ACT Questions and Answers - August 16, 2017

Electronic Supplier Visit (E-Visit)

E-Visits provide individualized one-on-one with education from POE and/or medical review staff. Find the form on the Educational Forms webpage.

Noridian Medicare Portal (NMP)-Self Service Reopening's

The NMP Self Service Reopenings has expanded to add additional options for supplier. This functionality allows real-time adjustments for claim corrections.

Fall In-Person Seminars

Noridian announced its Jurisdiction A fall In-Person seminar "Medicare Step by Step." It will be in Bowie, MD on September 28, 2017. Visit our In-Person Seminar webpage to obtain additional information.

DME On Demand

There are various topics available to accommodate supplier educational needs which include, but are not limited to, an overview of different Local Coverage Determinations (LCDs), forms (ABN, CMN, DIF and the CMS-1500 claim form). There is a section dedicated to the use of NMP and different sessions on documentation requirements. Some sessions contain quizzes to test the attendee's knowledge. A completion certificate is sent through e-mail and.

Clinician Resource Letters

Having trouble getting the clinicians you work with to send you the documentation that's needed when submitting your claims to Medicare? Send them the Dear Clinician letter that is available on our website. Access a copy of the letter by going to the Clinician  Resource Letters webpage. There are Medical Director Articles available as well. These are written collaboratively by all DME MAC Medical Directors and published on all DME MAC websites. They address a variety of topics, such as, local coverage information, coding or medical review related billing and claims considerations, newly developed educational materials, coding instructions or clarification of existing medical review related billing or claims policy.

Revised ABN Form

CMS recently revised the Advance Beneficiary Notice of Noncoverage (ABN) form CMS R-131, with the effective date of June 21, 2017. It is available in both English and Spanish. Special guidance regarding the ABN for use by nonparticipating suppliers is included. To read more about the ABN and access the form, go to the ABN webpage.

CURES ACT Adjustments

The DME MACs are currently adjusting the affected claims. The adjusted claims will be identified on a Supplier's Medicare Remittance Advice (RA) by RARC code N689 which states "Alert: This reversal is due to a retroactive rate change." They will not be sent on separate RAs and will display with other processed claims. There is no need to call the Supplier Contact Center for these adjustments. When the adjustments have been completed, DME MACs will notify suppliers. At that time, suppliers may submit a reopening request to add the KE modifier, if applicable. Visit the CR9968 CURES Act Fee Schedule Adjustments webpage for more information.

Resources and Reminders:

New Medicare Card Project - Formerly known as Social Security Number Removal Initiative (SSNRI). The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new randomly generated Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number on new Medicare cards for transactions like billing, eligibility status, and claim status. See the CMS New Medicare cards webpage for information on this transition and how it will impact both suppliers and beneficiaries.

Appeals Letter Suppression - All suppliers/providers (A/B/DME) who submit Redetermination and Reopening requests through NMP no longer receive a physical decision letter in the mail. The decision letter is available via the NMP Appeal status feature for suppliers/providers to review.

Email Updates - Suppliers are encouraged to register for the Noridian listserv. This listserv, sent out Tuesdays and Fridays, includes emails containing informative CMS and Noridian related articles. Users can customize the listserv to his/her business needs. Visit the Email List Sign Up webpage to register and/or view a tutorial with instructions on how to sign up. The listserv is a great way for suppliers to stay on top of any changes or updates as they roll out.

Website Survey - Noridian values suppliers and providers input. When on our website and the ForeSee survey pops up, we encourage visitors to select, "I'll give feedback" to complete the survey. Your feedback allows us to continue to enhance our website.

Q&A Session

Q1. If a transplant patient cannot swallow a pill and the pharmacist puts the medication into elixir, not adding any additional drug to it, does Noridian consider that compounding?
A1. Medicare does not pay an extra fee for the compounding of transplant medications. If a drug must be used in a suspension form, bill the number of pills used in the suspension the same way that pills dispensed but not used in a suspension would be billed.

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Last Updated Feb 05, 2020