Self-Service Pulse: What You Need To Know This Week
As your MAC, National Government Services wants to provide you with a comprehensive source containing the most current information available for our self-service tools.
Medicare BLAST is a quick, ten-question game that will challenge the Medicare knowledge of you and your peers. Who were our victorious winners on 2/21/2024?
Congratulations to our winners! If you weren't able to play Medicare BLAST, don't worry. We will offer more opportunities to play in the near future.
Curious on the questions that were asked during this Medicare BLAST? Scroll to the bottom of this edition to obtain the questions and correct answers.
Watch your Email Updates for your next opportunity to emerge victorious with Medicare BLAST.
Where are Medical Policies Located?
The Medical Policies area on our website houses the LCDs, Billing and Coding and Medical Policy Articles. You are also able to view draft and future policies.
If you are searching for NCDs, you will need to access the CMS website. The NCDs are located in the CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual.
Within the Medical Policies, you are able to search the LCDs and related articles by a keyword, LCD#, CPT or HCPCS via the Search option.
To locate Medical Policies either select Medical Policies on the Homepage or from the Resources dropdown.
NGSConnex: Part B Deductible Information Reminder
We have received questions about why the Part B Deductible information section under Eligibility Lookup is sometimes blank. If this section is blank or deductible information does not display for a specific year it may be because the beneficiary is or was enrolled in a QMB program.
If blank, you should verify the beneficiary’s QMB status in the ‘Qualified Medicare Beneficiary’ section of Eligibility Lookup. If the beneficiary is enrolled in a QMB program the remaining deductible information will not be provided. You should refer to the Remittance Advice to determine any payment amount applied to the Part B deductible or for coinsurance information. As a reminder, you are prohibited from billing a Medicare beneficiary enrolled in a QMB program for deductible and coinsurance.
You can find additional information and detailed step-by-step instructions in the NGSConnex User Guide.
Updating Your Medicare University Profile
Have you changed jobs? Has your email address changed? Each Medicare University student has a unique profile. You should keep your profile current and up-to-date at all times to experience all the benefits Medicare University has to offer. Use the Edit Profile form to update your personal information or change your password.
To update your Medicare University profile, follow these three steps:
Step 1: Log in to Medicare University. The Medicare University home page will display.
Step 2: Click Edit Profile. The Edit Profile window will open.
Step 3: Edit the information in the applicable fields, as necessary.
If you have created multiple Medicare University accounts, we can merge them for you. Just send an email to medicare.university@anthem.com and request we merge your accounts. Please provide your telephone number in case we need to contact you.
Using the IVR to Obtain Medicare Advantage Plan and Medicare Secondary Payer Information
Have you ever submitted a claim thinking Medicare was the primary payer just to receive a claim denial indicating that wasn't the case? Did you know that you can obtain MSP and MA plan information via the IVR system? The Eligibility Option 1 will provide the following:
- MA Plan
- MA Plan number
- Name
- Option Code
- Administering insurance company
- Effective/termination dates
- MSP
- MSP type
- Insurer name
- Effective/termination dates
- Diagnosis code(s), if applicable - if the primary insurance is limiting coverage to specific diagnosis codes, the codes will be provided
Refer to the IVR User Guide for all components available via the Eligibility option.
HHH On-Demand Videos
Watch this newly updated playlist of Home Health and Hospice on-demand video replays.
Medicare BLAST - Medicare Review Contractors
Answers are in bold
- Which contractor selects a random sample of Medicare claims to review?
- Recovery Auditor (RA formerly RAC)
- Comprehensive Error Rate Testing (CERT)
- Unified Program Integrity Contractor (UPIC)
- Medicare Administrative Contactors (MACs)
- Supplemental Medical Review Contractor (SMRC)
- The mission of the Supplemental Medical Review Contractor is to perform and/or provide support for a variety of tasks aimed at lowering the improper payment rates and increasing efficiencies of the medical review functions.
True
- Recovery auditors do not need CMS approval on the issues they will review.
False
- NGS will make review determinations within 30 calendar days of receiving the provider’s requested documentation.
True
- Performant Recovery, Inc is the recovery auditor contractor for Jurisdiction K and Jurisdiction 6.
True
- Which of the following processes does the Unified Program Integrity Contractor conduct?
- Performs data analysis
- Requests medical records and documentation
- Conducts interviews
- Conducts onsite visits
- All of the above
- The mission of the Unified Program Integrity Contractor is to help address fraud, waste and abuse.
True
- The NGS medical review process is a targeted probe and educate strategy.
True
- Noridian Healthcare Solutions, LLC is the Supplemental Medical Review Contractor under contract with CMS.
True
- Providers do not have appeal rights on claims that were reviewed by Medicare Review Contractors.
False
Related Content
- Centers for Medicare & Medicaid Services Internet-only Manual, Publication 100-08, Medicare Program Integrity Manual
Posted 2/26/2024