(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.