As discussed in yesterday’s blog, the Jurisdiction A DME MAC, NHIC, will no longer be issuing paper Acknowledgement Letters for redetermination requests effective April 1, 2012 – a trend that seems to be catching on. In another list serve released by the Jurisdiction D DME MAC, NAS announced that it too plans to eventually eliminate mailing paper Acknowledgement Letters as suppliers begin to utilize its Endeavor (a web-based alternative to calling the Jurisdiction D IVR) and IVR systems to verify the receipt and status of appeals.

Note: This change does not impact decision letters, only the acknowledgement letters sent to confirm your appeal was received.

Beginning yesterday, February 29^th, suppliers in Jurisdiction D may obtain the status of an appeal by calling the MAC’s IVR and selecting the appeals menu option. You must wait at least 10 days from date your appeal is received for it to be uploaded into the IVR system and will need the following information to access the status of your appeal:

1. Your National Provider Identifier (NPI)
2. Your Provider Transaction Access Number (PTAN)
3. The last five digits of your Tax Identification Number (TIN)
4. The patient’s Medicare number
5. The patient’s name as it appears on their Medicare card
6. The 14-digit claim control number (CCN). This can be found on your remittance advice in the Internal Control Number (ICN) field.

NAS has not specified the exact date it plans to discontinue mailing Acknowledgement Letters; however, we don’t expect it to be too far down the road. Information on how to use the IVR to check on the status of an appeal is available on the NAS website here.

Effective March 22, 2010, suppliers in NAS Jurisdiction D may verify a physician’s enrollment in PECOS via the Interactive Voice Response (IVR) System. To utilize this new feature, suppliers will need the physician’s NPI, along with their first and last name.

Verifying a physician’s PECOS enrollment via the IVR is a fairly simple process. First, suppliers must call the IVR and select option 7, or say “Provider Enrollment.” Next, they must key-in or state the physician’s NPI and name.

• If stating the physician’s name, say the first name, followed by the last name.
• If keying in the physician’s name, enter the first four letters of the last name, followed by the first letter of the first name.

You do not need to enter any keys for spaces, hyphens, etc. within the name.

The IVR will then indicate whether or not the physician is currently enrolled in Medicare and able to order or refer DME. If the IVR is unable to locate the physician, you may verify that the NPI and spelling of the physician’s name is correct via the NPPES registry. Once this information is confirmed, efforts should be focused on contacting the physician and educating them about Medicare’s PECOS enrollment requirement.

For additional information on verifying physician enrollment in PECOS, see “Find Physicians in PECOS Fast and Free!” and “Searchable PECOS Database now Available to DME Suppliers.”

Please note that with the addition of the PECOS option, some IVR menu options have changed. Please refer to the NAS IVR User Guide for complete details on utilizing the system.

(See: http://www.cms.hhs.gov/manuals/downloads/com109c06.pdf, Sec. 80.3.4, p.70)

Background

In an effort to reduce the numbers of inquiries Provider Call Centers (PCCs) receive, CMS is encouraging providers to learn how to read remittance advice notices (RAs) / explanation of benefits (EOBs) and review them prior to contacting their MAC’s PCC.

As part of an education outreach, contractors were instructed to educate providers on how to read their RAs/EOBs. Customer service representatives (CSRs) have also been instructed to teach providers how to use RAs/EOBs to find answers independently if they call with questions that can be answered using the documents.

The instruction came as part of a revision to CMS’ Internet-Only Manual (IOM) chapter 6, section 80.3.4, and became effective April 6, 2009.

Impact on DME Providers

Also part of the revision is the requirement for providers – or anyone calling on their behalf (billing staff, clearinghouses, etc.) – to have a RA/EOB on hand prior to contacting their region’s CSR.

If providers call with a question related to information on a RA/EOB, but do not have their RA/EOB on hand, the CSRs will be unable to assist them.

Region Updates

• Region D DME MAC Noridian Administrative Services (NAS)  will begin implementing the above CMS requirements on June 22, 2009.
• Region C DME MAC CIGNA Government Services will begin implementing the above CMS requirements on July 13, 2009.

Providers who contact these regions’ DME Contact Centers without a RA/EOB on hand on or after the above implementation dates will be instructed by the CSR to call back once they’ve obtained a RA/EOB.

For information on how to understand and read RAs, CMS has created the following publication: Understanding the Remittance Advice: A Guide for Medicare Providers, Physicians, Suppliers and Billers.