Presentation is loading. Please wait.

Presentation is loading. Please wait.

J15 Part A Provider Outreach and Education Annie Scriven and LJ Smith.

Similar presentations


Presentation on theme: "J15 Part A Provider Outreach and Education Annie Scriven and LJ Smith."— Presentation transcript:

1 J15 Part A Provider Outreach and Education Annie Scriven and LJ Smith

2  This presentation was current at the time it was published or uploaded onto the CGS website. Medicare policy changes frequently so links to the source documents have been provided within the document for your reference.  This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations. Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services.  The Centers for Medicare & Medicaid Services (CMS) 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 guide.  This publication is a general summary that explains certain aspects of the Medicare Program, but is not a legal document. The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings. 2 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

3  Discuss the changes to the beneficiary eligibility queries  Provide an overview of the updates and new reporting requirements for outpatient therapy services  Provide updates and request feedback on current and future POE activities Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

4  HIPAA Eligibility Transaction System (HETS) will replace the Common Working File (CWF) eligibility queries.  ELGB will be terminated effective April 1,  The termination date for inquiry option 10, ELGA, HIQA, and HUQA will be announced at a later date. References:  CMS MLN Matters article SE1249: and-Education/Medicare-Learning-Network- MLN/MLNMattersArticles/Downloads/SE1249.pdfhttp://www.cms.gov/Outreach- and-Education/Medicare-Learning-Network- MLN/MLNMattersArticles/Downloads/SE1249.pdf  CMS MLN Matters article MM8086: and-Education/Medicare-Learning-Network- MLN/MLNMattersArticles/Downloads/MM8086.pdfhttp://www.cms.gov/Outreach- and-Education/Medicare-Learning-Network- MLN/MLNMattersArticles/Downloads/MM8086.pdf Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

5 Beneficiary eligibility information will still be accessible via:  CGS Part A IVR:  myCGS Web portal:  HETS: Systems/CMS-Information-Technology/HETSHelp/index.htmlhttp://www.cms.gov/Research-Statistics-Data-and- Systems/CMS-Information-Technology/HETSHelp/index.html Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

6 CGS J15 Part A IVR User Guide: ser_Guide.pdf ser_Guide.pdf Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

7 myCGS The myCGS application provides real-time information access over the Web for the following online services:  Eligibility  Claims Status  Remittances Online  Financial Information Payment floor and last three checks paid  Part A Redetermination Requests Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC. 7

8 8 Published March 5, 2013

9 9 © 2013 Copyright, CGS Administrators, LLC.

10 10 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

11 Once finished, you will receive an to verify your registration. Click the link in the to complete the process. 11 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

12 12 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

13 13 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

14 14 Enter suffix (e.g., Jr., Sr.) if one is shown on the Patient’s Medicare card. Subscriber is the Medicare patient. Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

15 15 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

16 16 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

17 17 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

18 18 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

19 19 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

20 20 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

21 21 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

22  HETS 270/271 Must obtain a secure IP connection to the CMS Extranet Must develop or acquire a mechanism to construct and send 270 eligibility request files and receive and deconstruct 271 eligibility response files in a real-time environment.  HETS User Interface (UI) Internet-based application that is currently being tested Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

23 Therapy Cap PT and SLP services combined $1,880$1,900 OT services$1,880$1,900 Therapy Threshold PT and SLP services combined $3,700 OT services$3,700 CMS eNews dated January 3, 2013: Education/Outreach/FFSProvPartProg/Downloads/ Standalone.pdf 23 CMS MLN Matters article MM8129: MLN/MLNMattersArticles/Downloads/MM8129.pdf Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

24  The MPPR will increase from 25% to 50% effective for claims with dates of service April 1, 2013, and after.  Applies to the Practice Expense (PE) payment when more than one unit/procedure is provided to the same patient on the same day.  Full payment is made for the unit/procedure with the highest PE payment.  Each subsequent unit/procedure is reduced by 50%. Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

