November 2006 Medicare Bulletin - North Carolina Insert

Posted November 6, 2006

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Table of Contents

• Chiropractic Specialty Workshop
• Documentation Reminder: Provider Enrollment File Updates
• IVR Web Instructions
• North Carolina Health Professionals Shortage Areas (HPSAs)
• North Carolina Mental Health Professional Shortage Areas (HPSAs)

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Chiropractic Specialty Workshop

CIGNA Government Services will be conducting a “Chiropractic Specialty” workshop in Greensboro, North Carolina on Wednesday, December 6, 2006, at the Greensboro Airport Marriott. This workshop is scheduled from 9am-12pm ET, with sign-in beginning at 8:30am ET.
Topics to be covered include:

• Chiropractic coverage and billing guidelines
• Principles of medical record documentation
• Proper use of the Advance Beneficiary Notice (ABN)
• National Provider Identifer (NPI)
• Medicare tools and resources

Additional details and online registration are available on the CIGNA Government Services Web site:
http://www.cignagovernmentservices.com/wrkshp/nc/wrkshp_sem_NC.html.

Space is limited, so register now!

 

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Documentation Reminder: Provider Enrollment File Updates

Providers that bill the Medicare program are responsible for updating all provider enrollment information. At the time of enrollment, the provider signs the following attestation statement:

I, the undersigned, certify to the following:

I have read the contents of this application, and the information contained herein is true, correct, and complete. If I become aware that any information in this application is not true, correct, or complete, I agree to notify the Medicare fee-for-service contractor of this fact immediately.

1. I authorize the Medicare contractor to verify the information contained herein. I agree to notify the Medi- care contractor of any future changes to the information contained in this form within 90 days of the effective date of the change. I understand that any change in my status as an individual practitioner (or in the status of the organization listed in Section 4A of this application) may require the submission of a new application.
2. I have read and understand the Penalties for Falsifying Information, as printed in this application. I understand that any deliberate omission, misrepresentation, or falsification of any information contained in this application or contained in any communication supplying information to Medicare, or any deliberate alteration of any text on this application form, may be punished by criminal, civil, or administrative penalties including, but not limited to, the denial or revocation of Medicare identification number(s), and/or the imposition of fines, civil damages, and/or
   imprisonment.
3. I agree to abide by the Medicare laws, regulations, and program instructions that apply to me or to the organization listed in Section 4A of this application. The Medicare laws, regulations, and program instructions are available through the fee-for-sevice contractor. I understand that payment of a claim by Medicare is conditioned upon the claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, the Federal anti-kickback statute and the Stark law), and on the supplier’s compliance with all applicable conditions of participation in Medicare.
4. Neither I, nor any managing employee listed on this application, is currently sanctioned, suspended,
   debarred, or excluded by the Medicare or State Health Care Program, e.g., Medicaid program, or any other Federal program, or is otherwise prohibited from providing services to Medicare or other Federal program beneficiaries.
5. I agree that any existing or future overpayment made to me (or to the organization listed in Section 4A of this application) by the Medicare program may be recouped by Medicare through the withholding of future payments.
6. I understand that the Medicare identification number issued to me can only be used by me or by a provider or supplier to whom I have reassigned my benefits under current Medicare regulations, when billing for services rendered by me.
7. I will not knowingly present or cause to be presented a false or fraudulent claim for payment by Medicare, and will not submit claims with deliberate ignorance or reckless disregard of their truth or falsity.
8. I further certify that I am the individual practitioner who is applying for Medicare billing privileges.

The 42 U.S.C. § 489 further describes the provider’s responsibility to update and notify provider enrollment of any changes to the initial enrollment information.

When a currently enrolled provider is adding, deleting, or changing information under the same tax identification number, the provider must report the new/additional information to provider enrollment on Form CMS-855 with the required sections identified in section 1.

Most commonly, providers will submit the initial provider enrollment information, but fail to update the information to include any non-physician practitioners, such as nurse practitioners, physician assistants and clinical nurse specialists, that are practicing in the provider’s office/facility. It is important to notify provider enrollment with any updated information regarding non-physician practitioners.

For more information regarding provider enrollment guidelines, please reference the following resources:

42 U.S.C. § 489: Provider Agreements and Supplier Approval Medicare Provider Integrity Manual, Chapter 10 http://www.cms.hhs.gov/MedicareProviderSupEnroll/downloads/suppliers.pdf

You may download the most current applications at:
http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp

You can also contact CIGNA Government Services for any questions regarding changes to your provider enrollment information at 1.866.520.4007 or mail applications to CIGNA Government Services, Attn: Provider Enrollment, P.O. Box 25226, Nashville, TN 37202.

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IVR Web Instructions

You may access our IVR by calling the following toll-free telephone number:
North Carolina Providers: 866.238.9651

The Centers for Medicare & Medicaid Services (CMS) requires providers to utilize the Interactive Voice Response (IVR) System to check the status of claims. The IVR is available during and outside normal customer service hours with allowances for system maintenance and mainframe availability. You can also order duplicate remittance notices, as well as obtain the Medicare Part B deductible status, allowable for procedure codes, denial reasons, outstanding check amounts, and other claim processing information.

