Medicare Update - Summer 2010

By Alfred H. Moffett, Jr., MD, FACOG

The most recent meeting of the Carrier Advisory Committee for Medicare was on June 12 in Orlando. As always, on the agenda were several key issues for Medicare claims processing and reimbursement. The highlights of the meeting are below.

PECOS System
Effective January 11, 2011, all physician groups, as well as individual physicians in the group need to be enrolled in PECOS. If you are not enrolled, Medicare payments will be stopped until you complete the process.

You can enroll or check your status at www.fsco.com. Click on “provider enrollment” and then go to “PECOS.”

There are some things you should know that will help you avoid payment delays with the PECOS system:

The CMS 588 Electronic Funds Transfer (EFT) agreement form is required upon initial enrollment for new providers and for enrolled providers making changes to their enrollment information who currently receive paper checks

In accordance with regulations, qualified ordering and referring providers must be enrolled in Medicare. Claims must include the NPI of the ordering/referring provider.

If a revalidation effort is undertaken, providers should respond promptly to any requests. Failure to do so in a timely manner may result in revocation/deactivation of billing privileges and prohibit re-enrollment for one to three years.

Providers are responsible to report changes to the enrollment information.

PECOS web applications are processed faster than paper applications.

Tips for provider enrollment include:

pplications can be downloaded from the CMS website.

All applications must be signed and dated in ink or the application will be returned.

Section 15 must be signed and dated by an authorized/delegated offcial or the application will be returned.

Submission of wrong application will be returned

You can also access FCSO's Provider Enrollment webpage https://medicare.fcso.com for the latest news, frequently asked questions, forms, tips and tools.

Call Center Hours
It is also important to remember the Centers for Medicare & Medicaid Services allow Medicare Call Centers to close eight hours a month for training purposes. Normally, Medicare Part A and Part B Call Centers are closed most Fridays from 2:00–4:00 p.m. to conduct training. The Puerto Rico Part A & Part B Call Centers are generally closed most Thursdays from 2:00–4:00 p.m.

Reprocessing of Denials
The fastest way to have a service reprocessed when a denial has occurred is to simply re-file the claim/service, particularly when your claim/service was denied as un-processable with remark code MA 130.

In some cases you can call the Customer Service Line and request that your claim be adjusted. Common situations in which you can request a clerical reopening are as follows:

To add, change, or delete certain modifiers

To change a place of service

To change the units (quantity) billed on a service

To change the diagnosis on the claim/service

However, it is recommended for faster processing that you simply re-file your denied claim/service.

Last Revision: July 15, 2010