25 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

26  CMS MLN Matters article MM8005: Network-MLN/MLNMattersArticles/Downloads/MM8005.pdf Network-MLN/MLNMattersArticles/Downloads/MM8005.pdf  Testing period: Dates of service January 1 - June 30, 2013 CGS will process claims with or without the functional limitation HCPCS codes and modifiers  Implementation period: Dates of service on and after July 1, 2013 CGS will RTP claims without the functional limitation HCPCS codes and modifiers 26 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

27  Outpatients and inpatients who receive Part B therapy services  Rehabilitation agencies  Home health agencies  Comprehensive Outpatient Rehabilitation Facilities (CORFs)  Outpatient hospitals, including emergency departments  Critical Access Hospitals (CAHs) Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

28 MobilityMotor speech Changing and maintaining body position Spoken language comprehension Carrying, moving, and handling objectsSpoken language expressive Self careAttention Other PT/OT PrimaryMemory Other PT/OT SubsequentVoice SwallowingOther SLP functional HCPCS G-codes, 14 sets of 3 codes each Each functional G-code set contains: Current status Projected goal status Discharge status Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

29  Primary functional limitation or primary reason for treatment  Most clinically relevant to a successful outcome for the beneficiary  The one that would yield the quickest and/or greatest functional progress (e.g., select mobility over self-care even though both are addressed simultaneously and therapist expects beneficiary will attain self care goals before mobility goal)  The one that is the greatest priority for the beneficiary Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

30 HCPCS Modifier Impairment Limitation Restriction CH0% impaired, limited or restricted CIAt least 1% but < 20% impaired, limited or restricted CJAt least 20% but < 40% impaired, limited or restricted CKAt least 40% but < 60% impaired, limited or restricted CLAt least 60% but < 80% impaired, limited or restricted CMAt least 80% but < 100% impaired, limited or restricted CN100% impaired, limited or restricted 30 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

31  Required throughout the entire episode of care  Only one functional limitation is reported at a time  Exception: When the beneficiary has reached his or her goal or progress has been maximized on the initially reported functional limitation, but the need for treatment continues, reporting is required for a second functional limitation using another set of HCPCS G-codes. In these situations, two or more functional limitations will be reported for a beneficiary during one therapy episode of care. Reporting on more than one functional limitation may be required for some patients, but not simultaneously. Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

32  On the date of service of the initial therapy service  At least once every 10 treatment days  On the DOS of every evaluative procedure  Upon discharge from the therapy episode of care  When therapy for a particular functional limitation ends or changes 32 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

33  Two functional G-codes are required on a claim under one therapy plan of care: Current status and goal status Discharge status and goal status  May require more than two G-codes when a patient receives therapy services under multiple POCs from the same provider Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

34  Functional HCPCS G-code  HCPCS therapy modifier (GP, GO, GN)  HCPCS functional severity modifier  Date of service  Nominal charge (e.g., $0.01)  Another billable and separately payable (non-bundled) service  HCPCS modifier KX and CPT modifier 59 do not apply CPT only copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to government use. Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

35  Functional HCPCS G-codes and severity modifiers must be documented in the patient’s medical record for each required reporting.  Must be completed by: The qualified therapist furnishing the therapy services The physician/NPP personally furnishing the therapy services The qualified therapist furnishing services incident to the physician/NPP The physician/NPP for incident to services furnished by “qualified personnel” who are not qualified therapists. The qualified therapist furnishing the PT, OT, or SLP services in a CORF Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

36  CGS website:  CGS ListServ registration: asp asp  CGS Part A PCC: Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

37  CGS Electronic Data Interchange: EDI enrollment Electronic Remittance Advice (ERA) PC-ACE Pro32 software Direct Data Entry (DDE) software 37 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

38  CMS Medicare Learning Network (MLN) Products: Learning-Network-MLN/MLNProducts/index.html Learning-Network-MLN/MLNProducts/index.html  CMS MLN FFS National Provider Calls: Education/Outreach/NPC/index.html Education/Outreach/NPC/index.html  CMS Open Door Forums: and-Education/Outreach/OpenDoorForums/index.htmlhttp://www.cms.gov/Outreach- and-Education/Outreach/OpenDoorForums/index.html 38 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

