1. Electronic Initiatives Presented by: Provider Outreach and Education June 13, 2013 1

2. Disclaimer  This resource is not a legal document. This presentation was prepared as a tool to assist our providers. This presentation was current at the time it was created.  Although every reasonable effort has been made to assure accurate information, responsibility for correct claims submission lies with the provider of services. Reproduction of this material for profit is prohibited. 2

3. PECOS Web Application  Provider Enrollment Chain and Ownership System  Can be used in lieu of the Medicare enrollment application to:  Submit an initial Medicare enrollment application  View or change your enrollment information  Track your enrollment application through the web submission process  Add or change a reassignment of benefits  Submit changes to existing Medicare enrollment information  Reactivate an existing enrollment record  Withdraw from the Medicare Program  Submit a Change of Ownership (CHOW) of the Medicare- enrolled provider 3

4. Advantages of Internet-based PECOS  Faster than paper-based enrollment (45 day processing time in most cases, vs. 60 days for paper)  Tailored application process means you only supply information relevant to YOUR application  Gives you more control over your enrollment information, including reassignments  Easy to check and update your information for accuracy  Less staff time and administrative costs to complete and submit enrollment to Medicare 4

5. Who Should I Call? External User Services  User ID/Password Inquiries  System-error message while completing Inter- net based PECOS enrollment  Questions about Internet- based PECOS account registration Cahaba GBA  Help completing an enrollment  Status of the enrollment application  Rejected applications  Missing applications 5

6. Electronic Funds Transfer  EFT enrollment is required at the time of:  Initial enrollment  Revalidation  Enrollment changes  Complete the CMS-588 form:  Must contain original signature of the authorized/delegated official  Include voided check http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/CMS588.pdf 6

7. Redetermination Smart Form  Complete all required fields (highlighted in red)  Complete the form electronically  Submit original Document Claim Number (DCN) in box 6  Answer all questions in section 16  Print, sign and fax http://www.cahabagba.com/documents/2012/02/part-a-redetermination_request.pdf 7

8. Smart Form Tips  Complete all required fields  Check “Overpayment” if Appeal is related to an overpayment  Print and sign form  Fax is the preferred submission method  DO NOT include cover sheet  Fax bar coded forms only  Ensure automated faxing (ex. LanFax/Esker) is not set to include cover sheet  Retain confirmation sheet 8

9. Clerical Error Reopening Form  Used for minor clerical errors or omissions  Type directly on the form  Be specific  After typing, print, sign and mail form  Use appropriate address listed at the top of form http://www.cahabagba.com/documents/2012/05/partacerrrequestform.pdf 9

10. Immediate Offset Request Form  Submission options:  Fax  Secure Email  Mail  Used when overpayment demand letter issued  Attach copy of claim  Submit separate form and claim listing for each demand letter http://www.cahabagba.com/documents/2012/06/part-a-overpayment-immediate- offset-request-form.pdf 10

11. Medicare Secondary Payer Adjustment Form  Used to request MSP adjustments  Type directly on the form  Print, sign and mail to appropriate address listed on form  Submit separate form for each adjustments http://www.cahabagba.com/documents/2012/02/part-a-mspadjustmentform.pdf 11

12. Electronic Data Interchange 12

13. Electronic Remittance Advice  Benefits of ERA:  Reduction of paper handling  Improved claim processing accuracy  Elimination of mail time  Faster receipt of payment information  Effortlessly downloaded and stored for future reference  Faster account reconciliation via electronic posting 13

14. esMD  Electronic Submission of Medical Documentation  esMD went live in September 2011  Cahaba GBA began accepting esMD in November 2011  esMD is not mandatory  For more information go to:  www.cms.gov/esMD www.cms.gov/esMD 14

15. Cahaba’s Perspective on esMD  Cahaba is ready to accept electronic submissions of Medical Documentation using esMD  esMD process is parallel to our paper process today  Faster response time = faster claim cycle time  Suggested response time is 10-15 days from receipt  Standard time frames still apply:  Provider has 45 days to respond to ADR  Cahaba has 60 days from the date of receipt to complete the medical review 15

16. Paperwork Segment (PWK)  The PWK is a segment within the 837 professional and institutional electronic transactions  It provides the linkage between electronic claims and additional documentation  Through the PWK process, documentation is imaged and available for review during claims processing 16

17. PWK Fax/Mail Coversheet  Complete all fields  Fax/Mail form to appropriate address  Fax numbers provided at bottom of form  Complete one cover sheet for each electronic claim http://www.cahabagba.com/documents/2012/10/part-a-pwk-coversheet-for- electronic-claims.pdf 17

18. Medicare EHR Incentive Program  Eligible hospitals can qualify for incentive payments if they demonstrate meaningful use of certified EHR technology  Hospitals eligible to participate in the program:  Sub section (d) hospitals  Critical Access Hospitals (CAHs)  Medicare Advantage Hospitals  Payment adjustments begin 2015  For more information visit:  http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/index.html http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/index.html 18

19. Redesigned Homepage 19

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