Noridian’s Medicare Part B Provider Outreach Update

Noridian’s Medicare Part B Provider Outreach and Education Department has provided an update for WMS members below.  Noridian and CMS look to Associations to help facilitate communication of the following items to our members. This month’s update includes:

Redeterminations Submitted in Noridian Medicare Portal: Providers are encouraged to submit their redetermination requests and associated documentation through our portal. This prevents the requests from being dismissed for missing the signature and bypasses the time for postal delivery. When the redetermination is finalized, the paid/favorable adjustments are included in remittance advices. The partially/fully unfavorable decision letters are available in the portal’s appeal status feature. If a redetermination is submitted in the portal, the decision letters are not mailed; providers can access them right away through the portal. Learn More!  JF Appeals

Medicare After Hours: Based on the attendance trend so far this year; Noridian’s Education & Outreach team will extend the events only for Part B through December 2017. Upcoming events include Modifier 59, National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), Influenza Roster Billing, etc. Please visit our website under Education & Outreach to sign up to attend the 8:00 p.m. CST after hours webinars. Learn More! JF Schedule of Events

Incident To Services: Medicare pays for services rendered by employees of a physician or a physician-directed clinic only when all ‘incident to’ criteria are met. Medicare classifies Non-Physician Practitioner (NPPs) to include Physician Assistant (PA), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Nurse Midwife (CNM), Registered Nurse (RN), Licensed Practical Nurse (LPN), Pharmacist and a Medical Assist (MA). It is important that services rendered must be within the state’s scope of practice for that practitioner. If a physician is asking a NPP to do a procedure that is not within their scope of work, then it is not a billable service even if it is ‘incident to’. Learn More!  JF Incident to Services

Outsourced Calls: Noridian discovered communication between a provider’s office and their billing service may not always be clear. Noridian has encountered situations involving a provider using a billing service where the billing service then outsources the work to another company to call on the provider’s behalf regarding billing and posting of claims. Communication with the provider’s office and their billing company are important to ensure information is relayed correctly and the billing company has all the resources necessary to contact Medicare. Noridian has concerns with:

  • Longer call lengths when requested information is readily available to the provider
  • Security of Protected Health Information (PHI)
  • Prepared scripts with questions that often lead to information which is not necessary as it does not pertain to the reason for the call