On-Demand Webinar: Understanding Medicare Changes: An Impossible Dream? The California Medical Association (CMA) recently hosted a free webinar examining changes to the Medicare program for 2018 and providing tips for regulatory compliance, presented by the medical director of California’s Medicare contractor, Noridian Healthcare Solutions. The webinar is now available for on-demand viewing in the CMA resource library. This download is free for all. This review includes an overview of the Centers for Medicare and Medicaid Services’ (CMS) new Targeted Probe and Educate (TPE) program, a type of Medicare audit, and its review process; changes to Local Coverage Determinations (LCDs); and CMS’ new “Patients Over Paperwork” initiative, which aims to reduce reporting requirements by simplifying documentation and reducing the hassle factor. This webinar also covers simple coding tips for evaluation and management coding and reimbursement. February 5, 2018 CMA, Medicare Government Payors, Medicare, Noridian, Webinars 0 0 Comment Read More »
Noridian reports spike in provider deactivations and lost revenue Noridian, Medicare’s administrative contractor for California, has seen a spike in the number of providers deactivated for not responding to Medicare revalidation notices, resulting in a gap in billing privileges and lost revenue for physicians. Noridian will send revalidation notices via email two or three months prior to the revalidation due date. Revalidation notices sent via email will indicate "URGENT: Medicare Provider Enrollment Revalidation Request" in the subject line to differentiate from other emails. If the email is returned as undeliverable, only then will Noridian will send a paper revalidation notice to the correspondence, special payments and/or primary practice address on file. Physicians don’t, however, have to wait for a revalidation letter. CMS has a look-up tool that allows a practice to look up an individual physician’s or organization’s revalidation date. Providers due for revalidation in the near future will display a revalidation due date. All other providers/suppliers will see "TBD" in the due date field. What physicians need to know: When responding to revalidation requests, it’s important to revalidate your entire Medicare enrollment record, including all reassignment and practice locations through internet-based PECOS or via the CMS 855 form. If you have multiple reassignments/billing structures, you must coordinate the revalidation application submission with each entity. If a revalidation application is received but incomplete, Noridian will contact you via email for the missing information. If the missing information is not received within 30 days of the request, Noridian will deactivate your billing privileges. Do not assume that “no news is good news.” The contact person indicated on the application should receive an email notice of the application receipt, any discrepancies, and either a stop billing privileges or acknowledgement letter of approval. Check your spam filter if you’re not receiving these notices. Failure to revalidate may result in a deactivation of your Medicare billing privileges. If billing privileges are deactivated, a provider request to reactivate will result in the same Provider Transaction Access Number, but there will be a lapse in coverage with Medicare. The provider will be required to submit a new full and complete application in order to reestablish the enrollment record and related Medicare billing privileges. If the revalidation application is approved, the provider will receive email confirmation that the provider will be revalidated and no further action is needed. For more information on the revalidation process, see MLN Matters #SE1605. If you have questions about the revalidation process, click here or contact Noridian by calling (855) 609-9960. September 25, 2017 Medicare Medicare, Noridian, Provider Enrollment Chain and Ownership System 0 0 Comment Read More »
Updated payor profiles for 2017 now available The California Medical Association’s (CMA) Center for Economic Services is publishing updated profiles on each of the major payors in California including Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA, Health Net, UnitedHealthcare, Medicare/Noridian and Medi-Cal. Each profile includes key information on health plan market penetration; a description of the plan’s dispute resolution process; and the name and contact numbers for medical directors, provider relations, and other key contacts. Don’t waste your time searching the internet for this information – members can download CMA’s Payor Profiles free of charge in the CMA Resource Library. August 1, 2017 CMA, Managed Care, Medi-Cal, Medicare Aetna, Anthem Blue Cross, Blue Shield, Cigna, Health Net, Insurance, Medi-Cal, Medicare, Noridian, Payor, Payor Profiles, Running a Practice, UnitedHealthcare 0 0 Comment Read More »
Noridian to issue electronic Level 1 Medicare Redetermination Notices via web portal Effective June 16, 2017, providers who submit their redetermination and/or reopening requests through the Noridian Medicare Portal (NMP) will now receive their Level 1 Medicare Redetermination Notices (MRNs) via NMP. If a redetermination or reopening outcome results in a fully favorable (payable) determination, the remittance advice will provide details. For all other decisions in which providers receive an MRN, the determination letters will now be available through the Appeal Status Inquiry feature in NMP only. Practices that submit electronic reopening and redetermination requests should ensure that any assigned staff member is registered as an NMP user, as MRNs will no longer be mailed in these cases. Noridian encourages the submission of electronic reopening and redetermination requests and all supporting documentation (10 mb per file; unlimited number of file submissions per claim) via NMP. This submission method ensures that the requests contain all required information, including the signature on Redetermination requests. July 21, 2017 Medicare Medicare, Noridian 0 0 Comment Read More »
