Medicare Update New York State Society for Clinical

Medicare Update New York State Society for Clinical Social Work March 16, 2018 Jurisdiction K – Part B

Disclaimer No recording please National Government Services, Inc. has produced this material as an informational reference for providers furnishing services in our contract jurisdiction. National Government Services 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 material. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of publication, the Medicare Program is constantly changing, and it is the responsibility of each provider to remain abreast of the Medicare Program requirements. Any regulations, policies and/or guidelines cited in this publication are subject to change without further notice. Current Medicare regulations can be found on the Centers for Medicare & Medicaid Services (CMS) website at http: //www. cms. gov. Jurisdiction K – Part B

2018 Agenda topics § § § New Medicare Card Provider Enrollment and tips for Revalidation Billing Medicare changes in 2018 Medicare Basics for Clinical Social Workers Impact of legislative changes – 2016 PQRS and QPP going forward 3 Jurisdiction K – Part B

New Medicare Card • MACRA requires that CMS mail out new Medicare cards with a new Medicare Number starting in April 2018 – April 2019 • Does not affect Medicare benefits • There will be geographical waves of successive mailings. • People with Medicare can start using their new Medicare cards right away • The Medicare Beneficiary Identifier (MBI) is confidential like the SSN and should be protected as Personally Identifiable Information 4 Jurisdiction K – Part B

New Medicare Card § Your systems and business processes must be ready to accept the new Medicare number (MBI) by April 2018 for transactions, such as billing, claim status, eligibility status, and interactions with NGS contact centers. § There will be a transition period when you can use either the HICN or the MBI to exchange data and information with us § Transition period will start 4/1/18 and run through 12/31/19 § Your systems must be ready however, for people who are new to Medicare in April 2018 and later as they will only receive a card with the MBI § The patient’s MBI will be returned on every electronic RA for claims you submit with a valid and active HICN 5 Jurisdiction K – Part B

New Medicare Card § Characteristics of the MBI § § § 11 characters in length (no special characters) Randomly generated Contains numbers (0 -9) Uppercase letters (A-Z) • Except for S, L, O, I, B, and Z § No special characters § Prepare for this change: § Contact your vendors to discuss system changes § No end-to-end testing • Use the transition period as a live test 6 Jurisdiction K – Part B

New Medicare Card § Work to help your Medicare patients with MBI changes § Must have a valid address § Beneficiaries will not receive a new card if their address isn’t correct § Record correction § Social Security Administration at 1 -800 -772 -1213 § Electronically changing address online at: https: //www. ssa. gov/myaccount/ 7 Jurisdiction K – Part B

What You Can Do to Get Ready • CMS mailings will include instructions about a secure provider look-up tool • Check with your billing vendors • System changes • Order or print the new poster (#12009 -P) and tearoff sheets • Display in your offices and waiting rooms • Follow the Medicare Learning Network and look on www. cms. gov/newcard for the latest information about new Medicare cards 8 Jurisdiction K – Part B

Provider Enrollment 9 Jurisdiction K – Part B

Provider Enrollment Application Process Timeline § All required information available • Internet based PECOS application target is 45 days • CMS 855 paper application target is 60 days § An acknowledgment notice with a case number (faxed, mailed or emailed) to the contact from PEDo. Not. Reply@anthem. com § If necessary, additional documentation request will be faxed, mailed or emailed with a 30 days return date § Obtainable Status § Interactive Voice Response System § Application Status Inquiry Tool § Response letters may take up to 7 days to receive after the finalized application 10 Jurisdiction K – Part B

Provider Enrollment Revalidation § Check PECOS § https: //pecos. cms. hhs. gov/pecos/login. do § Check CMS website § https: //go. cms. gov/Medicare. Revalidation • https: //data. cms. gov/revalidation (Medicare Revalidation Look Up Tool) – Due date will display or “TBD” (To Be Determined) if not currently due § MLN Matters article SE 1211 § MLN Matters article SE 1605 § MLN Matters article SE 1126 11 Jurisdiction K – Part B

Provider Enrollment Revalidation § Who § All providers five years after initial enrollment or about last revalidation § When § Only when notified and before due date § Notices are mailed 2 - 3 months prior to due date § Unsolicited revalidation applications returned if received more than 6 months prior due date § What § Verify entire Medicare enrollment record § Why § Avoid payment hold or deactivation of Medicare billing privileges by responding promptly 12 Jurisdiction K – Part B

