1. Welcome to 2006 Updates for ANCO Presented by NHIC Provider Education and Outreach Representatives January 2006 TMP-EDO-0006 Version 2.0

2. Fee Schedule Update November, 2005 published fee schedule Proposed change before Congressional Congressional Action – Month end? www.medicarenhic.com

3. 2006 Deductible: $124 Medicare Part B Deductible

4. NPI Enrollment Choices Web based application Paper Application Electronic file application https://www.cms.hhs.gov Chose 1 method only

5. NPI Transition Time Line 1-3-06 - 10-1-06 PIN only, or PIN & NPI 10-2-06 – 5-22-07PIN or NPI 5-23-07NPI only

6. NPI Enumerator Fox Systems, Inc. 1-800-465-3203 (NPI Toll-Free) 1-800-692-2326 (NPI TTY) customerservice@npienumerator.com NPI Enumerator PO Box 6059 Fargo, ND 58108-6059

7. NPI Information Link from Our website

8. National Provider Identifier (NPI) http://www.cms.hhs.gov/NationalProvIdent Stand/ (NEW) http://www.cms.hhs.gov/NationalProvIdent Stand/ http://www.cms.hhs.gov/MedlearnMattersArticl es/downloads/SE0528.pdf (NEW) http://www.cms.hhs.gov/MedlearnMattersArticl es/downloads/SE0528.pdf Medlearn Matters article SE0555 at http://www.cms.hhs.gov/MedlearnMattersArticl es/downloads/SE0555.pdf (NEW) http://www.cms.hhs.gov/MedlearnMattersArticl es/downloads/SE0555.pdf

9. Surrogate UPIN Reporting Surrogate UPIN # OTH000 will become invalid as of April 1 st, 2006 Claims will reject Ordered or referred service must contain a valid UPIN UPIN Registry http://www.upinregistry.com/

10. Appeals Changes Redetermination Reconsideration as of January 1 Administrative Law Judge Departmental Review Board Federal Courts

11. Redetermination – First Level No Telephone Review New form CMS 20027 www.cms.hhs.gov/forms/CMS2002 7.pdf

12. Written Redeterminations Copy of claim Copy of Remittance Advice Additional documentation Pertinent claim information

15. Reopenings by Telephone Correct clerical errors – Provider or Carrier Dates of service entered incorrectly (i.e., 09152003 instead of 09152004) Units entered as 0001 instead of 0010 Dollars entered as 2.00 instead of 200.00 (only obvious errors; not just to increase billed amount)

16. CMS Medicare Contractor Provider Satisfaction Survey National in scope Gather provider’s opinions about Contractor’s performance NHIC’s providers selected to participate

17. CMS Medicare Contractor Provider Satisfaction Survey Notification packets sent out Respond on-line, by mail or Fax Respond by January 25,2006 Further Information: http://www.cms.hhs.gov/MCPSS/

18. Recovery Audit Contractor (RAC) Targets providers in CA, FL, NY Goal: to identify overpayments and underpayments Two recovery audit contractors MSP- Diversified Collections Claim Review- PRG Shultz

19. Recovery Audit Contractor (RAC) Letters requesting information Address questions directly to RAC, not NHIC RAC has 60 days to review the documentation Resource: Medlearn Matters SE0565 http://www.cms.hhs.gov/MedlearnMattersA rticles/downloads/SE0565.pdf

20. WEBSITE – www.medicarenhic.com Join our Mailing List

21. Reduce Paper RAs Use ERA Obtain software free from CMS “Medicare Remit Easy Print” http://www.medicarenhic.com/edi/download/mr epsoftware_1005.htm

22. Medicare Secondary Payer Can be billed electronically Use appropriate fields Claim will develop for primary RA if needed

23. MSP Electronic Claim Submission Primary payer name & address Insured’s effective date & termination date with primary payer Primary payer allowed amount Paid amount Deductible amount Coinsurance amount when applicable Disallowed amount Cost-containment amount when applicable

24. CR-3916 MSP Denial for Invalid GHP Updated MSP info by the Coordination of Benefits Contractor Re-process claims 1 year Automatically