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ListServ Messages 05/09/2008
Important information from The CMS.
New:
SE0814 Provider Authentication by Medicare Provider Contact Centershttp://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0814.pdf
MM5972 Prolonged Services (Codes 99354 - 99359)http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5972.pdf
MM6000 Ambulance Fee Schedule - Conversion Factor File for CY 2009 Ambulance Inflation Factor http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6000.pdf
MM5860 Adjusting Inpatient Prospective Payment System (IPPS) Reimbursement for Replaced Devices Offered Without Cost or With a Credit http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5860.pdf
MM5867 Billing Blood and Blood Products http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5867.pdf
MM6043 Blood-Derived Products for Chronic, Non-Healing Wounds http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6043.pdf
Revised:
MM5567 Reporting of Additional Data to Describe Services on Hospice Claims http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5567.pdf
RGBA has received the following instructions from The CMS.
The Internet Only Manual, Publication 100-04, Chapter 18, Section 30.5 states that coinsurance is applied to claims for Screening Pap Smears containing code Q0091 when this service is provided in Skilled Nursing Facilities, Federally Qualified Health Centers, Rural Health Clinics, Hospitals, and Critical Access Hospitals. It has come to our attention that due to a Fiscal Intermediary Shared System (FISS) error, coinsurance is not being applied to claims for Screening Pap Smears containing code Q0091, when these services are provided in hospitals (Type of Bills (TOBs) 12X, 13X, and 85X), for dates of service on and after April 1, 2008.
Currently, FISS is working to make system changes to insure that coinsurance is applied to claims for Screening Pap Smears containing Q0091 when provided in hospitals (TOBs 12X, 13X, and 85X). Until the system change is implemented into production on June 2, 2008, FIs and A/B MACs are to hold the affected claims.
When releasing these claims in your system, RGBA will code these claims as “clean claims” in which payment was delayed due to the Centers for Medicare & Medicaid Services’ (CMS) processing delay, and process with applicable interest.
The Reason code assigned to these claims is 75091 and the claims are held in S/LOC S M0091 within FISS. The HOLD locations can be viewed at: http://www.rgbagov.com/Tools/FISS-Hold-Locations/ on the Riverbend Website.
Information from The CMS.
The Centers for Medicare & Medicaid Services (CMS) issued CR 5653 on July 13, 2007. This CR specifically addressed that Medicare systems shall ensure no reimbursement is made when Condition Code 04 (Patient is HMO Enrollee) is present. It was brought to the attention of CMS that the programming for this CR did not address when no valid GHOD Record existed at the Common Working File (CWF).
Claims with Condition Code 04 and no valid GHOD Record at the CWF were processing for payment incorrectly, and the FIs and A/B MACs were approved to hold claims that met this condition.
With the implementation of FISS Change Request CR5653S1, with Release C200821F on April 7, 2008, no reimbursement will be made for 021X Bill Types that contain Condition Code 04.
The FIs and A/B MACs are authorized to place condition code 15 (clean claim delayed in the CMS’ processing system), indicating that these claims have been held through no fault of the FI or A/B MAC when releasing the claims that were held that met the condition described above.
2008 Physician Quality Reporting Initiative (PQRI) National Provider Call PowerPoint Presentation-April 30th, 2008 is now available
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that PowerPoint presentation that will be used during the April 30th, 2008 PQRI National Provider call is now available on the CMS website.
This presentation will provide an overview of the Establishment of alternative reporting periods and alternative criteria for satisfactorily reporting quality measures for the 2008 Physician Quality Reporting Initiative (PQRI) as authorized by the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (P.L. 110-173) which was enacted on December 29, 2007.
To access the presentation, go to, http://www.cms.hhs.gov/PQRI, and select the CMS Sponsored Calls tab on the left side of the page; next, scroll down to the Downloads section under the heading PowerPoint Presentations and select “PQRI PowerPoint Presentation – April 30th National Provider Call. Cut and paste the URLs into your internet browser should you have a problem accessing the URLs embedded in the message.
