- August 28, 2008
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The Centers for Medicare & Medicaid Services (CMS) reported today that Medicare health care providers continue to be satisfied with services provided by Medicare fee-for-service contractors showing a relatively smooth transition to the new Medicare Administrative Contractors (MACs).
The summary report of the survey findings is available on the CMS Web site in the MCPSS section - click here.
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- August 27, 2008
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Highmark Medicare Services will be hosting three workshops for providers new to the Medicare Program. So if you have office staff new to the Medicare Program join us for one of these informative workshops We look forward to seeing you! This workshop may also be helpful to thos needing a refresher course on the Medicare Program.
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Due to a nation-wide installation of an upgrade to the Fiscal Intermediary Shared System (FISS) at all Medicare Part A contractors, no access will be available to the FISS on-line system starting Saturday, August 30 and running through Monday, September 1, 2008. Access to the FISS on-line system will be available at the normal time on Tuesday, September 2, 2008.
As part of this upgrade to FISS, we are communicating changes impacting claims screens.
MLN Matters Article from CMS
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- August 26, 2008
Labor Day Holiday EDI Availability
Highmark Medicare Services will be observing the Labor Day holiday on September 1, 2008. Our business doors will be closed and the EDI Services Help Desk will not be available. However, you may continue utilizing EDI services.
On September 1, 2008, EDI platforms are available for claim submission,report retrieval, ERA, and claim status transactions. However, there will be no batch claim processing cycle executed for this date. EDI claims received after 4 PM on August 29, 2008, will be entered into the processing system on September 2, 2008. The EDI acknowledgement/edit reports for these claims will be available for retrieval on September 3, 2008. Medicare payments and ERA will not be generated on this day.
The Fiscal Intermediary Standard System (FISS) will not be available. Therefore, all Direct Data Entry (DDE) functions (online claim entry or the HIQA transaction for beneficiary eligibility) will not be available.
MLN Matters Articles from CMS
- August 25, 2008
Update to Appeals Guide and Forms
The Quick Reference Guide for Appeals, the Medicare Part A Redetermination Request Form and the Medicare Part A Clerical Error Reopening Request Form have all been updated to include addresses for New Jersey Providers.
Providers for all areas serviced by Highmark Medicare Service should use these updated documents.
Your Medicare Payments Could Be Reduced If The Internal Revenue Service (IRS) Needs To Collect Overdue Taxes That You Owe
The Taxpayer Relief Act of 1997, Section 1024, authorizes the IRS to reduce certain federal payments, including Medicare payments, to allow collection of overdue taxes. Should you owe such taxes and your payments are reduced, your remittance advice will reflect a provider level adjustment code (PLB) of "WU" in the PLB03-1 data field. For more information, please see MLN Matters Article #MM6125.
Installation of the Fiscal Intermediary Shared System (FISS) July 2008 U Release – Dark Days
Due to a nation-wide installation of an upgrade to the Fiscal Intermediary Shared System (FISS) at all Medicare Part A contractors, no access will be available to the FISS on-line system starting Saturday, August 30 and running through Monday, September 1, 2008. Access to FISS on-line systems will be available at the normal time on Tuesday, September 2, 2008.
- August 22, 2008
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The handout material is now available for the Medicare Claims Error Teleconference. Please join us on August 25, 2008 at 10:00 AM (EST) for an informative teleconference on Medicare's most frequent claim submission errors and how to resolve them.
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- August 20, 2008
Changes to the FISS Claim Screens
Effective September 1, 2008, screens within the Fiscal Intermediary Standard System (FISS) will be modified to identify HPCS codes that will be reimbursed at the Medicare Physician Fee Schedule (MPFS) fee rate so that the correct carrier and locality can be used in the payment of those services. All MPFS HCPCS codes retrieved from the Centers for Medicare & Medicaid Services will have a one byte indicator (M) added to the record within FISS. The (M) HCPCS Identifier field is a protected field, which can not be added to or updated manually.
The (M) HCPCS identifier signifies that the HCPCS is a MPFS code. The revenue line, flagged with an (M) will be investigated during pricing to determine if reimbursement will be at the MPFS fee amount. If the (M) remains on the claim through the editing process, the HCPCS will be reimbursed at the MPFS fee amount and that revenue line is subject to the nine digit zip code editing, which is outlined in MLN Matters Article MM5730. If the (M) is removed from the revenue line during the editing process, it indicates that even though the HCPCS is a MPFS code, it is not subject to the ZIP9 editing.
Due to the above process, there are screen changes necessary to the FISS. A new data field has been added to the claim screen (MAP171A), 'HCPC TYPE'. There also has been a new field added on the HCPCS screen, field 'TYP'. The indicator values for both FISS screen changes are 'M' or blank.
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Please join us on September 25, 2008 at noon for an informative Lunch and Learn Teleconference on the importance of Physician's Orders in medical documentation.
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Please join us on September 16, 2008 at 10:00am for an informative teleconference on SNF No-Payment Claims.
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Are you uncertain that Value Code 44 is right for your claim? If so, why not join us on September 10, 2008 at noon when Highmark Medicare Service Part A Outreach and Education presents focused information on billing and coding of MSP Value Code 44. This Lunch and Learn is suitable for personnel within institutional billing departments/business offices that already have an understanding of MSP Provisions. Please join us for this valuable discussion.
MLN Matters Articles from CMS
New:
MM5849 – Transition of Responsibility for Medical Review from Quality Improvement Organizations (QIOs)
MM6109 – Remittance Advice Remark Code and Claim Adjustment Reason Code Update
MM6125 – Reporting Withholding Due to IRS Federal Payment Levy Program (FPLP) on the Remittance Advice
MM6126 – Fiscal Year (FY) 2006 Supplemental Security Income (SSI) Data
Revised:
- August 19, 2008
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The Centers for Medicare & Medicaid Services (CMS) will be hosting a series of End-Stage-Renal-Disease Stakeholder Meetings to discuss the End-Stage-Renal-Disease (ESRD) Network (NW) Program.
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The Department of Health and Human Services (HHS) announced Friday a long-awaited proposed regulation that would replace the ICD-9-CM code sets now used to report health care diagnoses and procedures with greatly expanded ICD-10 code sets, effective October 1, 2011.
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The Centers for Medicare & Medicare Services (CMS) recently announced that as Medicare’s Part D prescription drug program enters its fourth year, beneficiary satisfaction rates remain high, program costs remain lower than originally expected and Medicare prescription drug plan bids reflect nationwide drug price trends.
In addition to average premiums for 2009, CMS has announced: the 2009 national average monthly bid; the base beneficiary premium; the regional low-income subsidy premium amounts for 2009; and the 2009 Medicare Advantage regional preferred provider organization benchmarks. To view this information visit here.
Pricer Updates
The provider data distributed with the IPF PPS PC Pricer has been updated as of July 2008. Download the latest version posted 08/12/2008.
Due to receiving updated quarterly provider data, the SNF PPS PC Pricer has been revised. Download the latest version posted 08/11/2008.
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