TMP-EDO-0006 Version 2.0

1. Welcome to2006 Updates for ANCOPresented by NHICProvider Education and Outreach RepresentativesJanuary 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. Medicare Part B Deductible 2006 Deductible: $124

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 – 5-22-07 PIN or NPI • 5-23-07 NPI only

6. 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

7. NPI Information Link from Our website

8. 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)

9. 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 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/CMS20027.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/MedlearnMattersArticles/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/mrepsoftware_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

25. Thank You! Any Questions?