DME MAC Jurisdiction B: Insider - Special Edition ... · SPECIAL EDITION IMPLEMENTATION AND CUTOVER...

© 2016 Copyright, CGS Administrators, LLC.

IMPLEMENTATION AND CUTOVER INFORMATION

SPECIALEDITION

2© 2016 Copyright, CGS Administrators, LLC.

SPECIAL EDITION


Welcome to CGS!This is a special edition of the Jurisdiction B DME MAC Insider quarterly supplier publication focused exclusively on implementation and contract cutover activities. This issue provides you with important implementation cutover timelines, the new addresses and telephone/fax numbers you will use starting July 1, 2016 and important details about the CGS Jurisdiction B DME MAC.

The DME MAC Insider is produced exclusively for our DME MAC suppliers in Jurisdictions B and C. CGS will begin our normal quarterly publications starting July 1, 2016. You will receive a notice via our Jurisdiction B ListServ as well as our Facebook and Twitter channels.

In this issue:Dr. Stacey Brennan Joins CGS 3

From the Desk of Medical Review 4

Meet Don “Roc” Via: CGS DME MAC Jurisdiction B Contract Program Manager 4

IMPORTANT: Jurisdiction B Contractor Number Change Instructions/Information 5

EIDM Early Registration Process Extended to June 5

CMS Enterprise Portal (EIDM): Social Security Number Requirements 6

myCGS New User Registration Available 6

Eligibility Information in myCGS—Did You Know? 7

Same Service….Different Name 8

Timelines for Correspondence Updates 9

Using the Jurisdiction B Interactive Voice Response (IVR) Unit 10


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Dr. Stacey Brennan Joins CGS

News Release

April 27, 2016 Media Contact: Elizabeth Hammond, 1.803.264.4626

CGS Names Dr. Stacey Brennan Chief Medical Officer for Medicare Contract

Nashville, Tenn. – Stacey V. Brennan, M.D., FAAFP will join CGS Administrators, LLC as the chief medical officer for the Jurisdiction B Durable Medical Equipment (DME) Medicare Administrator Contract (MAC).

Dr. Brennan currently serves as the DME MAC medical director for National Government Services in Indianapolis, Indiana. She will begin her duties at CGS on July 6.

In her new role, Dr. Brennan will provide expert clinical guidance in the development of local coverage determinations and policy articles to provide specific coverage criteria in support of the billing of durable medical equipment, prosthetics, orthotics, and supplies. She will have significant involvement in the development of the Jurisdiction B medical review strategy including pre-/post-payment audits, CERT error rate reduction plans and supplier-focused education. Dr. Brennan will work closely with CGS’s Jurisdiction C DME MAC management team to align processes and to support The Centers for Medicare & Medicaid Services (CMS) goals.

Dr. Brennan received degrees from Penn State University and the University of Pittsburgh School of Medicine. She served her residency in family medicine at the University of South Carolina School of Medicine.

Information on the new contract may be found at http://www.cgsadmin.com/pr/01.11.16.html.

About CGS Administrators, LLC

Headquartered in Nashville, CGS Administrators, LLC (http://www.CGSMedicare.com) is a leading provider of services for Medicare beneficiaries, healthcare providers, and medical equipment suppliers in 38 states, supporting the needs of over 24 million Medicare beneficiaries and 100,000 healthcare professionals nationwide. CGS operates as a Part A, Part B, home health and hospice and durable medical equipment Medicare administrative contractor for CMS. In addition to its headquarters in Tennessee, the company has offices in Illinois, Iowa, South Carolina and Texas.

About Celerian Group

Celerian Group (http://www.celeriangroup.com) is a consortium of companies that helps government and private health care plans navigate the complexities of benefits administration in a changed marketplace. As part of Celerian Group, CGS handles Medicare and Medicaid benefits administration, claims processing, member and provider services, provider credentialing, and education.

-end-

http://www.cgsadmin.com/pr/01.11.16.html

http://www.CGSMedicare.com

http://www.celeriangroup.com


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From the Desk of Medical Review

CGS Medical Review (MR) is excited to have the opportunity to work with Jurisdiction B suppliers. We remain dedicated to providing you with great service.

As we prepare for our first full day of operations as the new Jurisdiction B DME MAC, the CGS Medical Review department will adopt most of the prepay audits currently in place at NGS, and we will continue many MR-related activities already in progress. There will be minor variances; but, overall the majority of suppliers should not notice any significant changes in medical review functions.

