Business Practices for working with Centers for Medicare and Medicaid services

1. Business Practices for working with Centers for Medicare and Medicaid services Presented by: dixie gaikowski , rn, bsn Office of resource management

2. Program Objectives • Who is CMS • Recommended Material for a Billing Office • How to navigate through the CMS website • Who the contacts are for Medicare assistance • What is a Fiscal Intermediary/Carrier • How to navigate through the Medicaid site for your State. • Who the contacts are for Medicaid assistance

3. Who is CMS? • CMS develops policies and oversees the Medicare and Medicaid Programs-2 national health care programs that benefit about 75 million Americans. • Along with the Health Resources and Services Administration, CMS also oversees the State Children’s Health Insurance Program (this is expected to cover many of the approximately 10 million uninsured children of the United States.)

4. CMS’ Goals • Protect and improve beneficiary health and satisfaction • Foster appropriate and predictable payments and high quality of care • Promote understanding of CMS programs among beneficiaries, the health care community, and the public • Promote the fiscal integrity of CMS programs and be an accountable steward of public funds • Foster excellence in the design and administration of CMS programs • Provide leadership in the broader health care marketplace to improve health.

5. CMS Program Objectives • Access to Quality Care (Improve quality of care and health outcomes for the beneficiaries of CMS programs) • Services to Beneficiaries (improve beneficiary satisfaction) • Program Administration (Promote the fiscal soundness of CMS programs.)

6. CMS StructureCMS is organized into 3 Centers(each having a different focus) • Center for Medicare Management • Center for Beneficiary Choices • Center for Medicaid and State Operations

7. CMS Recommended Materials to Keep in the Billing Office • Provider Reimbursement Manual (Publication 15-1 and Publication 15-2) • ICD-9-CM book • Current Procedural Terminology (CPT) • Healthcare Common Procedure Coding System (HCPCS) Level II Coding Book • National Correct Coding Initiatives (NCCI) Manual • Medicare Information Resource (National Government Service’s monthly provider bulletin) • CMS manual • http://www.cms.hhs.gov/manuals/ • Available list serves

8. Centers for Medicare and Medicaid Services (CMS)http://www.cms.hhs.gov/Cynthia Gillaspie-Native American Contact-Region 8Phone: 303-844-4725 Fax: 303-844-7054cynthia.gillaspie@cms.hhs.govNancy Rios-Region 7email: nancy.rios@cms.hhs.gov

9. What is a Fiscal Intermediary/Carrier • Federal government will contract with a Private Insurance company that will process claims for services covered under Medicare Part A and Medicare Part B. • The processors of claims covered under Medicare A are known as fiscal intermediaries (FI) and the processor of claims covered under Medicare Part B are known as carriers. • Sometimes, the Federal Government contracts with one private insurance company to be both a FI and carrier

10. Fiscal Intermediary for IHS: • Trail Blazer Health Enterprises, LLC • Denison, TX • http://www.trailblazerhealth.com • Part B Provider-Denise Mohling • (903) 463-8183 Email: denise.mohling@trailblazerhealth.com • Part A Provider-Pamela Davis • (888) 763-9836 Email: pamela.davis@trailblazerhealth.com

11. State Medicaid Programs • http://dss.sd.gov/ for South Dakota • Mark Leonard: 605-773-3495 • http://www.nd.gov/dhs/ for North Dakota • Tribal Liaison-Theresa Snyder • Telephone number-701-328-1816 • http://www.ime.state.ia.us/ for Iowa Phone: Eligibility-800-338-7752; Medical Services-800-383-1173; EDI Support-800-967-7902 http://www.hhs.state.ne.us for Nebraska Phone Numbers: Claims-877-255-3092; Electronic Claims-866-498-4357; Client Eligibility-800-642-6092; Enrollment- 402-471-9717

12. Medicare is an ever changing program. • Utilize the CMS website for information and resources. • Check you FI/Carrier site daily to check on changes and information. • Get familiar with your State Medicaid program and know who your contacts are.

13. Questions??????