Medicare Tools, Education, and Resources for Professionals, Providers, and Manufacturers

Information regarding coding, coverage, and payment is provided as a service to our readers. Every effort has been made to ensure accuracy. However, HMP and the author do not represent, guarantee, or warranty that coding, coverage, and payment information is error-free and/or that payment will be received.

On a weekly basis, this author receives telephone calls and e-mails from wound/ulcer management stakeholders who are looking for answers to Medicare coding, payment, and/or coverage questions. Sometimes the question is complicated, and we need to discuss the underlying issues before we can determine the answer to the question. Most often the questions are easily answered by referring to information provided on the website of the Medicare Administrative Contractor (MAC) in the stakeholder’s Medicare jurisdiction. Without fail, the stakeholder is usually surprised to learn that her/his MAC’s website is so information-rich. The stakeholder is further surprised when this author shows her/him where to find a plethora of pertinent educational events sponsored by her/his MAC.  

Because so many wound/ulcer management stakeholders are unfamiliar with their MACs’ websites, which are like libraries, this month’s Business Briefs describes examples of some of the MAC’s reimbursement tools and educational programs that may not be familiar to you. A few examples were selected from each MAC’s website to encourage you to visit and explore your own MAC’s website. Because readers appreciate receiving links to resources discussed in this column, and because this particular article describes so many excellent resources, Today’s Wound Clinic has posted live links to all resources below.

Register on One or More MAC’s Listserv Distribution Lists

Every morning this author reads the e-mails that the MACs distribute to everyone who registered for their listserv. All wound/ulcer management stakeholders can receive those same e-mails by registering to be included on one or more MAC’s listserv distribution lists. If you are unsure about the name of your MAC and/or about the link to their provider portal, you will find the MAC directory of provider portals very helpful.¹

Locate One or More MACs’ Contact Lists

Many wound/ulcer management stakeholders tell this author they would like to contact their MAC with a question or a reimbursement issue, but do not know who to call and/or which department handles their specific topic. This information is posted on each MAC’s website. For example, if you are a durable medical equipment (DME) supplier in Jurisdiction B or C, CGS Administrators provides contact information for each CGS department as well as a downloadable/printable Whom to Contact list that includes an overview of the reimbursement topics covered by each department.^2,3  

Browse the Tools Section on One or More Websites

To assist providers with their coding, coverage, payment, and audit processes, the MACs provide a wide variety of online tools, which can be located by clicking on the “tools” section of their websites. Following is a list of helpful tools that may not be familiar to you:  

•    The 90-Day Global Period Calculator for Major Surgeries determines when the global period ends.⁴
•    The Additional Documentation Request (ADR) Tool lets providers enter the ADR number from denial letters to obtain additional information about the requested documentation.⁵
•    The ADR Timeliness Calculator assists providers to determine the date ADR documentation must be received in order to meet the time frame for submission.⁶ The ADR documentation must be received by the MAC on/before 45 calendar days of the request for review and payment determination. Claims will be denied if the documentation is not received by day 46.
•    The Advance Beneficiary Notice of Noncoverage (ABN) Form Instructions Tool provides an easy way to view instructions for each item on the ABN form.⁷
•    The Advanced Modifier Engine is a new tool that was designed by CGS to assist suppliers in billing proper Healthcare Common Procedure Coding Systems (HCPCS) codes and modifier combinations.⁸ The tool includes durable medical equipment prosthetics, orthotics and supplies (DMEPOS) commonly billed HCPCS codes with billing scenarios. Based on the specific HCPCS code entered and the billing scenario, the tool recommends modifiers for claim submission.
•    The CERT Claim Lookup Tool aids Medicare suppliers to obtain the results of their comprehensive error rate testing (CERT) review.⁹
•    The Consolidated Billing Tool for HCPCS Codes allows providers and suppliers to determine 1) if a HCPCS code is included in consolidated billing during a Part A stay in a skilled nursing facility (SNF) (typically the first 100 days), 2) if the item is payable in a SNF once the Part A stay has ended, 3) if the HCPCS code is included in home health consolidated billing, and 4) if a HCPCS code is separately payable while the beneficiary is enrolled in hospice.¹⁰
•    Documentation Requirements Checklists help identify records that are not routinely submitted by providers but must be available upon request.¹¹
•    The Fee Schedule Lookup provides quick access to the Medicare allowable payment rate for specific codes provided in a specific region.¹²
•    The Incident-to Self-Service Tool assists providers to understand the CMS Part B “incident-to” requirements, to apply the rules to their individual patient/provider circumstances, and to understand documentation requirements.¹³
•    Interactive Remittance Advice describes each part of the Remittance Advice (RA) that MACs send to providers once a claim has been processed.¹⁴ The RA contains finalized claim details and contains explanatory claim processing message codes.
•    The Medically Unlikely Edit (MUE) Lookup Tool helps determine the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.¹⁵
•    The Modifier Lookup Tool provides guidelines for documenting and correctly submitting CPT^® and HCPCS modifiers on Part B claims.^16,17
•    The New vs. Established Patient Decision Tree determines if the patient is new or established to that provider.¹⁸
•    The Podiatry Calculator determines next eligible date the patient can receive coverage for routine foot care.¹⁹
•    The Prior Authorization Look-Up Tool allows providers and suppliers to determine if a product with a HCPCS code requires prior authorization.²⁰ This is particularly important for wound/ulcer management stakeholders now that pressure reducing support surfaces require prior authorization.
•    Surgical Dressings Lookup Tools²¹
1.    Determine the type of dressings covered based on exudate and wound depth information
2.    Allow the user to search by HCPCS code to find the dressing type, wound depth, exudate and usual dressing change information.
3.    Determine wound depth, exudate and usual dressing change when a dressing category is selected

