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Electronic Initiatives

Presented by: Provider Outreach and Education

June 13, 2013

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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.

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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

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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

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Who Should I Call?

External User Services

User ID/Password Inquiries

System-error message while completing Inter-net based PECOS enrollment

Questions about Internet-based PECOS account registration

Cahaba GBA

Help completing an enrollment

Status of the enrollment application

Rejected applications

Missing applications

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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

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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

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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

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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

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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

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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

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Electronic Data Interchange

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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

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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

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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

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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

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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

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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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