Over the next several weeks, medical review staff along with Dr. Stacey Brennan, Chief Medical Officer for Jurisdiction B, will begin developing a new medical review strategy. New audits may be initiated and existing ones changed – all with a goal of reducing the CERT error rate and ensuring claims are paid in accordance with Medicare policies. As always, communication and education will be a top priority. Medical Review staff work side-by-side with our Provider Outreach and Education (POE) team to identify education opportunities. Our POE Community Coaches will provide you with customized, one-on-one education opportunities to help you understand and improve Medicare billing and to reduce errors. POE provides policy-based education in a variety of formats ranging from workshops and individual association meetings to webinars and video programming.

We are currently putting the finishing touches on our Medical Review section of the new Jurisdiction B website. Our new section will feature easy access to important resources such as current LCDs and Policy Articles, Supplier Manual, Supplier Checklists, Denial Aides, online resources, and education. We are also adapting some of our very popular tools for Jurisdiction B. In the coming weeks, we will introduce you to MR Wizard, which provides the most detailed medical review denial and resources available anywhere. Plus, we will launch our ADR online tool and resources along with a variety of other useful web-based resources.

As we prepare to finalize our implementation of the Jurisdiction B DME MAC to CGS, we encourage you to monitor our implementation website for important updates. We also ask that you attend our Ask-the-Contractor teleconferences, register for myCGS, sign up for our ListServ, “like” us on Facebook and follow us on Twitter. CGS uses all of these tools to provide you with important information before – and after – implementation.

Meet Don “Roc” Via: CGS DME MAC Jurisdiction B Contract Program Manager

Roc is a 17-year veteran of CGS and began his management career with the former “Region D” DMERC contract. After holding various management positions with increasing responsibilities, he served as the Assistant Program Manager for Jurisdiction C, leading several operational departments including Appeals, Reopenings and Redeterminations. Today, Roc is the executive leader and Program Manager for the new CGS Jurisdiction B DME MAC. Roc will have direct oversight of all facets for Jurisdiction B and he is poised to ensure his staff continually meets or exceeds Centers for Medicare & Medicaid (CMS) contract performance requirements. Roc has literal

“hands on” understanding of all DME MAC operational functions and recognizes the very important role he plays to ensure suppliers and CMS receive exceptional service. Roc has a Bachelor of Science Degree from Tennessee Technological University and an M.B.A. from Middle Tennessee State University.


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IMPORTANT: Jurisdiction B Contractor Number Change Instructions/Information

When Jurisdiction A and Jurisdiction B transition on June 30, 2016, the corresponding contractor codes will be changing as well. CEDI recommends suppliers work with their software vendors, billing services, and clearinghouses to ensure their software is updated to send the new contractor codes.

Inbound files (837, NCPDP and 276) will be accepted by CEDI up until 3:00 p.m. on June 30 with the current contractor codes for JB (17003) and JA (16003). In other words, the way you currently send your claims will still work UNTIL 3 p.m. on June 30.

After 3:00 p.m. on June 30, CEDI will apply the necessary changes for the transition and when they re-open the CEDI Gateway, the only valid contractor numbers that will be accepted will be 17013 for Jurisdiction B, 16013 for Jurisdiction A, 18003 for Jurisdiction C, and 19003 for Jurisdiction D. NOTE that only contractor numbers for Jurisdictions B and A are changing. The numbers for Jurisdiction C and D WILL NOT CHANGE.

You should plan to make the change on June 30.

CGS and CEDI will issue frequent messages about the contractor number change via ListServ. We will also publish updates to social media. You are encouraged to “like” the CGS Jurisdiction B DME MAC Facebook page (https://www.facebook.com/JBDMECGS) and follow us on Twitter (http://www.twitter.com/JBDMEPOE).

EIDM Early Registration Process Extended to June

To ensure early onboarding of the Jurisdiction B suppliers in the my CGS Web portal, CGS began sending letters on March 14 to Authorized Officials in Jurisdiction B who have at least one employee currently registered to use the NGS Connex Web portal. Users were notified that the pre-registration process would conclude on May 27 however, we have been able to extend pre-registration through June 2016.

We completed our initial mailing on April 1 and we have already started receiving and processing the pre-registration forms for “Designated Approvers.” This is the first step for existing NGS Connex users to register for access to the myCGS secure Web portal. Here are a few important notes:

1. ONLY Authorized Officials (those with at least one employee or staff member who currently uses NGS Connex) were sent a letter and pre-registration form. The Authorized Official is the person listed in the NPI Registry for the TAX ID of the supplier. This was a focused mailing to help move existing NGS Connex users through the EIDM registration process.