Last chance for some providers to prevent deactivation by Medicare Noridian, Medicare’s administrative contractor for California, will soon begin deactivating billing privileges for physicians who received revalidation notices from Noridian but have not submitted completed applications to the Centers for Medicare and Medicaid Services (CMS). Last month, Noridian reported that only 19 percent of providers had responded to the most recent Medicare Part B revalidation notices. Since the passage of the Affordable Care Act (ACA), all Medicare providers and suppliers have been required to revalidate their Medicare enrollment information under new enrollment screening criteria in an effort to prevent fraud within the Medicare system. Once a Medicare enrollment application is validated, the clock starts ticking on a five-year revalidation cycle. Now that five years have passed since the ACA's revalidation requirement took effect, CMS has initiated a second cycle of revalidation requests. Noridian will send revalidation notices two or three months prior to each provider’s revalidation due date. The first revalidation due date for this second cycle was May 31, 2016. Effective August 14, 2016, Noridian will deactivate the Medicare billing privileges for affected physicians who failed to complete their revalidation applications CMS prior to the May deadline. The due date for the second revalidation round was June 30, 2016. Noridian will deactivate billing privileges for physicians who missed the June deadline on September 13, 2016. To prevent deactivation, the California Medical Association recommends that practices look up their revalidation dates through the CMS look-up tool. If it shows that your practice missed the deadline, you should submit and sign your application online through the PECOS system immediately to prevent deactivation If you are ultimately deactivated for failure to respond to a revalidation notice, you will be required to submit a reactivation application. The date of receipt of the reactivation application will be the new effective date for your Medicare billing privileges. Noridian will not apply a retroactive effective date, and no payments will be made for the period of deactivation. If a revalidation application is received but incomplete, Noridian will contact you for the missing information. If the missing information is not received within 30 days of the request, Noridian will deactivate your billing privileges. If your revalidation application is approved, no further action is needed For more information on the revalidation process, see MLN Matters #SE1605. CMA is also hosting an upcoming webinar on this topic, “Medicare Provider Enrollment: Strategies for Revalidation, Reporting Changes and Avoiding Deactivations,” on Wednesday, August 17 from 12:15 to 1:15 p.m. This webinar will provide guidance on maneuvering the Medicare revalidation and enrollment process. Noridian experts will review how to avoid top errors and other key issues, including finding revalidation due dates, filling out the correct information on enrollment applications, responding to requests for additional information and keeping your enrollment record up to date. This webinar will also review new enrollment tools and tutorials. If you have questions about the revalidation process, click here or contact Noridian at (855) 609-9960. August 8, 2016 Medicare Noridian, Medicare 0 0 Comment Read More »
Noridian reports low response rate for Medicare Part B revalidations Noridian, Medicare’s administrative contractor for California, reports that only 19 percent of physicians have responded to the most recent Medicare Part B revalidation notices. Noridian is in the process of deactivating Medicare billing privileges for physicians who received a revalidation notice from Noridian but did not turn in a completed application to the Centers for Medicare and Medicaid Services (CMS) prior to the most recent deadline of May 31. If you are deactivated for failure to respond to a revalidation notice, you must submit a reactivation application. The date of receipt of the reactivation application will be the new effective date for your Medicare billing privileges. Noridian will not apply a retroactive effective date and no payments will be made for the period of deactivation. If a revalidation application is received but incomplete, Noridian will contact you for the missing information. If the missing information is not received within 30 days of the request, Noridian will deactivate your billing privileges. If your revalidation application is approved, no further action is needed. If you do not know when you are up for revalidation, you can look up your revalidation date through the CMS look-up tool. Those due for revalidation in the near future will display a revalidation due date. All other providers/suppliers will see "TBD" in the due date field. For more information on the revalidation process, see MLN Matters #SE1605. If you have questions about the revalidation process, click here or contact Noridian by calling (855) 609-9960. July 14, 2016 Medicare Noridian, Medicare 0 0 Comment Read More »