When a claim has completed processing and is being held due to the payment floor, you will not be able to obtain claim detail until the remittance is issued. If you have a business need to receive this information before the remittance is issued, you may want to consider Claim Status Inquiry. Contact the EDI department at 1.866.520.4022, or visit our Web site, EDI section at www.cignagovernmentservices.com for more information about Claim Status Inquiry. CIGNA Government Services encourages providers to utilize the IVR as a resource so that our Customer Service staff will be available should you require dedicated assistance with issues that can not be resolved via the IVR.

CIGNA Government Services requires providers to use the IVR for simple transactions, such as eligibility and claims status. This allows our Customer Service Staff to be available when you need dedicated assistance for your complex issues. If your inquiry cannot be resolved through the IVR you may reach a customer service representative by calling 1.866.655.7996.

Steps in Using the Interactive Voice Response (IVR) System Greeting:
“You have reached the Interactive Voice Response Access line for CIGNA Government Services Medicare Part B. To ensure excellent customer service, your call may be monitored or recorded for evaluation purposes.”

Main Menu:

• Press “1” for claim status
• Press “2” for eligibility information
• Press “3” for the current years deductible or physical or occupational therapy limitations
• Press “4” for outstanding information
• Press “5” for other inquiries
• Press “7” to repeat information
• Press “0” for the customer service representative phone number

Provider Number:

• If your provider number ends in one or more letters, press “1”, otherwise press “2”.
• After pressing “1”:
  o Your provider number consists of a series of numbers followed by a letter.
  • If your provider number does not end in a letter, press “#” (pound).
  • Enter the series of numbers followed by the “#” (pound) key.
  • Enter the letter now. For instructions for entering a letter press “0”, “0”.
  • If there is another letter press “1”, otherwise press “2”.
    • Now enter the second letter,
  • The provider number will be repeated, press one to confirm.

Instructions for entering letters:

• To enter a letter, you will press two keys:
  • First, press the key with the letter.
  • Then press “1”, “2”, or “3” depending upon the position of the letter on that key.
  • Example: To enter the letter A, press “2” then “1
    On telephones where Q appears with P, R, and S
    on key 7 assume that R and S are the second and
    third positions respectively. Regardless of your telephone type, assume that Q and Z are on the one key. Q would be positioned as the first letter and Z as the second.
  • Example: To enter Z, press “1” then “2”.
  • Enter the letter at the end of your provider number.

Patient’s Medicare Number:

• Press “1” if the Medicare number ends in a letter or letter-number combination.
• Press “2” if the Medicare number begins with one or more letters.
• Enter the first 9 digits of the Medicare number.
• If the letter at the end of the Medicare number is:
  

  A	press "1"
  B	press "2"
  C	press "3"
  D	press "4"
  M	press "5"
  T	press "6"
  W	press "7"
  Any other letter press "0" for the customer service representative phone number

• If there is a number after the letter, press that number now.
• If there is nothing following the letter, press “#” pound key.
• If there is another letter following the letter, press “*” star key.
  
  • o If the second letter is:

  A	press "1"
  B	press "2"
  If it is any other letter, press "0" for the customer service representative phone number.

The Medicare number and first 3 digits of the patient’s last name will be repeated.

Press “1” if correct.

Patient’s Name:
Enter the beneficiary’s first initial using the
letters on your telephone keypad.
Enter the first six digits of the beneficiary’s last name followed by the # key.
Example 1: Smith will be “7”, “6”, “4”, “8”. “4”.
Example 2: Smith Jr will be “7”, “6”, “4”, “8”, “4” “5”

Claim Status:

• Enter the date of service for this claim. Enter the date in a month-month, day-day, year-year format.
  • Example: If the date of service is January 25, 2000, enter “0”, “1”, “2”, “5”, “0”, “0”. Enter the date now.

Note:

• The system will give claim information in the following categories:
  • Claim pending
  • Applied to deductible
  • Paid
  • Denied
• The system only advises payment made to the provider.
• Non-assigned claim information will not be given.
• Press “1” for line-by-line information; otherwise press “2” to continue.
  • After pressing “1” and line information is given for the first line, press “1” for the next line and for each line until you receive the message there are no more lines for this claim.
  • Press “1” for a duplicate remit, otherwise press “2”.
  • After claim information and/or line-by-line information:

    • Press “1” to check another claim with the same date of service.
    • Press “2” to check for a claim with a different date of service.
    • Press “3” to check on a claim for a different HICN.
    • Press “7” to repeat the claim information
    • Press “9” to get information about a different provider number

    Eligibility Information:

  • • Enter the beneficiary’s 8 digit date of birth. Enter the date in a month-month, day-day, century-century, year-year format. (Example: November 01, 1933 enter “1”, “1. “0”. “1”. “1”. “9”, “3”, “3”)
    • Message:
    “The most current records we have on file from the Social Security Administration show this beneficiary has Medicare Part A entitlement effective… and Part B entitlement effective…”
    • To verify if this beneficiary is enrolled in a Medicare HMO, press “1”.
    o You will receive one of the following messages:
     “According to our records there is no Medicare HMO information available for the Medicare Number you entered.”
     “The most current records we have on file show this beneficiary is currently enrolled in a risk HMO beginning….”