2. Not every Jurisdiction B supplier received a pre-registration packet – only the Authorized Official (those with at least one employee or staff member who currently uses NGS Connex) received a letter.

Authorized Officials have until June 15 to submit their Designated Approver (DA) form. The DA should submit their registration form no later than June 20 in order to have the DA ready to use myCGS on July 5. For end users to be able to use myCGS on July 5, the DA should approve them by July 1.

CGS will continue processing forms as they are received however, we cannot guarantee July 5 access to myCGS for forms received after the dates outlined above.

https://www.facebook.com/JBDMECGS

http://www.twitter.com/JBDMEPOE


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If you are the Authorized Official with at least one employee currently registered to use NGS Connex and YOU HAVE NOT RECEIVED YOUR LETTER, please call the Jurisdiction B implementation help desk to request a copy by e-mail. In some situations, the Authorized Official information may differ from what we identified in the NPI Registry. The most common reason being that a new Authorized Official was added AFTER we pulled the information from the registry or there was a change in Authorized Official which has not yet been updated in the NPI Registry.

CMS Enterprise Portal (EIDM): Social Security Number Requirements

On April 27, the CGS implementation Provider Outreach and Education team conducted an Ask the Contractor teleconference. During that call, Jurisdiction B suppliers expressed concern over requirements to use a personal social security number as part of the CMS EIDM registration process to access the myCGS secure Web portal.

Following the call, CGS notified suppliers via ListServ on May 2 that we would modify the requirements for End Users and allow them to register without their social security numbers. Following release of the ListServ, CGS was notified that the CMS Enterprise Portal had been updated and that a social security number was now required for everyone who registers in EIDM. CGS sent a corrected ListServ to Jurisdiction B suppliers on May 3.

We recognize that some suppliers are not comfortable using a personal social security number when registering for access to federal government information. While CMS EIDM sums it up best in their online FAQs, CGS asks you to consider the following:

1. The CMS Enterprise Portal (EIDM) utilizes Experian for identify verification.

2. Most every person in the country who has applied for a mortgage, credit card, car loan or other major expense, provides personal information that is on file with Experian.

3. Using your social security number when applying for access to federal government information (including your own company’s information in myCGS) is the best way to authenticate your identity and to protect your information.

It is CMS’ intent that ALL contractor portals – not just myCGS – will eventually use EIDM before granting providers/suppliers access to federal government information. If you have questions about the CMS EIDM registration process, please call our CGS Jurisdiction B implementation help desk at 1.877.363.8895. The help desk is available Monday through Friday from 1:00 p.m. to 5:00 p.m. Central Time.

For more information on the CMS Enterprise portal, please review the EIDM Frequently Asked Questions located at https://portal.cms.gov/wps/portal/unauthportal/faq .

myCGS New User Registration Available

Jurisdiction B suppliers who do not use NGSConnex or myCGS and who do not currently have a CMS Enterprise Portal (EIDM) user ID and password may now register as a new user for access to myCGS.

CGS has produced a four-part video tutorial program that guides new users through the entire registration process in the CMS Enterprise Portal. CGS has also created a printable, easy-to-follow guide to also assist you.

https://portal.cms.gov/wps/portal/unauthportal/faq


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The video education and printable user guide are available on the Jurisdiction B implementation website located at http://www.cgsmedicare.com/jb under the Provider Outreach and Education section.

Eligibility Information in myCGS—Did You Know?

If you’re a myCGS (http://www.cgsmedicare.com/jc/mycgs/index.html) user, you probably already know that myCGS is a fast and easy way to access beneficiary eligibility information. What you may not know is that when you inquire about a beneficiary’s information, the data you enter in myCGS is first validated against the record on file with the Social Security Administration. If the beneficiary data that you enter in myCGS does not match any records, there are two possible issues: 1) The information you received from the beneficiary may have been incorrect—double check that your information matches the beneficiary’s records; 2) The CMS system data is incorrect and/or needs to be updated. In this case, the beneficiary will need to contact 1.800.MEDICARE in order to have their information corrected.

Easy to access eligibility information is just one of many benefits to using myCGS. Learn more by visiting our myCGS page (http://www.cgsmedicare.com/jc/mycgs/index.html).