Note:
Due to changes in the criteria in awarding Continuing Education Units (CEUs), CMS is unable to award CEUs for a conference training call. We are sorry for any inconvenience this may have caused you. We will try to offer CEUs for future 2008 Physician Quality Reporting Initiative Calls. We are thankful for your feedback which is being used as the initial needs assessment data to determine what part of the eligible professional population is interested in obtaining CEUs
CENTERS FOR MEDICARE AND MEDICAID SERVICES
SPECIAL OPEN DOOR FORUM:
WAGE INDEX REFORM
Tuesday, May 20, 2008
2pm-4pm Eastern Time
Conference Call Only
The purpose of this Special Open Door Forum (ODF) is to provide an opportunity for the public to discuss and share their opinions, suggestions, and expertise on the wage index and alternative methods for computing the wage index. Participants will be asked to comment on the 9 matters related to the wage index that Section 106(b)(2) of the MIEA-TRHCA requires CMS to consider, the MedPAC’s recommendations, and CMS’s proposals in the FY 2009 IPPS proposed rule. The comment period for the FY 2009 IPPS proposed rule ends on June 13, 2008 (see the Federal Register, volume 73, page 23528, April 30, 2008, for instructions on submitting comments for the proposed rule).
Background:
Section 106(b)(1) of the Medicare Improvements and Extension Act, Division B of the Tax Relief and Health Care Act of 2006 (Pub. L. 109-432; MIEA-TRHCA) required the Medicare Payment Advisory Commission (MedPAC) to submit a report on the hospital wage index by June 30, 2007, including recommendations on alternatives for computing the wage index. The MedPAC’s report was included in the Commission’s June 2007 Report to Congress. In addition, section 106(b)(2) of the MIEA-TRHCA required CMS to take into account the MedPAC's recommendations and include in the FY 2009 proposed rule for the hospital inpatient prospective payment system (IPPS) one or more proposals that consider nine specific issues related to the wage index. CMS awarded a Task Order to Acumen, LLC to assist CMS in evaluating the impact of MedPAC’s recommended revisions to the hospital wage index and in developing one or more proposals to revise the wage index.
Note: Participants who are unable to present their comments during the Special ODF, or are unable to elaborate within the 2 minute time frame allotted for commenting, will be able to submit them to CMS following the Special ODF via the following email address, CMS_Wage_Index_ODF@cms.hhs.gov . Submitting your comments to this email address will not replace the formal comment submission process listed in the Federal Register.
We look forward to your participation.
Open Door Participation Instructions:
Dial: 1-800-837-1935 & Reference Conference ID: 46680542
Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880 and for Internet Relay services click here http://www.consumer.att.com/relay/which/index.html . A Relay Communications Assistant will help.
An audio recording of this Special Forum will be posted to the Special Open Door Forum website at http://www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be accessible for downloading beginning May 28, 2008.
For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.hhs.gov/opendoorforums/
Thank you for your interest in CMS Open Door Forums.
The Clinical Laboratory Fee Schedule Fact Sheet, which provides general information about the Clinical Laboratory Fee Schedule, coverage of clinical laboratory services, and how payment rates are set, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visithttp://www.cms.hhs.gov/mlngeninfo/, scrolldown to “Related Links Inside CMS” and select “MLN Product Ordering Page.”
Reminder: CMS to Host National Provider Education Call on the DMEPOS Competitive Bidding Program - May 13, 2008
CMS to Host National Education Call on May 13th, 2008
The Centers for Medicare & Medicaid Services (CMS) will host a national education conference call to address the implementation of the new Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding program scheduled to begin on July 1, 2008. This call is being conducted for Medicare fee-for-service DMEPOS suppliers, physicians, and other providers – all of which may be affected by the program. The call will give a general overview of the new program and address some of the exceptions and situations you may encounter as the program is implemented. A presentation will be made by the Competitive Bidding Implementation Contractor (CBIC) and CMS Subject Matter Experts will be available to answer questions. A PowerPoint presentation will be posted on the CMS Website prior to the call.
