Tuesday, May 13, 2014

Novitas Address for mailing paper claims

According to Novitas Effective 04/15/2014, paper claims that were submitted to the old Novitas Solutions mailing addresses are no longer being forwarded by the postal service. The 1500 claim forms are being mailed back to the provider and will need to be resubmitted to the correct mailing address”

Herewith we have enclosed the Novitas mailing address

Jurisdiction H (JH) includes Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas, Indian Health and Tribal facilities as well as Veterans Affairs.

General Mailing Address


Novitas Solutions
Attn: (dept or function name or specific person)
2020 Technology Parkway, Suite 100
Mechanicsburg, PA 17050

Addresses for Claims and Development Responses


This section contains the addresses for submitting initial claims and responding to development requests for additional information.
Part B Claims
Novitas Solutions
Attn: Part B Claims
PO Box XXXX (replace the Xs with the PO Box number from the table below)
Mechanicsburg, PA 17055-XXXX (fill in the +4 from the table below)

Mechanicsburg, PA 17055-XXXX (fill in the +4 from the table below)

Part B Claims
CMS 1500 Claim Form (08/05)
PO Box
Zip +4
Arkansas
P.O. Box 3098
17055-1816
Colorado
P.O. Box 3107
17055-1823
Indian Health Services
P.O. Box 3111
17055-1857
Influenza/Flu Claims/Roster Billings
P.O. Box 3112
17055-1827
Louisiana
P.O. Box 3097
17055-1815
Mississippi
P.O. Box 3129
17055-1834
New Mexico
P.O. Box 3107
17055-1823
Oklahoma
P.O. Box 3107
17055-1823
Texas
P.O. Box 3108
17055-1824

Part B Development Letter Responses
Novitas Solutions
JH Part B ADR/Medical Records
PO Box 3094
Mechanicsburg, PA 17055-1812
General Written Inquiries and Appeals

This section contains the addresses for submitting redeterminations, clerical error reopenings, and general written inquiry requests. For more information on appeals, refer to Novitas Solutions Appeals Center.

Part B Providers
PO Box
Zip +4
Louisiana
PO Box 3100
17055-1817
Arkansas
PO Box 3101
17055-1818
Mississippi
PO Box 3130
17055-1835
Colorado/New Mexico/Oklahoma
PO Box 3109
17055-1825
Texas
PO Box 3110
17055-1826

Mailing Address for Veteran Affairs

Please use the following post office box, when submitting all mail, including appeals and correspondence to Novitas Solutions, Inc.
Novitas Solutions, Inc.
PO Box 3116
Mechanicsburg, PA 17055-1830

If Medicare documents are sent via Priority mail or through a commercial courier for which a PO Box cannot be used, please use the following street address:

Novitas Solutions, Inc.
Attention: (Department/Function Name or Specific Person)
2020 Technology Parkway
Mechanicsburg, PA 17050

Mailing Addresses for Indian Health Services/Tribal/Urban Indian Providers

Please use the following post office boxes, as indicated in the chart below, when submitting documents to Novitas Solutions, Inc.
Novitas Solutions, Inc.
PO Box XXXX
Mechanicsburg, PA 17055-XXXX


Type of Correspondence/Document being sent to Novitas
PO Box
Zip Code + 4
Paper Claims, Appeals, and General Correspondence
PO Box 3111
17055-1857
Electronic Billing (EDI)
PO Box 3093
17055-1811
Provider Enrollment/EFT
PO Box 3115
17055-1858
Part B Voluntary Checks Returns and Payments
PO Box 3106
17055-1822

If Medicare documents are sent via Priority mail or through a commercial courier for which a PO Box cannot be used, please use the following street address:
Novitas Solutions, Inc.
Attention: (Department/Function Name or Specific Person)
2020 Technology Parkway
Mechanicsburg, PA 17050

Electronic Billing (EDI) - Completed EDI Enrollment Forms

To enroll for electronic billing, please visit our Electronic Billing (EDI) Center and download the most recent version of EDI Enrollment forms. Please mail your completed EDI Enrollment forms to:
Novitas Solutions
ATTN: JH EDI
PO Box 3093
Mechanicsburg, PA 17055-1811

Provider Enrollment - Completed Provider Enrollment Forms

Paper enrollment forms/supporting documentation, hardcopy certification statements/supporting documentation for Internet-based PECOS submitted applications and other enrollment forms (e.g., CMS-460, CMS-588) must be sent through the U.S. mail. Please see below for the appropriate address.