Try myCGS Today! Not a myCGS user? Why not give it a try? We think that you will find myCGS to be a fast and user-friendly application that will help you save time and money.

Visit our myCGS page (http://www.cgsmedicare.com/jc/mycgs/index.html) to get started today!

http://www.cgsmedicare.com/jb

http://www.cgsmedicare.com/jc/mycgs/index.html




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Same Service….Different Name

Throughout implementation, CGS has mentioned we offer many of the same supplier information, tools and services that you receive today. The only difference may be the name. To guide you, CGS has created a quick reference table that provides the name of the tool or service you use today and what that same tool or service is called at CGS. The guide includes a high level overview of the types of information available.

NGS Product Name CGS Product Name Description

NGS Connex myCGS A secure Web portal providing customers with the ability to access claims-specific information, financial data, and eligibility. myCGS offers electronic upload and attachment services similar to those available through the NGS product.

Education Review Request

Not offered by CGS If you review our Jurisdiction C website, you will see a service called, CGS Connectssm. While this service provides many of the same review services as the NGS Education Review Request, it will not be available to Jurisdiction B. CGS is exploring options to make the service available.

Medical Review Denial Tool

MR WIZARD MR WIZARD provides the most detailed medical review denial information available…anywhere! It will be available to Jurisdiction B suppliers in late 2016. The information provided by MR WIZARD is dependent on CGS claims processing history. Once we have sufficient history, we will make MR WIZARD available to you.

CERT Denial Finder CERT Claim Identifier Tool

These tools are identical. In fact, CGS created the tool and shared it with all other DME MACs in 2009.

JB Connections DME MAC Jurisdiction B Insider

Quarterly supplier publication

Fee Schedule Lookup

DMEPOS Fee Schedules Exactly the same information available. You can search our database, download a .csv file or a .pdf file.

Medicare University Online Education Portal While the educational content remains the same, CGS does not use an online learning management system (LMS) for purposes of accessing education. Our portal provides you with a running list of courses completed and offers you the ability to download a certificate of completion for purposes of obtaining continuing education credits.

POE “Ombudsman” Community Coach In keeping with CMS changes to the original ombudsman program, CGS developed our highly successful Community Coach program. Much like the former ombudsman process, you will have a dedicated POE representative assigned to your state. Their purpose is to provide you with one-on-one educational guidance and assistance. The name, location, and contact information for your Community Coach representative will be published to the Jurisdiction B website under the “Education” menu.

Live Chat LiveLinePLUS CGS provides you with opportunities to discuss in-depth questions related to specific policy-based education. Similar to the “live chat” service, CGS gives you the ability to either submit your question electronically or you may pose your question via telephone. The benefit of LiveLinePLUS is that you can connect directly with your peers and receive common, consistent instruction/education from a POE representative and/or other subject matter expert.

Email Updates ListServ The CGS ListServ is the primary method for communicating with our customers. We also publish information and educaiton through our Facebook and Twitter social media outlets. At CGS, we only issue ONE e-mail message per day (unless urgent messaging is required). Each ListServ message contains information from both CMS and CGS. We link you directly to the news and information from the ListServ message.


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NGS Product Name CGS Product Name Description

https://www.ngsmedicare.com

http://www.cgsmedicare.com

Effective June 30, the NGS Jurisdiction B website will no longer be available. There will not be a “redirect” from their website to CGS. Beginning July 5, you will access the new Jurisdiction B website from CGS.

Timelines for Correspondence Updates

NGS will update all outgoing correspondence to include the new CGS address and phone and fax numbers where applicable. All letters will indicate that the changes are effective July 1, 2016.

This table provides an overview of letters which will be updated and the new address, phone and fax number which will be applied.

Important Changes to Current NGS JB Letters

Date Letters to be Updated CGS Address CGS Fax

NumberCGS Phone Number What you will see...

