Riverbend

General FAQ

What do the suffixes on the end of the patient's HIC numbers mean?

The Social Security Administration provides the HIC number's suffixes. You can access a list of definitions for those suffixes on  the Tools page of this Web site. (12/19/2007) 

What is the Online CMS Manual System?

The CMS Internet Only Manuals (IOMs)is an electronic Web-based manual system for all users. This allows a centralized location for CMS policies. The process includes the streamlining, updating, and consolidating of CMS' various program instructions, policies, and procedures. CMS transitioned to this system from a paper-based manual system on October 1, 2003. (6/20/2007)

Where can I find the Fee Schedule for HCPCS codes?

The fee schedule is located under the Tools section of this Web site. Choose the Reports option and under Online Reports the link is titled HCPCS Codes. Fee schedules are listed by State in alphabetical order. (9/12/2007)

Our claim was rejected for overlapping service dates. How do we correct this?

If the claim should not have rejected for overlapping dates, verify where the patient was during the overlap period. You may need to include an appropriate occurrence code and date on the adjustment claim. If the claim rejected appropriately you may want to review your from and through dates on field 6, statement covers period. (6/28/2007)

How can our facility receive Medicare's latest coverage and reimbursement rules and policies?

The Centers for Medicare and Medicaid Services (CMS) is committed to providing timely notification of program changes to providers, suppliers and physicians. CMS has implemented a new initiative - "Consistency in Medicare Contractor Outreach Material" or CMCOM. The product of this effort, Medlearn Matters... Information for Medicare Providers, is a series of articles prepared by actual clinicians and billing experts. Medlearn Matters...Information for Medicare Providers articles are tailored, in content and language, to the specific provider types who are affected by Medicare changes. To view the articles available, please visit: http://www.cms.hhs.gov/MLNMattersArticles.

CMS has created additional provider and supplier specific Web pages for quick access to accurate Medicare program information. Specialized information on these one-stop resource pages includes links to Federal Regulations (FR) and Notices, Transmittals/Change Requests (CRs), and Frequently Asked Questions (FAQs). Each page also includes a Highlights section to emphasize important and timely information. To view the Web pages, please visit: http://www.cms.hhs.gov/providers/default.asp (7/5/2007)

Where do we find the most up to date information regarding HIPAA?

You can access the most current information at the following web site: http://http://www.cms.hhs.gov/HIPAAGenInfo/. This web site provides a one-stop resource page for providers. You can locate information for: general information, regulations & standards, upcoming events, educational materials, and HIPAA related links. (7/5/2007)

How will Inpatient Psychiatric Facility Prospective Payment System affect our facility?

Medicare is changing the way it will pay for services provided to Medicare beneficiaries in Inpatient Psychiatric Facilities (IPF), including distinct part psychiatric units, effective with discharges on or after January 1, 2005. The BBRA of 1999, requires the implementation of a prospective payment system for IPFs. A Federal per diem base rate and various facility level and patient-level adjustments has been established in order to ensure that payment most accurately reflects cost. Please review Medi Letter Bulletin: 1959-04  . (8/15//2007)

How can our facility verify claim status?

Your facility may access claims status information through Direct Data Entry. If you do not have Direct Data Entry and would like more information about this system, visit the Electronic Billing section.   RGBA also provides and Interactive Voice Response Unit (IVR) through our telephone system. The IVR allows our provider customers to obtain information via the IVR without speaking directly to a Customer Service Representative (CSR). Call the IVR is 1-877-296-6189 or view instructions.
The following features are available via the IVR:

• · Claim Status
• · Financial (Check) information
• · Appeal process information (9/12/2007)

We have seen several instructions published about the National Provider Identifier (NPI). What is an NPI?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that the Secretary of Health and Human Services adopt a standard unique health identifier for health care providers. On January 23, 2004, the Secretary published a Final Rule that adopted the National Provider Identifier (NPI) as this identifier. The NPI must be used by covered entities under HIPAA. The NPI will identify health care provider in the electronic transactions for which the Secretary has adopted standards after the compliance dates. The transactions include claims, eligibility inquiries and responses, claim status inquiries and responses, referrals and remittance advices. (6/28/2007)

What can our facility do to assist our patients with the new drug prescription program?