Conference call details:
Date: May 13, 2008
Conference Title: Overview of the DMEPOS Competitive Bidding Program
Time: 12:30-2:00 p.m. EDT
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below.
Registration will close at 12:30 p.m. EDT on May 12, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
1. To register for the call participants need to go to: http://www2.eventsvc.com/palmettogba/051308
2. Fill in all required data.
3. Verify your time zone is displayed correctly the drop down box.
4. Click "Register".
5. You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as they may have gotten caught in that.
For those of you who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 2:30 p.m. EDT 5/13/2008 until 11:59 p.m. EDT 5/17/2008. The call in data for the replay is (800) 642-1687 and the passcode is 45744159.
CMS recommends the review of three MLN Matters articles prior to the call. There is a substantial amount of program information and how it will impact DMEPOS suppliers, physicians and other providers.
These Special Edition MLN Matters articles are:
MLN Matters Special Edition # SE0805 entitled ~ “Overview of New Medicare Competitive Bidding Program for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) – The first in a series of articles on the implementation of this program.” ~ This article is posted on the CMS Website at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0805.pdf .
MLN Matters Special Edition Article # SE0806 entitled ~ “Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program: Grandfathering, Repair and Replacement, Mail Order Diabetic Supplies and Advanced Beneficiary Notices (ABNs) – the second in a series of articles on the new DMEPOS Competitive Bidding Program.” ~ This article is posted on the CMS Website at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0806.pdf .
MLN Matters Special Edition Article # SE0807 entitled ~ “Important Exceptions and Special Circumstances that Occur Under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program:--The third in a series of articles on the new DMEPOS Competitive Bidding Program.” ~ This
Article is posted on the CMS Website at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0807.pdf .
Conference call details:
Date: May 19, 2008
Conference Title: CMS NPI Roundtable: Medicare Implementation Q&A Session
Time: 2:00-3:30 p.m. EDT
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below.
Registration will close at 2:00 p.m. EDT on May 18, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
- To register for the call participants need to go to: (http://www2.eventsvc.com/palmettogba/051908)
- Fill in all required data.
- Verify your time zone is displayed correctly the drop down box.
- Click "Register".
- You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as they may have gotten caught in that.
For those of you who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 3:30 p.m. EDT 5/19/2008 until 11:59 p.m. EDT 5/24/2008. The call in data for the replay is (800) 642-1687 and the passcode is 46175614.
The NPI is here. The NPI is now. Are you using it?
Important Information for Medicare FFS Providers
Additional Guidance and Clarification for Identifying Secondary Providers in Medicare Claims
In accordance with the NPI final rule, when an identifier is reported on a paper or electronically submitted claim for ordering/referring /attending/operating/supervising/purchased service/other/service facility provider (in the x12N 837 claims transactions) or for prescriber (in the NCPDP 5.1 retail drug claim transaction), that identifier must be an NPI. For Medicare purposes, this requirement is effective May 23, 2008. If the entity to be identified as the ordering/referring/attending/operating/supervising/purchased service/other/service facility provider or prescriber does not furnish an NPI at the time of the order/referral/purchase or time of service, the billing provider must attempt to obtain that NPI in order to use it in the claim. The billing provider may use the NPI Registry or may need to contact the ordering/referring/ attending/operating/supervising/purchased service/other/service facility or presciber in order to obtain the NPI. While the Implementation guides for the X12N claims transactions permit the reporting of the Social Security Number (SSN) for some secondary providers if there is no NPI, we do not believe the billing provider will be successful in the obtaining the SSN.
· If unable to obtain the NPI of the entity to be identified in the service facility location loop, no identifier should be reported in that loop.