6/13/2016 ADR Letters will include the CGS Jurisdiction B fax number and return address

CGS PO Box 20007 Nashville, TN 37202

1.615.660.5993 1.866.590.6727 Effective July 1, 2016, all ADR responses for DME MAC Jurisdiction B must be sent to CGS. They may be faxed to 1.615.660.5993, mailed to:

PO Box 20007 Nashville, 37202

or submitted via esMD.6/16/2016 Demand Letters

will include the new address where checks will be sent

Overpayment Recovery CGS DME MAC Jurisdiction B PO Box 953479 Saint Lois, MO 63195-3479

1.866.590.6727 Effective July 1, 2016, all checks for DME MAC Jurisdiction B must be sent to CGS. They should be mailed to:

PO Box 954379 Saint Louis, MO 63195-3479

6/17/2016 The Complaint Screening letter will include the CGS Jurisdiction B address and phone number

CGS PO Box 20007 Nashville, TN 37202

1.615.782.4507 1.866.590.6727 Effective July 1, 2016, all requests for additional information for Jurisdiction B must be sent to CGS. They may be faxed to 1.615.782.4507, mailed to:

PO Box 20007 Nashville, 37202

or submitted via esMD.






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Using the Jurisdiction B Interactive Voice Response (IVR) Unit

The CGS Interactive Voice Response (IVR) unit will be available to Jurisdiction B suppliers starting July 1, 2016. While the IVR provides some of the same information you currently receive from NGS, the functionality will be different. The CGS IVR does not use voice recognition to access information. The system will require you to manually enter your information using the telephone keypad. CGS has a name-to-number converter tool as well as a detailed user guide which will be available on the new Jurisdiction B website. CGS has streamlined the touchtone process for the IVR which eliminates the need to press a key multiple times to assign a letter. Detailed Instructions will be published to the website.

The Jurisdiction B IVR will offer information regarding claim status, pending claims, Redetermination status, beneficiary eligibility, Certificate of Medical Necessity (CMN) status for same or similar equipment inquiries, SNF/Inpatient hospital stay information, hospice information, diabetic supply claims, diabetic shoe claims, pricing, outstanding checks, the last 5 checks issued and offsets. It also offers some general information, such as customer service hours of operation.

There is some information that will no longer be available to you through the IVR. We have listed those in the table below along with alternate ways to get that information.

Narrative ChangesCategory Information Comments

Claims Status

• Diagnosis codes Not offered• Overlapping inpatient stays, SNF or Home Health

- Admit date - Discharge date - NPI of facility

Eligibility option of IVR and Portal

• Claim could not be processed Not offeredPayment Floor

• By NPI or PTAN CGS offers by PTAN only

Eligibility • Date of death myCGS Portal• Earliest and latest inpatient spell dates Not DME• Crossover information Not offered• Last pneumonia vaccine date or date eligible

for vaccineNot DME

CMN • Certifying provider name IVR provides phone number only; Portal provides name• CWF lookup Not offered

Appeals • Gives DCN Status only is provided.Finance • Voluntary refunds

- Check amount - Check date - Check status date - DCN Check was applied to - Date applied to DCN - Amount applied to DCN

Not offered


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Narrative ChangesCategory Information Comments

Finance • Checks by date - Check number - Cashed date

CGS provides the last 5 & any outstanding checks

Same or Similar

• CPAP• External breast prosthesis• External infusion pump supplies• Eye prosthesis• Facial prosthesis• Ankle/foot/knee orthosis• Knee orthosis• Lower limp prosthesis• Negative pressure wound therapy supplies• Mechanical in-exsufflation supplies• Ostomy supplies • Orthopedic footwear• RAD supplies• Refractive lenses• Spinal orthosis, TLSO, LSO• Suction pump supplies• Surgical supplies• Tracheostomy supplies• Urological supplies• TENS supplies

Available through myCGS Portal under Claims History

PECOS Enrollment

• Effective dates of enrollment• Termination date

Not offered

General • Phone numbers• Addresses• CERT information

Available on website and Supplier Manual

CGS encourages all Jurisdiction B suppliers to register for our myCGS secure Web portal. The online portal provides you with instant access to the same information currently available through our manual IVR system. CGS has published myCGS “new user” registration instructions to our implementation website located at https://www.cgsmedicare.com/jb.

New PO Box Addresses

Correspondence: CGS PO BOX 20007 Nashville, TN 37202

Claims: CGS PO BOX 20013 Nashville, TN 37202

Prior Authorization: CGS PO BOX 23110 Nashville, TN 37202

Overpayment Appeals: CGS PO BOX 23070 Nashville, TN 37202

https://www.cgsmedicare.com/jb


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Jurisdiction B Provider Contract CenterPCC - CCR 1.866.590.6727PCC - IVR 1.877.299.7900Telephone Reopening Line 1.844.240.7490PCC - TTY 1.888.897.7534

NEW Jurisdiction B Telephone/FAX NumbersFunctional Area Description Telephone Number

