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J14 A/B MAC 

NHIC, Corp. - Part A / RHHI - Weekly Updates

March 29, 2013

Welcome to the NHIC, Corp. J14 A/B MAC Website Mailings!

This information will assist in keeping you updated with Medicare changes.  

If you would like to make any changes or additions to your selections, or email address, click on Update Profile/Email Address at the VERY bottom of this email.

Updates

 

The Educational Teleconference section below is enhanced to include links to the summaries for each program. The link will take you to our NHIC, Corp. web site.

 

Upcoming Part A Educational Teleconferences 

  

Note: Teleconferences listed are scheduled for 10:00 AM to 12:00 Noon (ET), unless otherwise noted. 

 

04/02/2013

The Boomerang Effect - How to Avoid Medicare Advantage Organization Plan and Hospice Related Rejections via Virtual room 

04/04/2013


Note: This session will be held from 11 a.m.-12:00 p.m.

04/17/2013

A Visual Tour of the Fiscal Intermediary Standard System Direct Data Entry (FISS DDE) Inquiry Menu via Virtual room 


Upcoming RHHI Educational Teleconferences

 

Note: Teleconferences listed are scheduled for 10:00 AM to 12:00 Noon (ET), unless otherwise noted.  

04/04/2013


Note: This session will be held from 11 a.m.-12:00 p.m.

04/17/2013

A Visual Tour of the Fiscal Intermediary Standard System Direct Data Entry (FISS DDE) Inquiry Menu via Virtual room 

04/22/2013

Hospice Benefit: Billing and Payment via Virtual room 

04/23/2013

Home Health Coverage 

04/25/2013

Home Health and Hospice Ask- the- Contractor Teleconference (ACT) 


Educational Teleconference Reminders!

 

To provide the best customer service possible, we ask that you complete an assessment for the teleconference you attended. Your evaluation will be used in conjunction with other evaluations to determine in what areas our representatives are most helpful and where they need to strengthen their skills to better satisfy our customers' needs. Please indicate to what degree your expectations were met. Please evaluate each teleconference you attended. Thank you very much. 

 

J14 MAC Part A Assessment Form
J14 MAC RHHI Assessment Form 

 

Registration is required for all teleconferences. 

 

Please visit the J14 Part A and J14 RHHI Educational Programs webpage for further information.  

 

If you are registering for a group, and using only 1 telephone line, then only 1 registration is required. 


What's New from CMS

Question: How is the 2% payment reduction under sequestration identified on the electronic remittance advice (ERA) and the standard paper remittance (SPR)?
Answer: Claim adjustment reason code (CARC) 223 is used to report the sequestration reduction on the ERA and SPR.

Question: What is the verbiage for CARC 223?
Answer: "Adjustment code for mandated Federal, State or local law/regulation that is not already covered by another code and is mandated before a new code can be created."

Question: Will the 2% reduction be reported on the remittance advice in a separate field?
Answer: For institutional Part A claims, the adjustment is reported on the remittance advice at the claim level. For Part B physician/practitioner, supplier, and institutional provider outpatient claims, the adjustment is reported at the line level.

Question: How will the payments be calculated on the claims?
Answer: The reduction is taken from the calculated payment amount, after the approved amount is determined and the deductible and coinsurance are applied.

Example: A provider bills a service with an approved amount of $100.00, and $50.00 is applied to the deductible. A balance of $50.00 remains. We normally would pay 80% of the approved amount after the deductible is met, which is $40.00 ($50.00 x 80% = $40.00). The patient is responsible for the remaining 20% coinsurance amount of $10.00 ($50.00 - $40.00 = $10.00). However, due to the sequestration reduction, 2% of the $40.00 calculated payment amount is not paid, resulting in a payment of $39.20 instead of $40.00 ($40.00 x 2% = $0.80).

Question: How are unassigned claims affected by the 2% reduction under sequestration?
Answer: Though beneficiary payments toward deductibles and coinsurance are not subject to the 2% payment reduction, Medicare's payment to beneficiaries for unassigned claims is subject to the 2% reduction. The non-participating physician who bills on an unassigned basis collects his/her full payment from the beneficiary, and Medicare reimburses the beneficiary the Medicare portion (e.g., 80% of the reduced fee schedule amount. NOTE: The "reduced fee schedule" refers to the fact that Medicare's approved amount for claims from non-participating physicians/practitioners is 95% of the full fee schedule amount). This reimbursed amount to the beneficiary would be subject to the 2% sequester reduction just like payments to physicians on assigned claims. Both are claims payments, just to different parties. If the Limiting Charge applies to the service rendered, physicians/practitioners cannot collect more than the Limiting Charge amount from the beneficiary.

Example: A non-participating provider bills an unassigned claim for a service with a Limiting Charge of $109.25. The beneficiary remains responsible to the provider for this full amount. However, sequestration affects how much Medicare reimburses the beneficiary. The non-participating fee schedule approved amount is $95.00, and $50.00 is applied to the deductible. A balance of $45.00 remains. Medicare normally would reimburse the beneficiary for 80% of the approved amount after the deductible is met, which is $36.00 ($45.00 x 80% = $36.00). However, due to the sequestration reduction, 2% of the $36.00 calculated payment amount is not paid to the beneficiary, resulting in a payment of $35.28 instead of $36.00 ($36.00 x 2% = $0.72).

We encourage physicians, practitioners, and suppliers who bill unassigned claims to discuss with their Medicare patients the impact of the sequestration reductions to Medicare payments.

Question: Is this reduction based on the date of service or date of receipt?
Answer: In general, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment. Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding Program, will be reduced by 2 percent based upon whether the date-of-service, or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013.


Additional CMS Message(s)

 

These messages cover a variety of topics from the Centers for Medicare & Medicaid Services (CMS) that are important to the provider / supplier community. Articles are published on the NHIC, Corp. website.  Please "Click Here" to view the complete list.

 

Please click on the CMS e-News link below for CMS announcements.

 

  

CMS e-News for Thursday, March 28, 2013
(CMS Message 201303-05) (TDL 13263) (TDL 13271)

 

The CMS e-News for Thursday, March 28, 2013 includes the following provider education messages:

  1. TDL 13263,  "Therapy Cap Manual Medical Review Transition to Recovery Auditors" issued on March 14, 2013 and applicable to all Medicare fee-for-service providers.
  2. TDL 13271,  "Sequestration - Impact on Payments and the Medicare Cost Report"  issued on March 20, 2013 and applicable to Home Health Agencies, Skilled Nursing Facilities, Comprehensive Outpatient Rehabilitation Facility (CORF), Outpatient, Physicians and Non-Physician Practitioner.   
 
This e-mail account is not monitored for inquiries; contact forms are available for you on our website at www.medicarenhic.com.  
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