Deductible and Therapy Limitation Information:

• Enter the beneficiary’s 8 digit date of birth. Enter the date in a month-month, day-day, century-
  century, year-year format. (Example: November 01, 1933 enter “1”, “1. “0”. “1”. “1”. “9”, “3”, “3”)
• Press “1” for deductible.
• Message:
  “The amount of deductible applied for the current calendar year is XX dollar(s) and XX cent(s )”
• Press “2” for the physical therapy limitation.
• Message:
  “The amount of physical therapy limitation applied for the current calendar year is XX dollar(s) and XX cent(s).
• Press “3” for the occupational therapy limitation.
• Message:
  The amount of occupational therapy limitation applied for the current calendar year is XX dollar(s) and XX cent(s).

Outstanding Checks:

• Press “1” for outstanding checks released to your provider number within the last month.
• After receiving information on the first outstanding check, press “1” for the next outstanding check.
• Press “1” to repeat all check information until you receive the message there are no more outstanding checks.

Other Inquiries:

• Press “1” for an allowable
• Press “2” to order a duplicate remittance notice
• Press “3” for appeal rights

Allowable Information:

• Press “1” for an Ambulance code.
• Press “2” if the procedure code begins with a letter.
• Press “3” for all other procedure codes.

Note:

For Ambulance code:

• Enter the zip code where the ambulance service originated.
• Press “1” if the procedure code begins with an A.
• Press “2” if the procedure code begins with a Q.
• Enter the 4 numbers that follow the prefix.
• If the type of service is a number, press “1”.
• If it is a letter, press “2”.
• Enter the type of service.
• Message:
  “The current year allowed amount for this procedure code is _________.”

Procedure Codes that Begin With a Letter:

If the procedure begins with the letter:

A	press “1”
G	press “2”
J	press “3”
M	press “4”
Q	press “5”
R	press “6”
V	press “7”
E	press “8”
B	press “9”
D	press “#”

• Now enter the 4 numbers that follow the prefix.
• Press “1” if there is a modifier at the end of the procedure code.
• Press “2” for no modifier.
  

Note:

Modifier:

AH	press “1”
AJ	press “2”
AS	press “3”
TC	press “4”
26	press “5”
54	press “6”
55	press “7”
80	press “8”
78	press “9”

• Message:
  “The current year allowed amount for this procedure code is _________. “

Constant Prompts throughout the IVR:

• The following prompts are constant throughout the IVR:
  • Press “7” to repeat information.
  • Press “8” to return to the main menu.
  • Press “9” for information on a different provider number.

Example:
Checking status of a claim for a provider with a letter at the end to the provider number.

Provider number 11111D, Medicare number 111111111A, date of service 010303

• Press “1” - claim status.
• Press “1” - provider number ending with a letter.
• Press “11111# “ - the numeric portion of the provider number followed by #.
• Press “3”, then “1” - if the letter is a D, press “2” for no second letter.
• Listen to provider number repeated.
• Press “1” if provider number is correct.
• Press “1” for a Medicare number that ends in a letter or a letter-number combination.
• Press “111111111” - the numeric portion of the Medicare number.
• Press “1” - if the letter at the end of the Medicare number is an A.
• Listen to the Medicare number repeated and the first 3 digits of the patient’s last name.
• Press “1” if the information is correct.
• Press “010303” - for the date of service.

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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 MHCA Blanden Rural Brunswick Brunswick Rural Caldwell Caldwell Urban Camden Albermarle Camden Rural Cherokee2 Smokey Mountain MHCA Cherokee Rural Chowan Albermarle Chowan Smokey Mountain Rural Clay2 Smokey Mountain MHCA 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 MHCA Graham Rural Halifax Halifax MHCA Halifax Rural Haywood2 Smokey Mountain MHCA Haywood Rural Hertford Roanoke-Chowan Hertford Rural Hyde Tideland Hyde Rural Jackson2 Smokey Mountain MHCA Jackson Rural Macon2 Smokey Mountain MHCA Macon Rural Madison1 Madison 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 Smokey Mountain Rural Swain2 Smokey Mountain MHCA Swain Rural Tyrrell Tideland Tyrell Rural Washington Tideland Washington Rural Yadkin Surry-Yadkin Yadkin Rural

¹ Classified as a Mental Health HPSA, Effective February 2, 2005

² Classified as a Mental Health HPSA, Effective June 30, 2005

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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 Carteret5 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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