Appeals B QIC/AdQIC Effectuation 1.615.660.5973JB QIC Case File Forwarding 1.615.660.5974JB Hearing 1.615.660.5975JB Redeterminations 1.615.660.5976

Customer Service/Reopenings JB Reopenings 1.615.660.5978Customer Service/Congressional JB Congressional 1.615.660.5979DME MR - ADMC JB ADMC Requests 1.615.660.5988DME MR - Prior Auth JB Prior Auth requests 1.615.660.5992DME ADS (includes MR) JB ADS responses 1.615.660.5993MR - ALJ Participation JB ALJ faxes 1.615.660.5995MR DMD JB Medical Director fax line 1.615.660.5997Complaint Screening JB Complaint Screening 1.615.782.4507Overpayment Recovery JB OPR 1.615.782.4508Customer Service/General Inquiry JB General Inquiry 1.615.782.4509Customer Service/CSI JB CSI 1.615.782.4510PWK JB PWK 1.615.782.4511OPR Redeterminations JB OPR RED 1.615.782.4514Appeals - Redeterminations Supporting Documentation JB RED Support Docs 1.615.782.4516myCGS JB MyCGS 1.615.664.5994

NGS JB to CGS JB Supplier Manual CrosswalkNGS Jurisdiction B Supplier Manual Reference CGS Jurisdiction B Supplier ManualChapter 1: Overview Chapter 1: Introduction

General Information Chapter 1: Section 2Medicare Program Chapter 1: Section 2Medicare Card Chapter 1: Section 7

CWF Information not included

Deductible and Coinsurance Chapter 1: Section 4IOM Chapter 1: WelcomePrivacy Act Chapter 1: Section 11

Chapter 2: Enrollment Process Chapter 2: Supplier Enrollment

NPI Chapter 2, Section 1Accreditation Information not included

Surety Bonds Information not included


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NGS JB to CGS JB Supplier Manual CrosswalkNGS Jurisdiction B Supplier Manual Reference CGS Jurisdiction B Supplier Manual

Obtaining Privileges Chapter 2: OverviewApplication Fees Information not included

Change of Information Chapter 2, Section 5Directory of Suppliers Chapter 2, Section 9Supplier Standards Chapter 2, Section 3Change of Ownership Chapter 2, Section 10Participation Program Chapter 2, Section 6Enrollment Chapter 2, Section 4Benefits of Participation Chapter 2, Section 6Non-PAR Chapter 2, Section 6Assignment of Claims Chapter 2, Section 6Resources Chapter 2, Section 11Chapter 3: Medicare DMEPOS Competitive Bidding Program Chapter 5, Section 10Chapter 4: Intake Process CGS does not provide supplier manual instruction on the intake

process. A Suggested Intake Form is available under the “forms” section of the website.

Chapter 5: Medicare Secondary Payer Chapter 11: MSP

What is MSP Chapter 11: IntroductionMSP Benefits Chapter 11: IntroductionBilling Requirements Chapter 11, Section 4Claim Liability Calculation Chapter 11, Section 7MSP on Rental/Purchase items Chapter 11, Section 6MSP Overpayments Chapter 11, Section 8Benefits Coordination and Recovery Center Chapter 11, Section 9Chapter 6: Medical Policy Information and Medicare Audits Chapter 9: Coverage and Medical Policy

General Medical Policy Information Chapter 9, Section 3Medically Unlikely Edits Information not included

Medical Policy Development Chapter 9, Section 3Local Coverage Determination Reconsideration Process Chapter 9, Section 3Scope of Policies Chapter 9, Section 3

Current DMEPOS Medical Policies Current policies are available from the LCD page of the websiteReasons for Audits Chapter 9, Section 2

Addition information is available under the Claim Audit Resources section under the Medical Review menu on the website.

Additional Documentation Requests ADRs are not covered in the supplier manual. Specific information is located under the Claims Submission menu, Additional Documentation Requests section.

Consequences of Failure to Respond or Failure to Timely Respond

ADRs are not covered in the supplier manual. Specific information is located under the Claims Submission menu, Additional Documentation Requests section.

DME MAC Medical Review Section 2: Medical Review


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Steps to Resolve Denials Resulting From Failure to Respond to DME MAC Medical Review/Claims Department ADRs

ADRs are not covered in the supplier manual. Specific information is located under the Claims Submission menu, Additional Documentation Requests section.