39 CMS requires all Medicare contractors have a Provider Customer Service Program to assist providers in understanding and complying with Medicare’s operational processes, policies, and billing procedures. 39 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

40  Frequently Asked Questions (FAQs)  Webinars  Ask-the-Contractor (ACT) teleconferences  Articles  POE Advisory Group  Partnering with external entities  Training requests  Comprehensive Error Rate Testing (CERT)  CGS website enhancements 40 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

41  Are created based on provider inquiry analysis/reports  Play a large part in provider education efforts developed and implemented  Used to develop and deliver training to Provider Contact Center (PCC) staff  FAQ topics received from the POE Advisory Group  FAQs reviewed on a periodic basis to ensure current information is offered and published  New FAQs! – Medical Review, Medical Policy/Coverage, EDI, Customer Service  FAQ link: 41 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

42  Planned on a quarterly basis  Content based on current topics and suggestions solicited from POE Advisory Group members  Some training topics developed based on FAQs  Current schedule - Wednesdays (same time) for consistency’s sake and provider convenience  Toll-free and easy access (no charge to providers)  Repeated if popular demand dictates  Same schedule and topics for Kentucky and Ohio providers  CGS webinar page: html html 42 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

43  Provides a means for providers to ask specific questions concerning billing, Medicare policies or procedures.  Provides a method of sharing information, and function as a tool for listening to the provider community.  Toll-free (no charge to providers)  Q&A document posted on CGS website within 30 days after event  Encore available  Same schedule and topics for Kentucky and Ohio  CGS ACT website: 43 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

44  Developed based on current topics, requests from providers and suggestions from the PCC  Topics also solicited from POE Advisory Group members  Input from medical directors and other medical staff  News and Publications on the CGS website: ml ml 44 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

45  Primary functions: To assist CGS in the creation, implementation, and review of provider education strategies and efforts Provides input and feedback on training topics, provider education materials  Used as a provider education consultant resource (not as an approval or sanctioning authority)  Convenes quarterly 45 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

46  Members selected via a membership drive  Represents professional and geographic diversity, comprised of major provider specialties or provider institutions they serve  CGS’ POE Advisory Group website: html  Contains minutes from meetings, upcoming meetings dates and locations, list of organizations or entities comprising the Advisory Group 46 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

47  CGS establishes and maintains partnerships with external entities to help disseminate Medicare provider information.  Partnership activities do not take the place of CGS-led POE events, but supplements them.  Establishes a collaborative information dissemination effort: 1.To obtain Medicare program information through a variety of sources 2.Disseminate Medicare information to partners/associations, via their newsletters, websites, training events, conferences, etc. 47 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

48  CGS offers educational opportunities through special training requests  Tailored to meet the needs of the providers we serve  Education/training via webinars and teleconferences (cost effective)  J15 Part A Outreach and Education Request Form ation_request_form.pdf 48 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

49  A way for the Centers for Medicare & Medicaid Services (CMS) to look at the Medicare accuracy of claims processed by all Medicare Administrative Contractor (MAC)  An independent contractor that determines the paid claims error rates  CERT contractor reviews a random sample of processed claims, measures improper payments in the Medicare fee-for-service (FFS) program and reports results to CMS  Not considered a measure of fraud  CGS maintains an active internal CERT workgroup  Specialized CGS staff calculates CGS’ CERT errors  POE incorporates CERT information into training material  CGS’ CERT website: 49 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

50  New look! - corporate web page  Search engine: now powered by Google  Under discussion - enhancing and reorganizing some education pages to allow for easier access to material  CGS website feedback: https://www.cgsmedicare.com/feedback.html 50 Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

51 How can we assist you? Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.

52 Thank you for attending! Published March 5, 2013 © 2013 Copyright, CGS Administrators, LLC.


Download ppt "J15 Part A Provider Outreach and Education Annie Scriven and LJ Smith."

Similar presentations


Ads by Google