Welcome to

2006 Updates for ANCO

Presented by NHICProvider Education and Outreach

RepresentativesJanuary 2006

TMP-EDO-0006 Version 2.0

Fee Schedule Update

November, 2005 published fee schedule

Proposed change before Congressional

Congressional Action – Month end?

www.medicarenhic.com

2006 Deductible: $124

Medicare Part B Deductible

NPI Enrollment Choices

Web based applicationPaper ApplicationElectronic file application

https://www.cms.hhs.gov

Chose 1 method only

NPI Transition Time Line

1-3-06 - 10-1-06 PIN only, or PIN & NPI

10-2-06 – 5-22-07 PIN or NPI

5-23-07 NPI only

NPI EnumeratorFox Systems, Inc.

1-800-465-3203 (NPI Toll-Free)1-800-692-2326 (NPI TTY)

customerservice@npienumerator.com

NPI EnumeratorPO Box 6059Fargo, ND 58108-6059

NPI Information

Link fromOur website

National Provider Identifier(NPI)

http://www.cms.hhs.gov/NationalProvIdentStand/ (NEW)

http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/SE0528.pdf (NEW)

Medlearn Matters article SE0555 at http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/SE0555.pdf (NEW)

Surrogate UPIN Reporting

Surrogate UPIN # OTH000 will become invalid as of April 1st, 2006

Claims will reject Ordered or referred service must

contain a valid UPINUPIN Registry

http://www.upinregistry.com/

Appeals Changes

RedeterminationReconsideration as of January 1Administrative Law JudgeDepartmental Review BoardFederal Courts

Redetermination – First Level

No Telephone ReviewNew form CMS 20027www.cms.hhs.gov/forms/

CMS20027.pdf

Written Redeterminations

Copy of claimCopy of Remittance AdviceAdditional documentationPertinent claim information

Reopenings by Telephone

Correct clerical errors – Provider or CarrierDates of service entered incorrectly (i.e.,

09152003 instead of 09152004)Units entered as 0001 instead of 0010Dollars entered as 2.00 instead of

200.00 (only obvious errors; not just to increase billed amount)

CMS Medicare Contractor Provider Satisfaction Survey

• National in scope

• Gather provider’s opinions about Contractor’s performance

• NHIC’s providers selected to participate

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/

Recovery Audit Contractor (RAC)

Targets providers in CA, FL, NYGoal: to identify overpayments and

underpaymentsTwo recovery audit contractors

MSP- Diversified CollectionsClaim Review- PRG Shultz

Recovery Audit Contractor (RAC)

Letters requesting informationAddress questions directly to RAC, not

NHICRAC has 60 days to review the

documentationResource: Medlearn Matters SE0565

http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/SE0565.pdf

WEBSITE – www.medicarenhic.com

JoinourMailingList

Reduce Paper RAs

Use ERA

Obtain software free from CMS “Medicare Remit Easy Print”

http://www.medicarenhic.com/edi/download/mrepsoftware_1005.htm

Medicare Secondary Payer

Can be billed electronicallyUse appropriate fields

Claim will develop for primary RA if needed

MSP Electronic Claim Submission

Primary payer name & address Insured’s effective date & termination date

with primary payerPrimary payer allowed amountPaid amountDeductible amountCoinsurance amount when applicableDisallowed amountCost-containment amount when applicable

CR-3916 MSP Denial for Invalid GHP

Updated MSP info by the Coordination of Benefits Contractor

Re-process claims 1 yearAutomatically