April 2005 Medicare Bulletin - North Carolina Insert

Posted April 4, 2005

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Table of Contents

• North Carolina Customer Service Frequently Asked Questions
• North Carolina Health Professionals Shortage Areas (HPSAs)
• North Carolina Mental Health Professional Shortage Areas (HPSAs)
• North Carolina Policy Updates

North Carolina Customer Service Frequently Asked Questions

What information is required in order to obtain entitlement/eligibility data?

This information is now available via the IVR. Providers must key the Name, Gender, Medicare Number and Date of Birth of the patient. Once this is verified, the provider follows the system prompts to obtain eligibility information to include the Part A and B entitlement dates, the yearly deductible status, and Medicare HMO information.

How do I determine why my claim denied?

Denial information can be found on the Medicare Remittance Notice (MRN) Remark and Reason codes in the Glossary Section at the end of the MRN. Providers can also obtain this information via the IVR.

Why doesn’t a Customer Service Representative assist me when I call to inquire on the status of my claim?

CMS mandates that all Provider status requests must be obtained through the IVR. By utilizing this automated system, the Customer Service Representatives can be available to help you with questions that require personal assistance. Customer Service Representatives will offer to automatically transfer you to the IVR system for your convenience.

How do I determine if a service is covered?

Through the use of Local Medical Review Policies (LMRP), National Coverage Determinations (NCD), Provider Bulletin articles and ListServ notices, coverage and filing guidelines can be obtained.

How do I determine if the patient has met their annual Deductible?

Following the Privacy Act of 1974 and CMS Privacy policies, providers must supply the patient’s name, gender, Medicare number and Date of Birth in order to obtain if the patient has met their annual Deductible.

How do I determine how to bill a service or claim?

Coding or billing guideline assistance can be found in the Local Medicare Review Policies, Medicare Bulletins, and Specialty Manuals at www.cignamedicare.com. Information can also be found via CMS Internet Only Manuals at www.cms.hhs.gov/manuals

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North Carolina Policy Updates

Cardiac Catheterization (LCD 2004-06)

The following codes were added to those that support medical necessity:

427.31 Atrial Fibrillation
427.32 Atrial Flutter

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North Carolina Mental Health Professional Shortage Areas (HPSAs)

Designated Geographic Areas

COUNTY AREA NAME/PARTS RURAL/URBAN Beaufort Tideland Beaufort Rural Bertie Roanoke-Chowan Bertie Rural Bladen Southeast Regional Blanden Rural Brunswick Brunswick Rural Caldwell Caldwell Urban Camden Albermarle Camden Rural Cherokee Smokey Mountain Cherokee Rural Chowan Albermarle Chowan Rural Clay Smokey Mountain Clay Rural Columbus Southeast Regional Columbus Rural Currituck Albermarle Currituck Rural Dare Albermarle Dare Rural Duplin Duplin-Sampson Duplin Rural Gates Roanoke-Chowan Gates Rural Graham Smokye Mountain Graham Rural Halifax Halifax MHCA Halifax Rural Haywood Smokey Mountain Haywood Rural Hertford Roanoke-Chowan Hertford Rural Hyde Tideland Hyde Rural Jackson Smokey Mountain Jackson Rural Macon Smokey Mountain Macon Rural Martin Tideland Martin Rural Northampton Roanoke-Chowan Nothampton Rural Pasquotank Albermarie Pasquotank Rural Perquimans Albermarle Perquimans Rural Robeson Southeast Regional Robeson Rural Sampson Duplin-Sampson Sampson Rural Scotland Southeast Regional Scotland Rural Surry Surry-Yadkin Surry Rural Swain Smokey Mountain Swain Rural Tyrrell Tideland Tyrell Rural Washington Tideland Washington Rural Yadkin Surry-Yadkin Yadkin Rural

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North Carolina Health Professional Shortage Areas (HPSAs)

Designated Geographic Areas

COUNTY AREA NAME/PARTS RURAL/URBAN Alexander All Urban Anson All Rural Beaufort Bayboro - Aurora Richland Twp. Belhaven - Swan Quarter Bath Twp., Pantego Twp Rural Bertie All Rural Bladen1 All Rural Caldwell Western Caldwell - Globe Twp., Johns River Twp., Mulberry Twp., Patterson Twp., Wilson Creek Twp., Rural Carteret1 Eastern Cateret - Atlantic Twp., Cedar Island Twp., Davis Twp., Harkers Islands Twp., Marshallberg Twp., Merrimon Twp., Portsmouth Twp., Sea Level Twp., Smyrna Twp., Stacy Twp., Strait Twp. Rural Caswell All Rural Cherokee3 Andrews Area, Valley Town Twp. Rural Clay All Rural Columbus All Rural Currituck All Urban Dare Hatteras - Ocracoke SA Hatteras Twp., Kinnakeet Twp. Rural Edgecombe All Urban Franklin All Urban Gates All Rural Graham All Rural Greene2 All Rural Guilford Inner City Greensboro - Census Tracts 101, 107.02, 108.01, 110, 111.01, 112, 113, 114, 115 Urban       Hoke All Rural Hyde Belhaven-Swan Quarter Currituck Twp., Fairfield Twp., Lake Landing Twp., Lake Mattamuskeet Unorg., Swan Quarter Twp. Hatteras-Ocracoke Ocracoke Twp. Rural Lenoir East Kinston - Census Tracts 101-105, 107 Urban Macon1 Franklin - Burningtown Twp., Cartoogechaye Twp., Cowee Twp., Ellijay Twp., Flats Twp., Franklin Twp., Millshoal Twp., Nantahala Twp., Smiths Bridge Twp. Rural Mecklenburg Central Charlotte - Census Tracts 1, 4, 5, 6, 7, 8, 36, 37, 38.98, 39.01, 39.02, 41, 42, 45, 46, 47, 48, 49, 50, 51, 51.01, 52 Urban Montgomery1 All Rural Northampton All Rural       Pamlico Bayboro - Aurora Pamlico Rural Pender All Rural Person All Rural Randolph All Urban Robeson All Rural Stokes Danbury - Census Tracts 701, 702, and 703 Urban Tyrrell All Rural Warren All Rural Washington All Rural

¹ No longer classified as a HPSA, effective August 1, 2002.
² Classifed as a HPSA, effective June 1, 2004.
³ No longer classified as a HPSA, effective December 1, 2004.

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