Provider Enrollment Tools § Internet-based PECOS § Click on the Enrollment tab and select Learn About PECOS Web § Determine the correct CMS-855 application § Initial enrollment • Click on the Enrollment tab and select Submit an Enrollment Application: Start to Finish then select Choose the Correct Application for You § Changes in enrollment • Click on the Enrollment tab and select Make Changes to My Existing Enrollment § Revalidate an enrollment • Click on the Enrollment tab and select Obtain Revalidation Instructions § Provider Enrollment Educational Webinars § Click on the Education tab and select Webinars, Teleconferences & Events § Provider Enrollment Status Inquiry Tool (Application Status) § Click on the Enrollment tab and select Provider Enrollment Status Inquiry Tool 13 Jurisdiction K – Part B

Claim Submission 14 Jurisdiction K – Part B

The Basic Options in Medicare § Treating Medicare beneficiaries requires enrollment in Medicare. Beneficiaries have protections under the law. § If you are not enrolled, please communicate openly with your patients. Complete the Opt Out Affidavit. Enter in to a provide contract with the patient. (www. ngsmedicare. com) § Medicare has mandatory claims submission in place. Review policy statement. § Please share this message with your peers. 15 Jurisdiction K – Part B

Opt Out rules § Opting Out of Medicare allows you to render services to Medicare-enrolled beneficiaries under a private contract. § Neither the provider, nor the beneficiary submits the bill to Medicare for services rendered. § The beneficiary pays the physician or practitioner out-ofpocket and neither is reimbursed by Medicare. § A private contract is a signed agreement between the practitioner and the beneficiary that states, that neither one can receive payment from Medicare for the services that were performed. ( A condition for most Medigap plans is that a Medicare approved the service. ) 16 Jurisdiction K – Part B

Tele-Medicine § Medicare does provide coverage for beneficiaries residing in rural health areas. Check HRSA data warehouse This does not apply to urban areas in NYC. § Telephone and skype sessions with beneficiaries are not currently covered by Medicare. 17 Jurisdiction K – Part B

Claim Filing Requirements § SSA 1848(g)(4)(A) of the Social Security Act requires providers submit claims for all Medicare patients § Patients may not be charged for preparing or filing a Medicare claim § Clinical social workers are required to accept assignment for all Medicare claims • Beneficiary may be liable for any applicable deductible and 20 percent coinsurance • Per the Patient Protection and Affordable Care Act of 2010 the timely filing requirement was amended to one calendar year after the date of service 18 Jurisdiction K – Part B

Handwritten Claims Reduction § Effective July 10, 2017, NGS will not longer accept handwritten claims § Notice attached to the returned claim § Only the signature blocks on the CMS-1500 claim form are allowed to contain handwriting (Items 12, 13 & 31) Date Handwritten Paper Claims Will be Returned State/Locality 07/10/2017 Maine, New Hampshire, Rhode Island, Vermont 08/07/207 New York (Upstate Loc 03 New York Locality/Area and 99) and County Information 09/11/2017 Connecticut 03/30/2018 Massachusetts 05/30/2018 New York (Downstate Loc 01, 02 and 04) Jurisdiction K – Part B County Listing New York Locality/Area and County Information 19

Handwritten Claims Reduction § Alternate options to handwritten claims: § Electronic claims submission • Visit the EDI section of our website to get started § NGSConnex • Data enter your claim details into our portal • Get started here: NGSConnex § Resource/Documentation: § The CMS printing specifications for paper claims does not include instructions for handwriting § CMS IOM 100 -04, Ch. 26, Section 30 20 Jurisdiction K – Part B

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Jurisdiction K – Part B

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Medicare is moving from a volume based program to Value/Quality initiatives 1. The programs have evolved from PQRS to QPP ( MACRA/MIP ) 2. 2018 is the last year for PQRS using 2016 claims data. 3. Going forward using 2017 data, QPP will be in place. 4. MACRA will be in place in 2019. Two year look back in place. Exemption will apply. NASW site has an excellent summary. 24 Jurisdiction K – Part B

Call Quality. Net Help Desk – 1 -866 -2888912 25 Jurisdiction K – Part B

Fee Schedules and much more! Jurisdiction K – Part B

Jurisdiction K – Part B

JK Contact Information § § § Part B PCC: 866 -837 -0241 Part B IVR: 877 -869 -6504 Fax on Demand: 866 -709 -1905 EDI Helpdesk: 888 -379 -9132 Correspondence National Government Services Part B Provider General Written Inquiries P. O. Box 6189 Indianapolis, IN 46207 -6189 § New Direct Telephone line for Provider Enrollment (JK): 888 -379 -3807 Jurisdiction K – Part B

Thank you! Your questions 29 Jurisdiction K – Part B