Electronic Initiatives

1. Electronic Initiatives Presented by: Provider Outreach and Education June 13, 2013

2. Disclaimer • This resource is not a legal document. This presentation was prepared as a tool to assist our providers. This presentation was current at the time it was created. • Although every reasonable effort has been made to assure accurate information, responsibility for correct claims submission lies with the provider of services. Reproduction of this material for profit is prohibited.

3. PECOS Web Application • Provider Enrollment Chain and Ownership System • Can be used in lieu of the Medicare enrollment application to: • Submit an initial Medicare enrollment application • View or change your enrollment information • Track your enrollment application through the web submission process • Add or change a reassignment of benefits • Submit changes to existing Medicare enrollment information • Reactivate an existing enrollment record • Withdraw from the Medicare Program • Submit a Change of Ownership (CHOW) of the Medicare-enrolled provider

4. Advantages of Internet-based PECOS • Faster than paper-based enrollment (45 day processing time in most cases, vs. 60 days for paper) • Tailored application process means you only supply information relevant to YOUR application • Gives you more control over your enrollment information, including reassignments • Easy to check and update your information for accuracy • Less staff time and administrative costs to complete and submit enrollment to Medicare

5. Who Should I Call? External User Services Cahaba GBA Help completing an enrollment Status of the enrollment application Rejected applications Missing applications • User ID/Password Inquiries • System-error message while completing Inter-net based PECOS enrollment • Questions about Internet-based PECOS account registration

6. Electronic Funds Transfer • EFT enrollment is required at the time of: • Initial enrollment • Revalidation • Enrollment changes • Complete the CMS-588 form: • Must contain original signature of the authorized/delegated official • Include voided check http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/CMS588.pdf

7. Redetermination Smart Form • Complete all required fields (highlighted in red) • Complete the form electronically • Submit original Document Claim Number (DCN) in box 6 • Answer all questions in section 16 • Print, sign and fax http://www.cahabagba.com/documents/2012/02/part-a-redetermination_request.pdf

8. Smart Form Tips • Complete all required fields • Check “Overpayment” if Appeal is related to an overpayment • Print and sign form • Fax is the preferred submission method • DO NOT include cover sheet • Fax bar coded forms only • Ensure automated faxing (ex. LanFax/Esker) is not set to include cover sheet • Retain confirmation sheet

9. Clerical Error Reopening Form • Used for minor clerical errors or omissions • Type directly on the form • Be specific • After typing, print, sign and mail form • Use appropriate address listed at the top of form http://www.cahabagba.com/documents/2012/05/partacerrrequestform.pdf

10. Immediate Offset Request Form • Submission options: • Fax • Secure Email • Mail • Used when overpayment demand letter issued • Attach copy of claim • Submit separate form and claim listing for each demand letter http://www.cahabagba.com/documents/2012/06/part-a-overpayment-immediate-offset-request-form.pdf

11. Medicare Secondary Payer Adjustment Form • Used to request MSP adjustments • Type directly on the form • Print, sign and mail to appropriate address listed on form • Submit separate form for each adjustments http://www.cahabagba.com/documents/2012/02/part-a-mspadjustmentform.pdf

12. Electronic Data Interchange

13. Electronic Remittance Advice • Benefits of ERA: • Reduction of paper handling • Improved claim processing accuracy • Elimination of mail time • Faster receipt of payment information • Effortlessly downloaded and stored for future reference • Faster account reconciliation via electronic posting

14. esMD • Electronic Submission of Medical Documentation • esMD went live in September 2011 • Cahaba GBA began accepting esMD in November 2011 • esMD is not mandatory • For more information go to: • www.cms.gov/esMD

15. Cahaba’s Perspective on esMD • Cahaba is ready to accept electronic submissions of Medical Documentation using esMD • esMD process is parallel to our paper process today • Faster response time = faster claim cycle time • Suggested response time is 10-15 days from receipt • Standard time frames still apply: • Provider has 45 days to respond to ADR • Cahaba has 60 days from the date of receipt to complete the medical review

16. Paperwork Segment (PWK) • The PWK is a segment within the 837 professional and institutional electronic transactions • It provides the linkage between electronic claims and additional documentation • Through the PWK process, documentation is imaged and available for review during claims processing

17. PWK Fax/Mail Coversheet • Complete all fields • Fax/Mail form to appropriate address • Fax numbers provided at bottom of form • Complete one cover sheet for each electronic claim http://www.cahabagba.com/documents/2012/10/part-a-pwk-coversheet-for-electronic-claims.pdf

18. Medicare EHR Incentive Program • Eligible hospitals can qualify for incentive payments if they demonstrate meaningful use of certified EHR technology • Hospitals eligible to participate in the program: • Sub section (d) hospitals • Critical Access Hospitals (CAHs) • Medicare Advantage Hospitals • Payment adjustments begin 2015 • For more information visit: • http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html

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