Comprehensive Error Rate Testing Program Chapter 3, Section 12: Comprehensive Error Rate Testing

Medicare Recovery Auditor Program Overview Information not included

Zone Program Integrity Contractors Chapter 14, Chapter 5: Fraud and Abuse

Supplemental Medical Review Contractor Information not included

Appeals of Audit Findings Chapter 13, Section 6: Inquiries, Reopenings, Appeals

Chapter 7: Certificates of Medical Necessity/Durable Medical Equipment Information Forms

Chapter 4: CMNs

DME Forms Chapter 4, Section 1CMN Completion Instructions Chapter 4, Section 2DIF Completion Instructions Chapter 4, Section 2Additional CMN/DIF Information Chapter 4, Section 1Cover Letters Chapter 4, Section 2HCPCS Codes Requiring a CMN or DIF Appendix A

CMN Common Scenarios Chapter 4, Section 5Chapter 8: Documentation Chapter 3: Supplier Documentation

Documentation Overview Chapter 3, Section 1Orders Chapter 3, Section 3Certificates of Medical Necessity Chapter 4: CMNs

Documentation in the Patient’s Medical Record Chapter 3, Section 4Request For Refill – Documentation Chapter 3, Section 6Proof of Delivery Requirements Chapter 3, Section 8

Chapter 9: Advance Determination of Medicare Coverage Chapter 9: Coverage and Medical Policy

ADMC Introduction Chapter 9: IntroductionEligible Items Chapter 9, Section 4Submitting ADMC Requests Chapter 9, Section 4ADMC Requirements Chapter 9, Section 4ADMC Documentation Chapter 9, Section 4Chapter 10: Advance Beneficiary Notice of Noncoverage Chapter 3: Supplier Documentation

General Guidelines Chapter 3, Section 9Financial Liability Protection Provisions Chapter 3, Section 9Mandatory ABN Billing Instructions Chapter 3, Section 9ABN as a Voluntary Notice Chapter 3, Section 9Upgrades Chapter 6, Section 15

Advance Beneficiary Notice of Noncoverage Completion Refer to the CMS Manual System, Pub. 100-04, Medicare Claims Processing Manual, Chapter 30, §50

Chapter 11: Claim Filing Jurisdiction Chapter 6: Claim Submission

Claim Filing Based on Beneficiary Address Chapter 6, Section 6Disposition of Incorrectly Filed Claims Chapter 6


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Durable Medical Equipment Medicare Administrative Contractors and Jurisdictions

Chapter 6, Section 7

Chapter 12: Claim Submission Chapter 6: Claim Submission

Acceptable Claim Formats Chapter 6Claim Filing Time Limits Chapter 6, Section 8Signature on File Requirements Chapter 6, Section 6Ordering Claim Forms Chapter 6, Section 4Claim Completion Hints and Tips Chapter 6, Section 6CMS-1500 Claim Form (Version 02-12) Chapter 6, Section 4Abbreviation List Chapter 18: Acronyms and Abbreviations

Mailing Address Chapter 6, Section 7Resources Chapter 15: Resources

Chapter 13: Electronic Data Interchange Chapter 8: Electronic Data Interchange

Administrative Simplification Compliance Act Chapter 8, Section 2Electronic Media Claims Chapter 8: IntroductionOutsourcing Electronic Transactions Overseas Information on outsourcing overseas is not providedCommon Electronic Data Interchange Chapter 8, Section 4Electronic Format Chapter 8: IntroductionHow to Become and Electronic Submitter Chapter 8, Section 4Front-end Edit Report Chapter 8, Section 4

Electronic Remittance Advice Chapter 17, Section 3

Electronic Funds Transfer Chapter 6, Section 10

Claim Status Inquiry Chapter 8, Section 3Jurisdiction B DME MAC EDI Help Desk EDI Help Desk information is not provided in the Supplier

Manual. Information is available in the EDI section of our Claims menu on the website

Email Updates CGS ListServ Notification SystemChapter 14: Level II HCPCS Codes and HCPCS Modifiers Appendix A

Structure of HCPCS Codes Chapter 16: Coding

Level II HCPCS Codes Appendix A

DMEPOS HCPCS Jurisdiction List Chapter 16, Section 3HCPCS Modifiers Chapter 16, Section 4Overflow Modifiers (KB and 99) Chapter 16, Section 4The Pricing, Data Analysis, and Coding Contractor Chapter 16, Section 1Chapter 15: DMEPOS Payment Categories Chapter 5: DMEPOS Fee Schedule Categories

