Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

Five Things You Must Know for 2014 If You Submit Professional Medical Claims to Medicare

With major shifts occurring in healthcare – from quality programs and ICD-10 to Health Insurance Exchanges and the sustainable growth rate – it’s easy to overlook some of the smaller changes that may impact the day-to-day operations of revenue cycle management.

So, as we enter 2014, here are five things you must know if you submit Part B claims to Medicare:

1. The Office of Management and Budget recently approved changes to the CMS 588, Electronic Funds Transfer (EFT) Authorization Agreement.

Medicare Administrative Contractors (MACs) will continue to accept the 05/10 version of the CMS 588 through December 31, 2013. After December 31, 2013, the MACs will return any newly submitted 05/10 versions of the CMS 588 applications with a letter explaining the CMS 588 application has been updated and the provider/supplier must submit a current version (09/13) of the CMS 588 application.

The revised EFT agreement is available on the CMS Forms List.

2. CMS will instruct contractors to turn on Phase 2 denial edits on January 6, 2014.

These edits will check the following claims for a valid individual National Provider Identifier (NPI) and deny the claim when this information is invalid:

  • Claims from clinical laboratories for ordered tests;
  • Claims from imaging centers for ordered imaging procedures;
  • Claims from suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) for ordered DMEPOS; and
  • Claims from Part A Home Health Agencies (HHAs).

If you order or refer items or services for Medicare beneficiaries and you do not have a Medicare enrollment record, you need to submit an enrollment application to Medicare. You can do this using the Internet-based Provider Enrollment, Chain, and Ownership System (PECOS) or by completing the paper enrollment application (CMS-855O).

For more information, review MLN Matters® Article #SE1305.

3. The new Calendar Year (CY) 2014 Medicare premium, coinsurance, and deductible amounts were released by CMS.

2014 PART B – SUPPLEMENTARY MEDICAL INSURANCE (SMI) RATES

Standard Premium

  • $104.90 a month

Deductible

  • $147.00 a year

Pro Rata Data Amount

  • $114.99 1st month
  • $32.01 2nd month

Coinsurance

  • 20 percent

For more information, review MLN Matters® Article #MM8527.

4. A new Claim Adjustment Reason Code (CARC) will be reported on Medicare EOBs and remittances when payments are reduced due to Sequestration.

Previously, CARC 223 was used to indicate the reduction. Effective June 3, 2013, a new CARC was created and will replace CARC 223 on all applicable claims. The new CARC, which will begin appearing on EOBs and remittances as of January 6, 2014, is CARC 253 – “Sequestration – Reduction in Federal Spending.”

For more information, review MLN Matters® Article #MM8378.

5. Beginning January 6, 2014, MACs have been instructed to redact beneficiary Health Insurance Claim Numbers on all Medicare Redetermination Notices.

Medicare contractors are required to issue a notice of Medicare redetermination after an appeal is requested; the redaction of the HICN on that notice protects personally identifiable information. The HICNs will be redacted by replacing 5 or more values of the HICN with Xs or asterisks (*). The last 4 or 5 digits of the HICN will continue to be displayed. This applies to HICNs with both alpha and numeric digits.

For more information, review MLN Matters® Article #MM8268.

— All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com. Photo by Jenna via Flickr used with permission under the Creative Commons License.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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