Please direct responses to requests for information (development) to the specific Credentialing Specialist listed in the development letter.

General Provider Enrollment and Phase 2 Revalidation Applications (requests dated on or before September 20, 2013):

Novitas Solutions
Provider Enrollment Services
P.O. Box XXXX
Mechanicsburg, PA 17055-XXXX

Type of Provider
PO Box
Zip Code +4
All Providers (except Indian Health Services/Tribal/Urban Providers)
3095
1813
Indian Health Services/Tribal/Urban Providers
3115
1858

Phase 3 Revalidation Applications (requests dated after September 20, 2013):
Novitas JH Provider Enrollment
P.O. Box 44137
Jacksonville, FL 32231
Note that although Internet-based PECOS instructs providers to send hardcopy certification statements/supporting documentation to a specific Novitas address, please mail all Phase 3 revalidation documents to the address immediately above.
Gifts - Offers and Receipt of Gifts
Novitas is a government contractor and is therefore prohibited from accepting gifts of any kind from providers, vendors or third parties doing business, or seeking to do business, with us. Therefore, any gifts received by a Novitas employee/s will be returned. Thank you for your understanding.

Medical Director

Novitas Solutions - Office of the Medical Director
Attn: Debra Patterson M.D.
2020 Technology Parkway
Mechanicsburg, PA 17050

Freedom of Information (FOIA)

Send your request to the following addresses.
Novitas Solutions
All JH FOIA
Freedom of Information
PO Box 3700
Mechanicsburg, PA 17055-1856

Saturday, April 5, 2014

How to get Cash from a Life Insurance policy

Unfortunately, a diagnosis of a terminal illness often comes with many expenses. If you need money to pay for your medical care or comfort, you may be able to use your life insurance policy to get some immediate cash.

Allows terminally ill individual to sell their life insurance policies. Alternatively, some insurance companies allow you to receive an accelerated death benefit. A viatical settlement is similar to life settlement, but it is designed for individuals that are terminally ill. You sell your policy to a company, which then collects the death benefit when you die. Most companies required that you have owned your policy for at least two years, your beneficiaries sign release or waiver, you have a life expectancy of anywhere from two to four years ( depending on the company), and you allow the company access to your medical records.

A company will usually pay more than the cash surrender value, but less than the death benefit, although the exact price depends on a number of factors.
Rather than selling your policy, some insurance companies allow you to collect a portion of your death benefit before you die. This is called accelerated death benefits. This option may be included as a part of your policy or you may have pay extra for it.
Both Viatical Settlements and Accelerated death benefits could have tax consequences and affect Medicaid planning. Before taking either option, you should consult with a qualified elder attorney.

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Carecredit will help members to manage and Improve personal and family health

What is Carecredit:

Carecredit is a trusted source and it is a part of GE Capital and it offers healthcare financing for consumers through a network of over 175,000 providers. Founded in 1987, CareCredit was initially offered to doctors to help their patients pay for new dental implant technology. Continued advancements in technology, and procedures that are often not covered or fully covered by insurance, have created new choices for care, increasing the demand for special financing options. CareCredit is a health, beauty, and wellness credit card that can be used as a payment option for certain expenses not covered by insurance or to bridge situations when desired care exceeds insurance coverage. You can even use it for co-payments and deductibles
Many patients may post pond or just stop their treatment since their insurance will not cover those services or they cannot afford to pay for the treatment. Carecredit offering a better way to manage and improve personal and family health, Your Doctors offer CareCredit payment options as an alternative to consumer credit cards, cash or checks. CareCredit allows you to pay over time instead of a lump sum prior to treatment. Offering CareCredit removes the accounts receivable responsibilities from the doctor and allows them to focus on recommending and providing the best care to their patients.