DMEPOS Payment Categories Overview Chapter 5: IntroductionInexpensive or Other Routinely Purchased DME Chapter 5, Section 1Transcutaneous Electrical Nerve Stimulators Chapter 5, Section 1Items Requiring Frequent or Substantial Servicing Chapter 5, Section 2Customized Items Chapter 5, Section 3Other Prosthetic and Orthotic Devices Chapter 5, Section 4


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Parenteral and Enteral Nutrition Pumps Chapter 5, Section 5Therapeutic Shoes and Inserts Chapter 9: Coverage and Medical Policy, Section 1

Surgical Dressings Chapter 9: Coverage and Medical Policy, Section 1

Home Dialysis Supplies Information not included

Capped Rental Items Chapter 5, Section 5Interruptions in a period of Continuous Use Chapter 5, Section 5Oxygen and Oxygen Equipment Chapter 5, Section 6Repairs, Maintenance and Replacement Chapter 5, Section 9Chapter 16: Pricing Chapter 10: Pricing

Pricing Overview Chapter 10, IntroductionFee Schedules Chapter 10, Section 1Reasonable Charges Chapter 10, Section 2Drug Pricing Chapter 10, Section 3Individual Consideration Chapter 10, Section 5Inherent Reasonableness Chapter 10, IntroductionChapter 17: Benefit and Denial Categories Chapter 9: Coverage and Medical Policy, Section 1

Benefit Categories Chapter 9, Section 1Denial Categories Chapter 9, Section 6Prevention of Common Claim Submission Errors Refer to our website Claims menu and “Common Claim Errors”

for additional informationChapter 18: Supplier Remittance Notice Chapter 17: System Outputs

General Information Chapter 17Tips for Reading the Remittance Notice Chapter 17, Section 3Remittance Notice Key Information not included

Resources Information not included

Chapter 19: Medicare Summary Notice Chapter 17: System Outputs, Section 2

Medicare Summary Notice Introduction Chapter 17, Section 2Summary of Numbered Fields on Sample MSN Information not included

Resources Information not included

Chapter 20: Appeals and Reopenings Chapter 13: Inquiries, Reopenings and Appeals

Overview of the Appeals Process Chapter 13, Section 6Levels of Appeals and Time Limits for Filing Appeal Chapter 13, Section 6Reopenings for Minor Errors and Omissions Chapter 13, Section 5Chapter 21: Overpayments Chapter 12: Overpayments and Refunds

Overview Chapter 12, Section 1Overpayment Refunds Chapter 12, Section 1The Offset Process Chapter 12, Section 2Collecting Against Surety Bonds MLN Matters® Number: MM7167Appealing a Refund Chapter 12, Section 5Limitation on Recoupment Chapter 12, Section 5Extended Repayment Plans Chapter 12, Section 4


SPECIAL EDITION



Advance Payments No information is provided on Advance PaymentsLost or Mutilated Checks No information is provided on Lost or Mutilated ChecksChange of Address Chapter 2: Supplier Enrollment, Section 5

Chapter 22: Customer Care Chapter 13: Inquiries, Reopenings and Appeals

Customer Care Program Overview Chapter 13, Section 1Interactive Voice Response System Chapter 13, Section 1Provider Contact Center Chapter 13, Section 1Telephone Inquiries Chapter 13, Section 1Written Inquiries Chapter 13, Section 2Chapter 23: Connex Portal Chapter 13: Inquiries, Reopenings and Appeals

Connex Overview Chapter 13, Section 3myCGS Web Portal Overview (myCGS menu on website)

Connex Setup Instruction myCGS Registration Guide (myCGS Menu on website)Chapter 24: Resources Chapter 15: Resources

Medicare University Online Education Welcome Center (website)Training Events Calendar Calendar of Events (website)Email Updates Program CGS ListServ Notification ServiceSelf-Service Tools Online Tools (website)DME MAC Contact Information Contact Other CGS Departments/Resources (website)Additional Resources Other Contractors (website)DME MAC Forms Index CGS FormsAcronyms Chapter 18: Acronyms and Abbreviations

http://www.cgsmedicare.com/medicare_dynamic/ls/001.asp

DME MAC Jurisdiction B: Insider - Special Edition ... · SPECIAL EDITION IMPLEMENTATION AND CUTOVER...

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Transcript of DME MAC Jurisdiction B: Insider - Special Edition ... · SPECIAL EDITION IMPLEMENTATION AND CUTOVER...