· If unable to obtain the NPI of the ordering/referring/attending/operating/supervising/purchased service/other or prescriber, the billing provider (in the X12N 837 transactions) or the service provider (in the NCPDP 5.1 transaction) shall use its own NPI to identify those secondary providers. Medicare will not pay these claims if these secondary providers are not identified by NPIs.
CMS will Host NPI National Roundtable Q&A Session on May 19, 2008
CMS will host a national NPI Roundtable Q&A session to address questions from the Medicare provider community prior to May 23rd. This Roundtable will be on May 19th from 2-3:30PM EDT. Questions will not be collected during the registration process for this call. There will be no presentations during this call; we will open the lines to take questions following a brief introduction. For registration details, visit http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/listserv_wording_5-19-08_call.pdf on the CMS website.
REMINDER: CMS will Host NPI National Roundtable on May 14, 2008
Registration is still open for the Roundtable to be held on May 14th from 2-3:30PM EDT. Providers will be able to submit questions through the online registration system at the time of sign up for this call. Similar to the most recent NPI Roundtable, Subject Matter Experts will create presentations based on the questions submitted. For registration details, visit http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/listserv_wording_5-14-08_call.pdf on the CMS website.
Need More Information?
Still not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information.
Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage.
Follow Up from the Recent End-Stage Renal Disease Open Door Forum
CMS is offering members of the End-Stage Renal Disease (ESRD) provider community and other ESRD stakeholders a venue to submit questions about the newly published ESRD Conditions for Coverage (CfCs). Our goal is to provide responses that will help inquirers understand the new requirements. We are requesting that members of the ESRD renal community submit questions pertaining to the ESRD CfCs to the CMS ESRD_Final_Rule_Rollout mailbox at ESRD_Final_Rule_Rollout@cms.hhs.gov beginning May 12, 2008. Please submit only questions that pertain to the CfCs, as we will only answer these questions, and on a rolling basis. We will also try to communicate the questions and answers in the most efficient manner back to stakeholders. Our goal is to be as timely as possible with responses, but we cannot commit to a prescribed schedule.
Questions pertaining to ESRD payment, claims processing, Network activity, and survey and certification issues should be directed to your usual contact within CMS. Please contact Lynn Riley at 410-786-1286 or Lauren Oviatt at 410-786-4683 with questions about this announcement.
Information from The CMS.
In conjunction with National Osteoporosis Awareness and Prevention Month, the Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare provides coverage of bone mass measurements for beneficiaries at clinical risk for osteoporosis.
Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures of the hip, spine, and wrist. Both men and women are affected by osteoporosis. One out of every two women and one in four men over 50 will have an osteoporosis-related fracture in their lifetime. The good news is that osteoporosis is a disease that can be prevented and treated. Medicare’s bone mass measurement benefit can aid in the early detection of osteoporosis before fractures occur, provide a precursor to future fractures, and determine rate of bone loss.
As a health care professional, you play a crucial role in helping your patients maintain strong, healthy bones throughout their life. CMS needs your help to ensure that all eligible Medicare beneficiaries take full advantage of the bone mass measurement benefit. Please join with CMS in spreading the word about prevention and early detection of osteoporosis and the bone mass measurement benefit covered by Medicare.
How Can I Help?
National Osteoporosis Awareness and Prevention Month provides an excellent opportunity for health care professionals to help increase awareness, knowledge and understanding of prevention, early detection, and treatment of osteoporosis as well as strategies for managing the disease. You can help in a number of ways:
1) Stay abreast of the latest clinical guidelines for prevention, diagnosis, and treatment;
2) Become familiar with Medicare’s coverage of bone mass measurements;
3) Talk with your patients about their risks factors for osteoporosis, prevention measures they can take to reduce their risk factors, and the importance of utilizing bone mass measurements; and
4) Encourage eligible Medicare patients to take full advantage of Medicare’s bone mass measurement benefit.
Together we can help Medicare beneficiaries reduce bone fractures and maintain strong healthy bones.