Your Next question how do i qualify for Carecredit?

Approval is based on information from your credit application and past credit history. This includes information from the primary applicant as well as any co-applicant.
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Friday, April 4, 2014

President Obama Signs the Protecting Access to Medicare Act of 2014

According to Novitas

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014. This new law prevents a scheduled payment reduction for physicians and other practitioners who treat Medicare patients from taking effect on April 1, 2014. This new law maintains the 0.5 percent update for such services that applied from January 1, 2014 through March 31, 2014 for the period April 1, 2014 through December 31, 2014. It also provides a zero percent update to the 2015 Medicare Physician Fee Schedule (MPFS) through March 31, 2015.

 
Section 101 – Physician Payment Update – As indicated above, the new law provides for a 0.5 percent update for claims with dates of service on or after January 1, 2014, through December 31, 2014. It also provides a zero percent update to the 2015 Medicare Physician Fee Schedule (MPFS) through March 31, 2015. CMS is currently revising the 2014 MPFS to reflect the new law’s requirements as well as technical corrections identified since publication of the final rule in November. For your information, the 2014 conversion factor is $35.8228.
 
Section 102 - Extension of Work GPCI Floor - The existing 1.0 floor on the physician work geographic practice cost index is extended through March 31, 2015. As with the physician payment update, this extension will be reflected in the revised 2014 MPFS.
 
Section 103 - Extension of Therapy Cap Exceptions Process - The new law extends the exceptions process for outpatient therapy caps through March 31, 2015. Providers of outpatient therapy services are required to submit the KX modifier on their therapy claims, when an exception to the cap is requested for medically necessary services furnished through March 31, 2015. In addition, the new law extends the application of the caps, exceptions process, and threshold to therapy services furnished in a hospital outpatient department (OPD).
 
The therapy caps are determined for a beneficiary on a calendar year basis, so all beneficiaries began a new cap for outpatient therapy services received beginning on January 1, 2014. For physical therapy and speech language pathology services combined, the 2014 limit on incurred expenses for a beneficiary is $1,920. There is a separate cap for occupational therapy services which is $1,920 for 2014. Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached, and also apply for services above the cap where the KX modifier is used.

 
The new law also extends the mandate that Medicare perform manual medical review of therapy services furnished January 1, 2014 through March 31, 2015, for which an exception was requested when the beneficiary has reached a dollar aggregate threshold amount of $3,700 for therapy services, including OPD therapy services, for a year. There are two separate $3,700 aggregate annual thresholds: (1) physical therapy and speech-language pathology services combined, and (2) occupational therapy services.

 
Section 104 - Extension of Ambulance Add-On Payments - The new law extends the following two expiring ambulance payment provisions: (1) the 3 percent increase in the ambulance fee schedule amounts for covered ground ambulance transports that originate in rural areas and the 2 percent increase for covered ground ambulance transports that originate in urban areas is extended through March 31, 2015 and (2) the provision relating to payment for ground ambulance services that increases the base rate for transports originating in an area that is within the lowest 25th percentile of all rural areas arrayed by population density (known as the “super rural” bonus) is extended through March 31, 2015. The provision relating to air ambulance services that continued to treat as rural any area that was designated as rural on December 31, 2006, for purposes of payment under the ambulance fee schedule, expired on June 30, 2013.

Section 105 - Extension of Increased Inpatient Hospital Payment Adjustment for Certain Low-Volume Hospitals - The new law extends, through March 31, 2015, a provision that allowed qualifying low-volume hospitals to receive add-on payments based on the number of Medicare discharges from the hospital. To qualify, the hospital must have less than 1,600 Medicare discharges and be 15 miles or greater from the nearest like hospital.

Section 106 - Extension of the Medicare-Dependent Hospital (MDH) Program - The MDH program provides enhanced payment to support small rural hospitals for which Medicare patients make up a significant percentage of inpatient days or discharges. This provision extends the MDH program through March 31, 2015.