Research the Educational Events Sponsored by One or More MACs

Not only does this author visit one or more MAC websites nearly every day, but this author also spends many hours per month participating in educational webinars and teleconferences facilitated by each MAC.²² These webinars and teleconferences are very good, and they are free: all you need to do is register, connect via your computer or your phone, listen, and ask questions during the question and answer portion of the event. If the presenter uses a slide deck, she/he usually sends it to the registrants before the event. In some instances, she/he sends it to the attendees the day after the program. The MACs usually post, on their websites, Events Calendars of these educational programs, and they send notices to people who registered on their listserv distribution lists. This link shows you an example of the CGS Part B Calendar of Events.²³ If you cannot attend the live programs, you can visit the MAC’s Learning on Demand webpage to access recordings.²⁴

When the MACs implement new processes, they often facilitate Ask-the-Contractor teleconferences.²⁵ The facilitator may have a short educational program, but most of the teleconference time is allotted for the participants to ask questions about the new process. This author finds these teleconferences very educational because she learns from the participants questions and the MAC’s answers. As a bonus, the MAC typically posts the questions and answers and any pertinent handouts after each Ask-the-Contractor teleconference.   

The MACs also offer self-paced, free online courses that allow stakeholders to receive training when and where it is most convenient. The MACs post course catalogs that allow stakeholders to find Medicare training that fits their specific needs. For example, First Coast Service Options’ First Coast University Course Catalog currently lists 19 online courses such as: Evaluation and Management Documentation, Introduction to Global Surgery, and Modifier 25.²⁶ In addition, several of the MACs’ online courses offer CEUs.

This author was surprised when the MACs began offering one and two-day workshops/symposiums that have many informative topics on their agendas. For example: CGS recently held a two-day Mega Workshop for the DME suppliers. Many of the MAC medical directors and staff members from various departments are typically in attendance to present and answer questions.²⁷ The cost of the workshops/symposiums is very reasonable, and the programs are usually held in easy-to-reach locations. This author was further surprised to learn that some of the MACs are also making these workshops/symposiums available virtually. The 2020 Novitas Explore Medicare Education Symposiums are great examples of symposiums that will be offered in person and virtually.²⁸

Many MACs also post job aids and manuals on their websites.²⁹ If stakeholders prefer to read about a topic, they will be surprised at the wide variety of resources that are available. If stakeholders prefer to receive their reimbursement education via their mobile phones and/or tablets, the MACs now offer numerous short educational programs via YouTube. These are great programs for busy wound/ulcer management stakeholders who want to learn about reimbursement topics in “small bites.”

Summary

The MACs are going out of their way to provide reimbursement tools, resources, and education to all members of the clinical and revenue cycle teams. Although this article only highlighted a few of the many useful reimbursement-related items found on the MACs’ websites, it should have piqued your interest to visit one or more of the MAC websites to find the tools, educational programs of all types, job aids and manuals, as well as education via YouTube. This author recommends bookmarking your favorite pages on one or more of the MAC websites because you will most likely visit them often. 

Kathleen D. Schaum is a founding member of the Today’s Wound Clinic editorial advisory board and oversees a consulting business. She can be reached for consultation and questions by emailing kathleendschaum@bellsouth.net.