We are very glad you have asked this question! Posters are now available, free of charge. The posters are suitable for display in your office or any health care setting where Medicare beneficiaries will see this information. The poster directs Medicare beneficiaries with limited income to a toll free number where they can find out if they are eligible for help with prescription drug costs. You may order the size and style appropriate for your use. To view and order the poster, go to the Medlearn Prescription Drug Coverage web page located at http://www.cms.hhs.gov/MLNProducts/23_DrugCoverage.asp on the CMS website. (9/12/2007)

We understand there is a new contractor called the QIC. How does this change the appeals process for providers?

RGBA has added a new web page explaining the new appeals process.  (9/12/2007)

Where can we locate more information about the Remittance Advice?

Understanding the Remittance Advice: A Guide for Medicare Providers, Physicians, Suppliers, and Billers is now available on the Medicare Learning Network web page located at http://www.cms.hhs.gov/MLNProducts/downloads/RA_Guide_Full_03-22-06.pdf on the CMS website. Chapters 1 and 2 describe a Remittance Advice (RA) and the components of an RA. For institutional providers, Chapter 3 includes a sample Electronic Remittance Advice (ERA) and Standard Paper Remittance Advice (SPR) with field descriptions. Chapter 4 includes a crosswalk between ERA and SPR fields and a sample SPR with field descriptions, specifically for professional providers. At the end of Chapters 3 and 4, providers can find information on remittance balancing. Print the chapter that fits your needs! The guide also includes informative resources such as an acronym list, a glossary, and important websites and phone numbers. Finally, the guide has three comprehensive indexes: 1) for key terms and concepts; 2) for institutional ERA and SPR field descriptions; 3) professional ERA and SPR field descriptions. (6/20/2007)

What is the Medicare Contractor Provider Satisfaction Survey (MCPSS)?

The Medicare Contractor Provider Satisfaction Survey -- or MCPSS -- is designed to garner quantifiable data on provider satisfaction with the performance of Medicare Fee-for-Service (FFS) contractors. Specifically, the survey will enable the Centers for Medicare & Medicaid Services (CMS) to gauge provider satisfaction with key services performed by the 42 contractors that process and pay the more than $280 billion in Medicare claims each year (7/5/2007)

What is the timeline for implementation and the delivery of results of Medicare Contractor Satisfaction Survey?

The 1st national implementation of the MCPSS began in January 2006. CMS analyzed the data and released a summary report in July 2006,made available on the Internet. Each contractor will also receive a customized report with their individual survey results. The 2nd national administration began January 2007, with final reports due in July 2007. The MCPSS will be conducted on an annual basis. (7/5/2007)

What is the purpose of the Medicare Contractor Provider Satisfaction Survey survey?

The Medicare Contractor Provider Satisfaction Survey -- or MCPSS -- is designed to garner quantifiable data on provider satisfaction with the performance of Medicare Fee-for-Service (FFS) contractors. Specifically, the survey will enable the Centers for Medicare & Medicaid Services (CMS) to gauge provider satisfaction with key services performed by the 42 contractors that process and pay the more than $280 billion in Medicare claims each year. (7/5/2007)

Is this the first time CMS has conducted the Medicare Contractor Satisfaction Survey?

The 2006 MCPSS is the first national assessment of the interface between Medicare providers and contractors. We did, however, conduct a pilot of the survey earlier in 2005 with 8,200 Medicare providers (approximately two percent of providers served by 12 selected FFS ontractors) to ensure the validity of the survey methodology. (7/6/2007)

How many providers will be in the 2007 sample?

A sample of approximately 36,000 Medicare FFS providers were randomly selected to participate in the survey and will receive a survey notification package in January 2007. (7/5/2007)

What provider types are surveyed in the Medicare Contractor Satisfaction Survey?

We considered the following for the randomly selected sample: a. Physicians b. Licensed practitioners c. Hospitals d. Skilled nursing facilities e. Rural health clinics f. Home health clinics g. End-stage renal disease (ESRD) facilities h. Durable medical equipment (DME) suppliers i. Ambulance service providers j. Other Part A and Part B providers (7/5/2007)