Tuesday, April 1, 2014

What is HCPCS code G0248, G0249 & G0250

G0248 - DEMONSTRATION, PRIOR TO INITIATION OF HOME INR MONITORING, FOR PATIENT WITH EITHER MECHANICAL HEART VALVE(S), CHRONIC ATRIAL FIBRILLATION, OR VENOUS THROMBOEMBOLISM WHO MEETS MEDICARE COVERAGE CRITERIA, UNDER THE DIRECTION OF A PHYSICIAN; INCLUDES: FACE-TO-FACE DEMONSTRATION OF USE AND CARE OF THE INR MONITOR, OBTAINING AT LEAST ONE BLOOD SAMPLE, PROVISION OF INSTRUCTIONS FOR REPORTING HOME INR TEST RESULTS, AND DOCUMENTATION OF PATIENTS ABILITY TO PERFORM TESTING AND REPORT RESULTS

G0249 - PROVISION OF TEST MATERIALS AND EQUIPMENT FOR HOME INR MONITORING OF PATIENT WITH EITHER MECHANICAL HEART VALVE(S), CHRONIC ATRIAL FIBRILLATION, OR VENOUS THROMBOEMBOLISM WHO MEETS MEDICARE COVERAGE CRITERIA; INCLUDES: PROVISION OF MATERIALS FOR USE IN THE HOME AND REPORTING OF TEST RESULTS TO PHYSICIAN; TESTING NOT OCCURRING MORE FREQUENTLY THAN ONCE A WEEK; TESTING MATERIALS, BILLING UNITS OF SERVICE INCLUDE 4 TESTS

G0250 - PHYSICIAN REVIEW, INTERPRETATION, AND PATIENT MANAGEMENT OF HOME INR TESTING FOR PATIENT WITH EITHER MECHANICAL HEART VALVE(S), CHRONIC ATRIAL FIBRILLATION, OR VENOUS THROMBOEMBOLISM WHO MEETS MEDICARE COVERAGE CRITERIA; TESTING NOT OCCURRING MORE FREQUENTLY THAN ONCE A WEEK; BILLING UNITS OF SERVICE INCLUDE 4 TESTS

Medicare Payment details for G0248, G0249& G0250

CMS Created these three HCPCS codes ( G0248,G0249 & G0250) to be used for billing home PT/INR monitoring. These codes are included in Medicare Fee Schedule and are subject to a 20% Co insurance like other physicians services.

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ICD 10 Delay – October 1, 2015

On March 31st 2014, the US senate passed a bill to delay the planned ICD 10 by one year, ICD 10 will not be implemented until October 1st 2015.

The bill H.R. 4302, Protecting Access to Medicare Act of 2014, which was mainly created a temporary fix to the Medicare sustainable growth rate. A seven line section of the bill states that the Department of Health and Human Services (HHS) cannot adopt the ICD-10 code set as the standard until at least October 1st 2015.

Big news coming in for health care industry because from Physicians, Physician Staff, Insurance and Clearing housing had been preparing for ICD-10 code set. Now it’s not on October 1st 2014 as per above rule it will delay for another year.

Another way it’s good for all physicians, staff, insurance and clearing houses got another 365 days time period to prepare for ICD-10.

Sunday, March 23, 2014

Points to Remember before Sending Electronic Medical Records

These are the point that all the medical billing resources need to keep in mind before sending electronic Medical records.

According to Novitas:

Under the Health Insurance Portability and Accountability Act (HIPAA), claims for reimbursement by the Medicare Program must be submitted electronically, except where waived, even for claims with attachments. The process at Novitas Solutions for accepting medical documentation and attaching it to the electronic claim has been improved due to our imaging system. The Claim Supplemental Information segment (PWK) is used whenever paper documentation has been sent for an electronic claim. When sending an electronic claim that contains an attachment, follow these rules to submit the attachment for your electronic claim:

Maintain the appropriate medical documentation on file for electronic (and paper) claims.

Complete the Medicare Part A Fax/Mail Cover Sheet * or the Medicare Part B Fax/Mail Cover Sheet * form. For accurate processing of your claim(s), please complete all requested information in capital letters and avoid contact with the edge of the boxes.

Only send medical documentation when necessary for the adjudication of procedures/services that are unusual or require such documentation on a pre-payment basis.

