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MEDICARE NEWS
Regulatory Updates

It’s good to know this about new Medicare ID: 

  • The MBI is 11 characters in length consisting of numbers 0–9 and most letters of the alphabet. 
  • Letters S, L, O, I, B and Z will not be used in the MBI because they can be misconstrued as numbers. 
  • The MBI’s 2nd, 5th, 8th and 9th characters will always be a letter. 
  • Characters 1, 4, 7, 10 and 11 will always be a number. 
  • The 3rd and 6th characters will be a letter or a number. 

The dashes aren’t used as part of the MBI. They won’t be entered into computer systems or used in file formats. Do not enter the dashes on the claim file.  Examples: 

MBI as it appears on the Medicare card: 1EG4-TE5-MK73

MBI as it appears in a claim file: 1EG4TE5MK73 

More details here

!  The MBI is not required on claims until January 2020, however, providers are encouraged to start using the MBI as soon as they receive it from their patients. 

 

Quality Payment Program: Other Payer Advanced APM Resources 

CMS posted two new resources related to Other Payer Advanced Alternative Payment Models (APMs): 

Medicaid Other Payer Advanced APMs in the Quality Payment Program for Performance Year 2019 

Eligible Clinician Initiated Submission Form 

For More Information: APMs Overview and 2018 Resources 

Contact: QPP@cms.hhs.gov or 866-288-8292 (TTY: 877-715-6222)

  

Help Your Medicare Patients

Avoid and Report Scams 

Medicare will never call beneficiaries uninvited and ask for personal or private information to get their new Medicare Number and card.

Scam artists may try to get personal information (like their current Medicare Number) by contacting them about their new card. If your Medicare patient is asked for their information, for money, or someone threatens to cancel their health benefits if they don't share their personal information, ask them to call 1-800-MEDICARE (1-800-633-4227). 

The new Medicare Number is also called the Medicare Beneficiary Identifier (MBI) and is replacing the current Social Security-based Health Insurance Claim Number (HICN) on Medicare health insurance cards. We will continue to accept the HICN through the transition period

Find identity theft resources for people with Medicare.

Regulatory updates

 

INFLUENZA VIRUS VACCINE CODE UPDATE 

Effective on or after January 1, 2019 influenza virus vaccine code 90689 (Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25mL dosage, for intramuscular use) will be payable by Medicare. 

Details here.

Regulatory updates

MEDICARE NY NEWS: 

As of 9/15/2018, the following submission, processing and payment guidelines will apply to E/M claims submitted by JK and J6 providers and groups for services by NPs (Specialty 50) and PAs (Specialty 97): 

  1. NP and PA E/M claims will continue to be submitted as per prior guidelines, indicating the rendering/billing provider as either Specialty 50 or Specialty 97.
  2. In the 2300 or 2400 Loop NTE Segment (or Box 19 on paper claims), include the specialty of the group under which the NP or PA has provided the service (e.g., Specialty 20 or Specialty 26).
    • We encourage providers to initiate this process as soon as possible; supervising specialty information is essential to the success of this processing and having this information on history claims will enhance payment for claims processed September 15th and later.
    • We also encourage providers to refrain from including other information in the 2300 or 2400 Loop NTE segment on these specific claims unless absolutely necessary.
  1. An NP or PA E/M claim submitted subsequent to the first paid NP or PA claim for a date of service will be considered for payment if specialty information in Loop 2300 or 2400 NTE Segment (or Box 19 on a paper claim) varies from that on the paid claim and if detail diagnoses on the claims vary, supporting care for a different clinical condition.
  2. Multiple NP and PA claims submitted for the same date of service that do not meet the above criteria will continue to be denied  and may be submitted for redetermination via the standard and previously established method.
  3. Providers are reminded that claims denied relative to this issue prior to 9/15/2018 may not be re-submitted and will still need to go through the standard redetermination process.

Beyond implementation of this editing change, NGS will continue to monitor NPP E/M claim and appeal trends, and continue to offer education as needed. We anticipate a highly successful outcome for our NPP providers and will be pleased to address questions during our upcoming webinars, mentioned above.

Regulatory updates

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Insights
September 2018