Medicare Do’s and Don’ts

The do's and don'ts in this list may apply to you, depending on your specialty and/or circumstances. Note that some are timely!

Important! DON'T overlook or ignore a letter you receive from Notivas Solutions the first week of June 2014 demanding you return a Physician Quality Reporting System duplicate payment. Novitas Solutions, the Medicare payer for Texas, says that due to a system problem, it generated payments for some physicians that duplicate payments originally issued on Nov. 1, 2013. Physicians received duplicate electronic payments the week of May 5, 2014; duplicate payments by paper check went out May 9. 

If your practice receives one of the 500 demand letters Novitas mailed, you must refund the full amount of the overpayment within 15 days of the date of the letter. If you don't, Novitas will recoup the amount from future payments to you. After 30 days from the date of the letter, Novitas will begin charging interest on the unpaid balance as well.

If you disagree with Notivas' demand for repayment, the normal Medicare appeals process does not apply. Contact the Quality Net Help Desk at (866) 288-8912 immediately. 

Do notify Notivas about certain rejected vaccine claims for hospice patients. CMS now says it will allow (PDF) professional claims containing modifier GW for vaccines (influenza, PPV, and hepatitis B) and vaccine administration when the date of service falls within a hospice election.  

Novitas will adjust vaccine claims with dates of service on or after Oct. 1, 2013, which it previously had rejected due to a hospice election, if you bring such claims to Novitas' attention by filing a redetermination using this form.

Read more about billing Medicare for hospice payments.

Do, when appropriate, bill Medicare for a 12-month supply of antigens. CMS has revised its policy regarding payment for a "reasonable supply" of antigens. The revised policy says: "The associations of allergists that CMS consulted advised that a reasonable supply of *antigens is considered to be not more than a 12-month supply of antigens that has been prepared for a particular patient at any one time." Previously the limitation was 12 weeks.

See the policy in full in Publication 100-02, Medicare Benefit Policy Manual Chapter 15 (PDF)  Covered Medical and Other Health Services (go to section 50.4.4.1  Antigens).

Do, if you are a Part A home health agency (HHA) certifying physician, look for ordering and referring denial edits to apply to you. Effective July 7, 2014, CMS will apply Phase 2 ordering and referring denial edits to certifying physicians of Part A HHAs. Currently the edits apply only to the attending physician of an HHA. The edits will ensure that in addition to the attending physician, the certifying physician meets the following requirements:

  • Valid individual National Provider Identifier,
  • Specialty type eligible to order and refer HHA items and services, and
  • Enrolled in Medicare in an approved or opt-out status.

 For more information, see:

Do, if needed, unlock your Medicare Identity & Access Management (I&A) System accounts after three unsuccessful attempts at logging in by resetting your password via the "Forgot Password" prompt. "Forgot Password" will allow you three attempts to correctly enter the user information associated with your account. After three unsuccessful attempts, you will be directed to contact the External User Service Helpdesk at (866) 484-8049 or EUSsupport@cgi.com.

Not sure of your password?  Skip the steps above and select "Forgot Password" before trying to log on. You will be given the option to answer three of your security questions orenter personal information.

I&A controls access to the Provider Enrollment, Chain and Ownership System (PECOS), National Plan and Provider Enumeration System, and Medicare and Medicaid Electronic Health Record Incentive Programs.

Don't send paper claims and other correspondence to Novitas' old mailing addresses. The post office is no longer forwarding items to Notivas from its old addresses but is returning them to the sender. Be sure to use current Novitas addresses

Don't use the old CMS-1500 claim form anymore. That's the one with a date of 08-05 in the lower right hand corner, which Novitas will return to you without payment. Use the new form dated 02-12. The National Uniform Claim Committee explains the changes in this presentation.

Don't submit an outdated electronic data interchange (EDI) enrollment form to Novitas. As of July 1, 2014, Novitas' EDI Services will return all EDI forms it receives that are not current. The current form is dated 01-14, shown in the lower left-hand corner of the form. Novitas recommends completing the form online, then printing and faxing it, as indicated on the form, to avoid errors commonly found on handwritten forms. Get the current forms on the Novitas website. If you have questions about EDI enrollment, call EDI Services at (855) 252-8782. 

Don't look for results of ICD-10 end-to-end testing. Due to the ICD-10 implementation delay, CMS canceled its scheduled testing for the week of July 21-25, 2014. 

Published May 14, 2014

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