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Medical Liason Report

Alfred H. Moffit, Jr., MD - Medicare Representative

In looking over the state of Medicare issues current facing our members, it is apparent that several key issues need to be touched on and responded to in a timely fashion.

  1. If you don't have it already, get a copy of the free Medicare Remit Easy Print (MREP) software. It is used for viewing and printing HIPPA-compliant Electronic Remittance Advice (ERA). This software can save you substantial time resolving Medicare claim issues. In order to utilize the MREP software, you'll first need to receive a HIPPA-compliant ERA.

    With MREP installed, you can:
    • Easily navigate and view the ERA using your personal computer.
    • Print the ERA in Standard Paper Remittance (SPR) format.
    • Use the search function that allows providers and suppliers to find claims information easily.
    • Print and export reports about ERAs including denied, adjusted, and deductible-applied claims.
    • Take advantage of easy-to-use methods for archiving, restoring, and deleting imported ERAs.
    Contact Medicare EDI at 904-354-5977 (option 7) to find out more about MREP and procedures for receiving a HIPPA-compliant ERA.
  2. First Coast Service Options, Inc. (FCSO) will have sent the 2006 Provider Enrollment Participation information on a CD-ROM in early November 2005. The CD-ROM contains a vast number of resources in addition to the usual information that accompanies the fee schedule, e.g., an announcement about Medicare participation for the upcoming calendar year, a Medicare Participating Physician or Supplier Agreement, and a Fact Sheet. You'll find these value-added features to be a great tool.
  3. The third and most important information to know and use is the National Provider Identifier (NPI). The NPI is now the standard unique health identifier for all healthcare providers. Transition dates for Medicare providers are as follows:
    1. May 23, 2005-January 2, 2006
      1. Use existing Medicare numbers
      2. Claims using NPI will be rejected
    2. January 3, 2006-October 2, 2006
      1. NPI is optional and legacy UPIN numbers are required.
    3. October 2, 2006-May 22, 2007
      1. NPI is required and legacy UPIN numbers are optional
    4. May 23, 2007-Forward
      1. Use NPI numbers only—otherwise claims will be refused.
    Sources for additional information:
    • Visit: nppes.cms.hhs.gov for Web-based applications
    • Call: 1-800-465-3203 (toll free) or 1-800-692- 2326 (TTY) for paper applications
    • Visit: www.cms.hhs.gov/medlearn/npi/npiviewlet.asp
      • Explains NPI
      • Provider description of the system
      • Leads you through the applications

In most cases you'll find it is necessary to access CMS and Medicare websites in order to function properly with Medicare reimbursement.