The narrative field on the claim is to be utilized in situations where sufficient information for the documentation of a procedure/modifier can be provided without sending the medical records. When additional information cannot be contained in the narrative of the claim, additional documentation (medical records) may be submitted via mail or fax.

Only fax documentation for one patient per cover sheet. The cover sheet is for Part A or B electronic claims.

Clearly write the: Attachment Control Number, Internal Control Number (ICN/DCN), Patient Name, Health Insurance Claim (HIC) Number, Date of Service, Total Claim Billed Amount, National Provider Identification (NPI) Number, Contact Information, and State Where Services Were Provided on the cover sheet.  Failure to submit all items requested will result in documentation being returned and could delay claim processing.

The fax/mail cover sheets are not to be modified.

Only the first iteration of the PWK, at either the claim level and/or line level, will be considered for adjudication.

Submitters must send ALL relevant PWK data at the same time for the same claim.

After submitting the electronic claim, locate the ICN/DCN number on the 277CA claims acknowledgement report.  The ICN/DCN is located in the 2200D REF segment.

Fax the cover sheet and medical documentation to (877) 439-5479. You may fax documentation any time after claim submission, including the same day. Faxing is available 24 hours a day, 7 days a week. Faxes should be sent within seven calendar days of your electronic claim submission.

Novitas Solutions strongly recommends faxing your medical documentation. If you are not able to fax your documentation, mail the Medicare Part A Fax/Mail Cover Sheet * or the Medicare Part B Fax/Mail Cover Sheet * and all pertinent medical documentation within ten calendar days of your electronic claim submission to:

Jurisdiction L Part A
Jurisdiction L Part B
Jurisdiction H Part A
Jurisdiction H Part B
Novitas Solutions
PO Box 3385
Mechanicsburg, PA 17055-1840
Novitas Solutions
PO Box 3065
Mechanicsburg, PA 17055-1807
Arkansas, Louisiana, Mississippi:
Medical Review JH Part A
Novitas Solutions
PO Box 3103
Mechanicsburg, PA 17055-1819
Colorado, J04911, New Mexico, Texas:
Medical Review JH Part A
Novitas Solutions
P.O. Box 3113
Mechanicsburg, PA 17055-1828

Oklahoma:
Medical Review JH Part A
Novitas Solutions
P.O. Box 3114
Mechanicsburg, PA 17055-1829
Novitas Solutions
PO Box 3094
Mechanicsburg, PA 17055-1812

 

In the Claim Supplemental Information Segment (PWK) of the electronic claim:

Select the appropriate Report Type Code for the medical documentation

Use the By Fax or By Mail option for the Attachment Transmission Code

Enter AC for the Identification Code Qualifier

Report the Attachment Control Number - This number may be assigned by your software or can be any number you chose including the patient account number or other identifying number.

Note: Only send medical documentation when necessary for the adjudication of procedures/services that are unusual or require such documentation on a pre-payment basis. 

Technically Speaking, Claim Supplemental Information (PWK) is reported as follows: 

Data Element
Segment
Attachment Report Type Code
2300 or 2400 - PWK01
Attachment Transmission Code
2300 or 2400 - PWK02
Identification Code Qualifier
2300 or 2400 - PWK05
Attachment Control Number
2300 or 2400 - PWK06

Novitas recently announced stating if physician or Physicians office sending medical records in encrypted format make sure Novitas can able to access the file.

Novitas reports receiving encrypted CDs without passwords and is thus unable to view the records. Novitas says you can email the password to SECUREPSWD@novitas-solutions.com.

Novitas asks that you include the following information in your email:

Subject line: CD Password, [Beneficiary Name/Provider Name]; and

Body of email: List the provider name, provider transaction account number (PTAN), document control number/internal control number applicable to the CD, and password.

If you do not send the password, Novitas will make up to three attempts to contact you for the information. Failure to obtain the password from you will impact (most likely not in the way you'd like) Novitas' review of the claim for which you sent the records.

Consider sending your files to Novitas by fax-to-image rather than CD. Fax to (877) 439-5479, available 24/7.
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