For More Information
· For more information about Medicare’s coverage of bone mass measurements, please visit the CMS website http://www.cms.hhs.gov/BoneMassMeasurement/
· The Medicare Learning Network (MLN) Bone Mass Measurements Brochure – this tri-fold brochure provides fee-for-services health care professionals and their staff with an overview of Medicare’s coverage of bone mass measurements. http://www.cms.hhs.gov/MLNProducts/downloads/Bone_Mass.pdf
· To learn more about National Osteoporosis Awareness and Prevention Month, please visit The National Osteoporosis Foundation website http://www.nof.org/
“Osteoporosis – It’s Beatable. It’s Treatable.”
Thank you for your support.
CMS PROPOSES MORE ACCURATE PAYMENT RATES FOR MEDICARE SKILLED NURSING FACILITIES IN
FISCAL YEAR 2009 RECALIBRATION OF CASE-MIX ADJUSTMENT
The Centers for Medicare & Medicaid Services today announced its proposal for new, more accurate fiscal year (FY) 2009 payment rates for Medicare skilled nursing facilities that more closely reflect differences in patient care needs.
“CMS is committed to providing high quality care to those in skilled nursing facilities and to paying those facilities properly for that care,” said Acting Administrator Kerry Weems . “The proposed adjustments to the payment rates for next year reflect that policy.”
To view the entire Press Release: http://www.cms.hhs.gov/apps/media/press_releases.asp
To view the SNF PPS Page: http://www.cms.hhs.gov/SNFPPS/
MEDICARE EXPANDS COVERAGE FOR ARTIFICIAL HEART DEVICES
The Centers for Medicare & Medicaid Services (CMS) today issued a final National Coverage Determination (NCD) expanding Medicare coverage of artificial hearts when they are implanted as part of a study that is approved by the Food and Drug Administration (FDA) and that meets CMS’ Coverage with Evidence Development (CED) clinical research criteria.
“Our decision revises a long-standing non-coverage policy and allows beneficiary access to this advanced technology,” said CMS Acting Administrator Kerry Weems. “Our decision also encourages the completion of FDA post-approval studies.”
To view the entire Press Release: http://www.cms.hhs.gov/apps/media/press_releases.asp
To view the National Coverage Decision:
http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=211
Medicare DMEPOS Competitive Bidding Program
This is an important reminder that CMS has now issued three articles through the Medicare Learning Network to educate and prepare you for the July 1, 2008 implementation of the Medicare DMEPOS Competitive Bidding Program. These Special Edition MLN Matters articles, numbered SE0805, SE0806, and SE0807, contain information of both a general nature about the program as well as policy-specific topics such as grandfathering, mail order diabetic supplies, and advance beneficiary notices. All three articles can be easily accessed by going to the Medicare Learning Network General Information Web page at http://www.cms.hhs.gov/MLNGenInfo and clicking on the link entitled “DMEPOS Competitive Bidding Articles” in the downloads section of the page.
The new program begins July 1, 2008 and additional educational materials will be made available to you as we approach this date.
We are pleased to announce the latest release of the PC-ACE electronic billing software. PC-ACE version 1.91 is now available for downloading from the RGBA website:
http://www.rgbagov.com/Tools/Electronic-Billing-EDI/Downloads.shtml
The full install and updates along with the User Manual, Installation Directions and Quick Tips Guide are also available at the above link.
If you have questions or problems with the download process of this software, please contact
eBusiness Service Center at (423) 535-5717.
3rd Qtr. 2008 Riverbend GBA Ask-the-Contractor Teleconference (ACT)!
Thursday, May 29, 2008, 2:00 PM EST.
Toll Free call in number: 1-877-856-1962.
There will be 100 call-in lines available!
Participants may dial in 15 minutes before the teleconference begins.