Noridian begins deactivation of providers who failed to revalidate The due date for physicians to revalidate their Medicare enrollment information has passed for the most recent cycle of physician revalidation required by the Centers for Medicare and Medicaid Services (CMS). Physicians who received a revalidation notice from Noridian, CMS’ Medicare contractor for California, and who did not turn in a completed application to CMS prior to the May 31 deadline, will have their Medicare billing privileges deactivated. If you are deactivated for failure to respond to a revalidation notice, you must submit a reactivation application. The date of receipt of the reactivation application will be the new effective date for Medicare billing privileges. No payments will be made for the period of deactivation. If a revalidation application is received but incomplete, Noridian will contact you for the missing information. If the missing information is not received within 30 days of the request, Noridian will deactivate your billing privileges. If your revalidation application is approved, the provider will be revalidated and no further action is needed. If you do not know if you received a notice, you can look up your revalidation date through the CMS look-up tool. Those due for revalidation in the near future will display a revalidation due date. All other providers/suppliers will see "TBD" in the due date field. For more information on the revalidation process, see MLN Matters #SE1605. If you have questions about the revalidation process, click here or contact Noridian by calling (855) 609-9960. June 8, 2016 Medicare Noridian, Medicare 0 0 Comment Read More »
Noridian posts updated Medicare Physician Fee Schedule California's Medicare contractor, Noridian, has posted an updated 2016 Medicare Physician Fee Schedule on its website. Last week, Noridian had removed the fee schedule because it contained several technical errors that needed to be fixed. This update is not expected to cause any delays in reimbursement for physicians, because under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt. The updated fees are valid for dates of service from January 1 through December 31, 2016. To see the updated fee schedule, click here. Contact: Cheryl Bradley, (213) 226-0338 or cbradley@cmanet.org. January 25, 2016 Medicare Medicare, Noridian, Fee Schedule 0 0 Comment Read More »
Noridian Medicare announces web-based provider enrollment workshops Noridian, the Medicare Administrative Contractor for California, announced that it will offer web-based workshops focusing on provider enrollment. These webinars are intended for the Part B provider using the online Provider Enrollment, Chain and Ownership System (PECOS) to change enrollment information, track revalidation or set up a sole proprietorship. The Internet-based PECOS process can be used in lieu of the Medicare enrollment application (i.e., paper form CMS-855). The advantages of PECOS are: Faster than paper-based enrollment (45-day processing time in most cases, vs. 60 days for paper) Tailored application process means you only supply information relevant to YOUR application Gives physicians more control over their enrollment information, including reassignments Easy to check and update your information for accuracy Less staff time and administrative costs to complete and submit enrollment to Medicare There is no registration or teleconference fee. The presentations will be conducted through a web-based training tool that requires an Internet connection and a telephone (toll-free number provided in confirmation email). For more details and to register, visit https://med.noridianmedicare.com/web/jeb/education/training-events. October 14, 2015 Medicare Noridian, Medicare, PECOS, Provider Enrollment Chain and Ownership System 0 0 Comment Read More »
Noridian announces new audits Noridian, California's Medicare administrative contractor, has announced it will be conducting service-specific targeted audits of procedure codes 99205 and 99233 when rendered by providers with specific specialties: 99205 performed by cardiology (Centers for Medicare and Medicaid Services specialty designation 06) and pulmonary (29) 99233 performed by internal medicine (11) and hematology/oncology (83) Noridian conducts these targeted reviews based on data analysis. An analysis of these procedure codes, when performed by physicians in these specialties, indicated a higher utilization by California providers when compared to national claim payment ratios for the same services by the same specialties. These reviews are conducted on a pre-payment basis, meaning Noridian will notify physicians selected for claim audits through the additional documentation request (ADR) process before payment is made. Upon receipt of a request for information, practices must submit all applicable documentation for each claim with a copy of the ADR as a cover sheet. Records should be mailed (hardcopy or CD) or faxed to Noridian within 45 days of receipt, or a claim denial will result. More information on the ADR process can be found here. Documentation that may support the services billed includes: Legible copy of the patient's medical record for listed date(s) of service Legible physician signature Consultation reports Physician progress notes Diagnostic test results/reports, including imaging reports if applicable Any other documentation to support the CPT Code that was billed For more assistance on signature and documentation requirements, refer to the Documentation Guidelines for Medicare Services on Noridian’s website. Noridian will review the documentation submitted within 30 days of receipt. No letters will be sent on the outcome of each individual claim. The claim decisions will be reflected in the remittance advice and may be appealed through the normal appeal process, if unfavorable. When the audit is complete, Noridian will analyze the results and determine if any subsequent actions are necessary. The results will be posted to Noridian’s JE Part B website. August 5, 2015 Medicare Medicare, Noridian, Audits 0 0 Comment Read More »
