J15 Self-Service Options & Other Helpful Tools Ask-the-Contractor Teleconference (ACT) – March 10, 2022
View the handout for the March 10, 2022, Self-Service Tools Ask-the-Contractor Teleconference (ACT).
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- When a MC claim is denied at clearing house level and they advise us to "call Medicare," what do you advise?
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If the file/claim rejected at the clearinghouse, the clearinghouse should address that error. Medicare does not have access to the edits the clearinghouse has setup in their system.
- EDI Customer Service (Select Option 2):
Published: 03.23.22
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- Can the actual providers name be listed/located on the actual claim upon verifying status or at least an account number? (myCGS)
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Currently, the performing provider's name cannot be listed. However, we have forwarded a suggestion to list the performing provider's National Provider Identifier (NPI) on the Detailed Claim Status Information screen.
Published: 03.23.22
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- Can you give examples of when to use which self-service tool? Sometimes I start one and realize I am using the wrong one.
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Depending on the type of information you are looking for, would depend on the type of tool needed. For example, if a service/claim denied or was rejected, providers can use the Reason/Remark Code Tool, to look up the definition of the reason/remark code(s) on their remittance. This tool will also give additional information on how to resolve. Please refer to our Self-Service webpage for tools available. Hover your mouse over the link and a small pop-up box will display a description of the tool.
Published: 03.23.22
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- Is it possible to get step-by-step instruction on refunding to Medicare? We find it confusing.
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When you recognize that Medicare overpaid on a claim, complete the Voluntary Overpayment Refund form, and include the refund check. If you identify a Medicare overpayment, but will not be submitting an immediate refund, use the Overpayment Recovery Request Form. Please refer to the appropriate contract for the forms and further guidance:
Published: 03.23.22
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- May the webinar provide helpful tools for the PECOS systems?
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Providers submitting enrollment applications (CMS-855, CMS-20134, and CMS-588) through the Medicare Provider Enrollment, Chain and Ownership System (PECOS), the CMS provides step-by-step enrollment tutorials for online applications. When using PECOS:
- Applications are processed more quickly than paper applications
- Support is available to help with questions such as registration, access, and application fees
CGS offers additional resources and tools on our Provider Enrollment web pages:
Published: 03.23.22
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- When to [sic] waiver ends for 3-day inpatient hospital stay for skilled nursing coverage, where is the information Medicare uses?
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Providers can reference the CMS MLN Matters article SE2011 and SNF Benefit Period Waiver Claims.
Published: 03.23.22
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- Medicare was allowing home health agencies to bill two RAPs at a time. Meaning in December 2021, you could bill a RAP for Dec?
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The Notice of Admission (NOA) replaced request for anticipated payments (RAPs) for dates of service on or after January 1, 2022. For guidance related to periods of care that continue from 2021 to 2022, please reference the following:
- Billing the Home Health NOA Electronically
- Billing the Home Health NOA via DDE
- Top Provider Questions – Home Health Notice of Admission (NOA)
Published: 03.23.22
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- Telehealth bill coding change in April 2022. Current Procedural Terminology (CPT) Code I typically use is 90837. Will telehealth claim now be POS 10, MOD 95?
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Continue to bill how you are currently with place of service (POS) 11. During the public health emergency (PHE), Medicare does not require use of telehealth POS codes. Any change of policy regarding use of telehealth POS codes following the end of the PHE will be addressed in subsequent instruction.
- MLN Matters Article 12549 – CY2022 Telehealth Update Medicare Physician Fee Schedule
- CMS Change Request 12427 – New/Modifications to the Place of Service (POS) Codes for Telehealth
Published: 03.23.22
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- Do each of the claims that pertain to the NOA need to the have the HIPPS code 1AA11 on them, if so, what date is used?
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This will depend on the method of submission, i.e., billing electronically or via Direct Data Entry (DDE). Please review the NOA job aids, available on the HHH Claims webpage. (Resources are also mentioned in question #7.)
Published: 03.23.22
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- Can a previous non-compliant continuous positive airway pressure (CPAP) patient requalify and receive new CPAP (DME picked up old c-pap)? How should it be billed?
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We encourage all Medicare durable medical equipment (DME) suppliers to contact the appropriate DME Medicare Administrative Contractor (MAC) for any questions or concerning regarding DME billing and/or guidelines. Click here for the DME MAC contact list.
Published: 03.23.22
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- If physician documents enough MDM to support a low level of service can you still bill under physician?
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For 2022, if medical decision making (MDM) is used as the substantive portion, each practitioner can perform certain aspects of MDM; however, the billing practitioner must perform all portions or aspects of MDM that are required to select the visit level billed.
Published: 03.23.22
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- I have had several claims that went to return to provider (RTP) due to date of death overlapping episode period. Is CGS fixing?
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The beneficiary/or beneficiary's representative will need to contact the Social Security Administration (SSA) and request to have the date of death removed from their master file. The SSA can be reached at SSA.gov/MyContact. The SSA will be able to answer any questions/concerns the beneficiary may have about the date of death being on their file.
Published: 03.23.22
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- We can't ask a question if you don't allow enough space to type it out.
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Providers and suppliers may submit questions prior to and after any CGS webinar to appropriate outreach and education mailbox at:
- Home Health & Hospice – J15_HHH_Education@cgsadmin.com
- Part A – J15_PartA_Education@cgsadmin.com
- Part B – J15_PartB_Education@cgsadmin.com
Published: 03.23.22
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- So far, I have learned about home health care and hospice. What about mental health providers? I am a LISW-S (Licensed Independent Clinical Social Worker).
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This course applies to all lines of business HHH, Part A (institutional) and Part B (professional). However, we recommend the following:
- Provider Enrollment webpage for enrollment tips and tools
- Medical Policies webpage for our mental health local coverage determinations policies
- Fee Schedule Search Tool
- CMS Medicare Benefit Policy Manual, Chapter 15
- CMS Medicare Claims Processing Manual, Chapter 12
Published: 03.23.22
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