior to 6 month of due date will be returned. It is important to understand the entire Medicare enrollment record will need to be verified, so all NPI and PTAN combinations for practice locations (groups/institutions) and all group affiliation (individuals) must be indicated on the application. Avoid payment hold or deactivation of Medicare billing privileges by submitting the revalidation application timely and responding to attentional information requested. Otherwise deactivation of enrollment will result in an interruption in claim payment.

Provider Enrollment Tools Internet-based PECOS Click on the Enrollment tab and select Learn About PECOS Web Determine the correct CMS-855 application Initial enrollment Click on the Enrollment tab and select Submit an Enrollment Application: Start to Finish then select Choose the Correct Application for You Changes in enrollment Click on the Enrollment tab and select Make Changes to My Existing Enrollment Revalidate an enrollment Click on the Enrollment tab and select Obtain Revalidation Instructions Provider Enrollment Educational Webinars Click on the Education tab and select Webinars, Teleconferences & Events Provider Enrollment Status Inquiry Tool (Application Status) Click on the Enrollment tab and select Provider Enrollment Status Inquiry Tool

Claim Submission

The Basic Options in Medicare Treating Medicare beneficiaries requires enrollment in Medicare. Beneficiaries have protections under the law. If you are not enrolled, please communicate openly with your patients. Complete the Opt Out Affidavit. Enter in to a provide contract with the patient. (www.ngsmedicare.com) Medicare has mandatory claims submission in place. Review policy statement. Please share this message with your peers.

Opt Out rules Opting Out of Medicare allows you to render services to Medicare-enrolled beneficiaries under a private contract. Neither the provider, nor the beneficiary submits the bill to Medicare for services rendered. The beneficiary pays the physician or practitioner out-of- pocket and neither is reimbursed by Medicare. A private contract is a signed agreement between the practitioner and the beneficiary that states, that neither one can receive payment from Medicare for the services that were performed. ( A condition for most Medigap plans is that a Medicare approved the service.)

Tele-Medicine Medicare does provide coverage for beneficiaries residing in rural health areas. Check HRSA data warehouse This does not apply to urban areas in NYC. Telephone and skype sessions with beneficiaries are not currently covered by Medicare.

Claim Filing Requirements SSA 1848(g)(4)(A) of the Social Security Act requires providers submit claims for all Medicare patients Patients may not be charged for preparing or filing a Medicare claim Clinical social workers are required to accept assignment for all Medicare claims Beneficiary may be liable for any applicable deductible and 20 percent coinsurance Per the Patient Protection and Affordable Care Act of 2010 the timely filing requirement was amended to one calendar year after the date of service

Handwritten Claims Reduction Effective July 10, 2017, NGS will not longer accept handwritten claims Notice attached to the returned claim Only the signature blocks on the CMS-1500 claim form are allowed to contain handwriting (Items 12, 13 & 31) Date Handwritten Paper Claims Will be Returned State/Locality County Listing 07/10/2017 Maine, New Hampshire, Rhode Island, Vermont 08/07/207 New York (Upstate Loc 03 and 99) New York Locality/Area and County Information 09/11/2017 Connecticut 03/30/2018 Massachusetts 05/30/2018 New York (Downstate Loc 01, 02 and 04)

Handwritten Claims Reduction Alternate options to handwritten claims: Electronic claims submission Visit the EDI section of our website to get started NGSConnex Data enter your claim details into our portal Get started here: NGSConnex Resource/Documentation: The CMS printing specifications for paper claims does not include instructions for handwriting CMS IOM 100-04, Ch. 26, Section 30

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Medicare is moving from a volume based program to Value/Quality initiatives 1. The programs have evolved from PQRS to QPP ( MACRA/MIP ) 2. 2018 is the last year for PQRS using 2016 claims data. 3. Going forward using 2017 data, QPP will be in place. 4. MACRA will be in place in 2019. Two year look back in place. Exemption will apply. NASW site has an excellent summary.

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JK Contact Information Part B PCC: 866-837-0241 Part B IVR: 877-869-6504 Fax on Demand: 866-709-1905 EDI Helpdesk: 888-379-9132 Correspondence National Government Services Part B Provider General Written Inquiries P.O. Box 6189 Indianapolis, IN 46207-6189 New Direct Telephone line for Provider Enrollment (JK): 888-379-3807 28

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