CSMS EVP/CEO Matthew Katz, recently participated in a National Government Services (NGS) listening session and would like to share some insight, tips, and tools with members. See the list below to learn about the NGS updated website, Medicare identification cards, duplicate claims, annual wellness visits, and updates on revalidation.
- The NGS website has been updated and it is best for physicians and their staff to register on the site in order to access all of the information available to them. The contact us tab now provides a way to reach key NGS staff specific to Connecticut. Unfortunately, in some places the NGS site has information that links those using the site off the NGS site and onto the CMS site and it can get confusing.
- With the new Medicare identification cards, it is important that when inputting information and submitting a claim, that you use what appears on the Medicare card, not what you have in your system, as the Medicare card is tied to what Medicare has for the patient and if that information (name, date of birth, etc.) is not used, the claim will be denied in the system.
- Duplicate claim is the most common reason for confusion and denial of payment. Some practices have their billing company or system set up to send in a claim (the same claim) every 30 days, but if the claim is pending or in error, the resubmission will do nothing and will further complicate the process. Duplicate claim is only used if the claim was received already and paid or if it was received and is still in process. Some physicians are counting duplicate claims as denials (they are just duplicate claims) and physicians and their staff can look up in the Connex system where the claim is BEFORE resending.
- The Annual Wellness Visit (AWV) can now be checked per patient online, so that the practice doesn’t do one when the patient has already had one. Physicians who are billing Medicare for AWVs should use the Connex system to check edibility (if they are not eligible it means it has been done in the last 12 months and it was paid for by Medicare). Yes, the problem of others doing the AWV and not sharing information with the primary care physician or specialist still persists, but Medicare does now allow physicians to check the system prior to service provision to verify if the patient is eligible.
- The update/revalidation continues, and physicians need to remember that every five years Medicare is asking them to validate themselves and that they still accept Medicare. If this revalidation is not done, then claims will not be processed or paid tied to that NPI/TIN. Any claims provided between the deadline to sign up and finally signing up will not be paid (the last time around we got these claims paid, but since this is the second revalidation period, Medicare is no longer paying claims when revalidation is delayed, missed, or not done timely).