New Call Back Assist Program Eliminates Wasted Time

Palmetto GBA now offers a new option that you can choose when you call into the Provider Contact Center (PCC) and call wait times are long. This feature will allow you to choose to leave a message with your name and contact number in order to get a callback as opposed to waiting on the phone line. This callback will occur within the same day, and sometimes within the hour.

eServices: Claim Status

 

To check on a particular claim status, please enter the HICN and other required beneficiary information, as well as the date(s) of service. Should you not know the exact date of service, you are able to enter a span or range of up to 45 days.

 

eServices: How Often is Patient Eligibility Updated?

 

The eServices application is required to use CMS' HETS 270/271 system for all eligibility inquiries. Although eServices pulls data from HETS in real time, the data available in the HETS 270/271 system is only updated at certain times. CMS currently pulls the updated data Tuesday through Saturday during the hours of 6 p.m. and 8 p.m. This data is then uploaded into HETS during the hours of 9 p.m. to 6 a.m. As soon as updated data is available in the HETS 270/271 system, providers will be able to view it in eServices.

 

eServices Password Login Recommendation

 

Palmetto GBA recommends logging in to eServices every 30 days to ensure your user ID is not disabled. CMS system security requirements require your password to be changed every 60 days. This is especially important if you are a provider administrator, as this could also impact those account user IDs who are signed up under your ID.

Medicare Secondary Payer (MSP) eServices Tab

 

eServices allows users to identify when a patient has coverage primary to Medicare under the Medicare Secondary Payer (MSP) tab. The MSP tab will display active MSP data based on the dates you request if they are within the past 12 months.

 

 

Protecting Patient Personal Health Information

MLN Matters Number: SE1616 reminds physicians of the HIPAA requirement to protect the confidentiality of the PHI of their patients. Recently, the Centers for Medicare & Medicaid Services (CMS) learned of a potential security breach in which someone was offering for sale over 650,000 records of orthopedic patients. Remember that a covered entity must notify the Secretary of Health and Human Services if it discovers a breach of unsecured protected health information. They are required to report any actual or potential security breaches to you, especially threats that compromise patient PHI.

 

Revised CMS-855R Application - Reassignment of Medicare Benefits

Physicians and non-physician practitioners must use the revised CMS-855R (Reassignment of Benefits) application beginning January 1, 2017. The revised application will be posted on the CMS Forms List by mid-summer. Medicare Administrative Contractors (MACs) will accept both the current and revised versions of the CMS-855R through December 31, 2016.

 

 

Timely Reporting of Provider Enrollment Information Changes

 

The timely reporting of changes in your Medicare enrollment information helps you avoid disruption of your Medicare claims payments. All physicians and other healthcare providers must report changes in their enrollment information to their MAC (Palmetto GBA) via the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) or the CMS 855 paper enrollment application within 30 days of the change.

E/M Tips

E/M Tip: Hospital Visit and Critical Care on Same Day

If a hospital inpatient or office/outpatient evaluation and management service (E/M) is furnished on a calendar date at which time the patient did not require critical care and the patient subsequently requires critical care, both the critical care services (CPT codes 99291 and 99292) and the previous E/M service may be paid on the same date of service.

 

E/M Tip: Double Dipping

Documentation cannot be used twice under the History Component. This is referred to as 'double dipping.' Example: Allergies may be used under the ROS (Allergic/Immunologic) or under past history.

E/M Tip: Prolonged Care Time Requirement

The start and end times of the visit shall be documented in the medical record along with the date of service.

 

E/M Tip: Risk of Significant Complications, Morbidity and/or Mortality (Risk Assessment)

 

The risk of significant complications, morbidity, and/or mortality is based on the risks associated with the following categories: presenting problem(s), diagnostic procedure(s), and possible management options. The highest level of risk in any one category determines the overall risk. The level of risk of significant complications, morbidity and/or mortality can be: minimal, low, moderate or high.