1. Medicare Administrative Contractor directory of provider portals: https://www.cms.gov/Medicare/New-Medicare-Card/Providers/MACs-Provider-Portals-by-State.pdf . Last accessed March 1, 2020.
2. CGS Department Contact list: https://cgsmedicare.com/jb/cs/cgsdepts.html . Last accessed March 1, 2020.
3. CGS Topics Handled by Each Department list: https://www.cgsmedicare.com/jb/help/pdf/dme_whomtocontact.pdf for Jurisdiction B, and https://www.cgsmedicare.com/jc/help/pdf/dme_whomtocontact.pdf for Jurisdiction C.
4. 90 Day Global Period Calculator for Major Surgeries: https://www.ngsmedicare.com/ngs/portal/ngsmedicare/newngs/home-lob/pages/calculators/90-Day-Global-Period-Calculator/. Last accessed March 2, 2020.
5. Additional Documentation Request Tool: https://www.cgsmedicare.com/medicare_dynamic/jc/adr/adr.aspx . Last accessed March 1, 2020.
6. ADR Timeliness Calculator: https://cgsmedicare.com/medicare_dynamic/dme/jc/adr_calc/adr_calc.aspx . Last accessed March 1, 2020.
7. Advanced Beneficiary Notice of Noncoverage Form Instructions Tool: https://med.noridianmedicare.com/web/jddme/topics/abn/abn-tutorial . Last accessed March 1, 2020.
8. Advanced Modifier Engine: https://www.cgsmedicare.com/medicare_dynamic/jc/advanced_modifier_engine/ .
Last accessed March 1, 2020.
9. CERT Claim Lookup Tool: https://www.wpsgha.com/wps/portal/mac/site/claim-review/guides-and-resources/cert-lookup . Last accessed March 1, 2020.
10. Consolidated Billing Tool for HCPCS codes: https://med.noridianmedicare.com/web/jddme/claims-appeals/billing-situations/consolidated-billing/consolidated-billing-lookup . Last accessed March 1, 2020.
11. Documentation Requirements Checklist: https://med.noridianmedicare.com/web/jfb/topics/documentation-requirements . Last accessed March 1, 2020.
12. Fee Schedule Lookup: https://www.ngsmedicare.com/ngs/portal/ngsmedicare/newngs/home-lob/Tools/CodePricingSearch/ . Last accessed March 2, 2020.
13. Incident-to Self-Service Tool: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/IncidentTool .
Last accessed March 3, 2020.
14. Interactive Remittance Advice: https://palmettogba.com/internet/irar.nsf/index.html . Last accessed March 3, 2020.
15. Medically Unlikely Edit Lookup Tool: https://med.noridianmedicare.com/web/jeb/topics/claim-submission/medically-unlikely-edits#toolInterface . Last accessed March 2, 2020.
16. CPT is a registered trademark of the American Medical Association. All rights reserved.
17. Modifier Lookup Tool: https://www.palmettogba.com/Palmetto/Providers.nsf/docsr/JJ%20Part%20B~Browse%20by%20Topic~Modifier%20Lookup?open&Expand=1 . Last accessed March 3, 2020.
18. New vs. Established Patient Decision Tree: https://med.noridianmedicare.com/web/jfb/specialties/em/new-vs-established-patient-decision-tree . Last accessed March 1, 2020.
19. Podiatry Calculator: https://www.ngsmedicare.com/ngs/portal/ngsmedicare/newngs/home-lob/pages/calculators/podiatry-calculator/ . Last accessed March 2, 2020.
20. Prior Authorization Lookup Tool: https://cgsmedicare.com/medicare_dynamic/jc/cppa/cppa.aspx . Last accessed March 1, 2020.
21. Surgical Dressings Lookup Tools: https://med.noridianmedicare.com/web/jddme/dmepos/surgical-dressings/tools . Last accessed March 1, 2020.
22. NGS Future Webinars: https://www.ngsmedicare.com/ngs/portal/ngsmedicare/newngs/home-lob/pages/webinars- . Last accessed March 4, 2020.
23. CGS Part B Calendar of Events: https://cgsmedicare.com/medicare_dynamic/wrkshp/pr/partb_report/partb_report.aspx . Last accessed March 4, 2020.
24. First Coast Service Options Learning on Demand recordings: https://medicare.fcso.com/Events/160889.asp . Last accessed March 4, 2020.
25. CGS Ask-the Contractor teleconferences: https://cgsmedicare.com/partb/education/materials.html . Last accessed March 4, 2020.
26. First Coast Service University Course Catalog: https://medicare.fcso.com/Online_learning/173802.asp . Last accessed March 3, 2020.
27. CGS Mega Workshop: https://www.cgsmedicare.com/jc/education/workshops.html . Last accessed March 4, 2020.
28. 2020 Novitas Explore Medicare Education Symposiums: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00080149 . Last accessed March 4, 2020.
29. NGS Job Aids and Manuals: https://www.ngsmedicare.com/ngs/portal/ngsmedicare/newngs/home-lob/pages/job-aids-manuals/ . Last accessed March 4, 2020.