Please submit any questions before May 22, 2008 that you would like answered on the call to:
http://www.rgbagov.com/Education/Training/training.do
Listed below are the Webinars available on the RGBA Website. Please register at:
http://www.rgbagov.com/Education/Schedule-Events/Workshop-Registration/event.do
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| Description: Discussion of ED visits and Medical Review criteria. |
| Time: 2:00 PM EST |
| Date: 2008-05-13 |
| Description: Review of Inpat Rehab Facility billing |
| Time: 2:00 PM EST |
| Date: 2008-06-18 |
| Description: This Webinar will cover the MSP provisions as mandated by The CMS. Issues covered will be; responsibilities of each party involved, the claims flow process, how and when claims may be submitted for Medicare Secondary payment. This Webinar information is great for all levels of billing personnel. |
| Time: 2:00 ET |
| Date: 2008-05-13 |
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| Description: This Webinar covers the HIQA and DDE screens as they pertain to Medicare beneficiary eligibility, and information used to submit Medicare claims. Also, the DDE screens and their functions will be covered. This Webinar is designed for all levels of DDE and HIQA users. |
| Time: 2:00 ET |
| Date: 2008-05-15 |
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| Description: This Webinar will cover Rural Health Clinic regulations, coverage, and billing. The material presented is suited for new RHC's as well as existing RHC that would like a refresher course in these subject matters. There will be a Q&A session available. |
| Time: 2:00 ET |
| Date: 2008-05-27 |
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| Description: This Webinar is for providers that recently obtained RHC status and provider number. Topics covered will include; Riverbend GBA reports, UB-04 claims submission, payment schedules, payment processes, signing up for electronic claims, RGBA Website, reference materials and much more! |
| Time: 2:00 ET |
| Date: 2008-06-10 |
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| Description: This Webinar will cover the MSP provisions as mandated by The CMS. Issues covered will be; responsibilities of each party involved, the claims flow process, how and when claims may be submitted for Medicare Secondary payment. This Webinar information is great for all levels of billing personnel. |
| Time: 2:00 ET |
| Date: 2008-06-12 |
Let’s Go Paperless…
We are encouraging all providers to submit their cost report supporting documentation on electronic media instead of in hardcopy. We can accept flash drives, compact discs (CD), or 3 ¼ floppy disks. Logs for bad debts, disproportionate share, injections, etc. that are submitted electronically (Excel versions please!) are much easier for our staff to review. We can accept Excel files, Word documents, .tif and .pdf files. Please ensure your electronic files are properly labeled so our staff can determine what the files represent.
Submitting electronic files in lieu of paper will also reduce your postage cost for mailing the cost report since it won’t weigh nearly as much. CMS does still require that you submit the certification page of the cost report and the CMS Form 339 Questionnaire with original signatures so we still require hardcopies of these documents.
If you are unable to provide all of your supporting documentation electronically, please do not use staples, spiral binders or notebooks to separate or hold your data. Effective, May 1, 2008, Riverbend will image all incoming mail (including cost reports). Paper clips, binder clips, rubber bands, or folders are acceptable. If you are submitting more than one cost report in a package, please ensure proper separation of the various reports.
If you have questions, contact Riverbend’s Provider Audit & Reimbursement department at (423) 535-5906.
Reminder: Please be aware that your facility will continue to receive a remittance advice with the legacy number in the heading for claims that were adjudicated without the NPI number.Claims that were adjudicated with the NPI number will be indicated on a separate remittance advice with the NPI number in the heading.
Due to this change your facility may have two remittance advices for a specific paid date, one with the legacy number in the heading and one with the NPI number in the heading.
Special Note: If your facility processes adjustments or cancels on claims that were originally processed without the NPI number, the adjustment or cancel will be reflected on your remittance advice with the legacy number since that is how the original payment was processed. These amounts will have a negative reimbursement amount, thus creating a claims accounts receivable balance within FISS under the legacy number.
The correct reimbursement amount of the claim adjustments that were filed with the NPI will process and pay under the NPI number. Since the claims accounts receivable created from the adjustment or cancel is processed under the legacy number, this amount is not offset by the payments being made under the NPI number.
The CMS has been made aware of this issue, and RGBA is currently awaiting a correction.
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