Medicare - New Timely Filing Requirements

Timely Filing Requirements shortened for Medicare...

Under the new law, claims for services furnished on or after January 1, 2010 must be filed within one calendar year after the date of service.

In addition, claims for services furnished before October 1, 2009 to January 1, 2010, must be filed no later than December 31, 2010.

The law does permit the Secretary of HHS to make certain exceptions to the one-year filing deadline, but at this time no exceptions have been established. However, proposals for exceptions will be specified in future proposed rulemaking.

Iowa Medicaid - No more paper checks, No more Informational Letters

Effective July 1st - the checks won't be in the mail!

Effective July 1, 2010, Medicaid will no longer be sending out paper checks, in fact they won't be sending out any kind of paper thru the mail. These changes were made to reduce costs to the State.

Providers are encouraged to sign up NOW for EFT (electronic funds transfer) to avoid any possible grid lock when July 1st comes around. (This does not effect CDAC providers). Providers must fill out an EFT authorization form (form 470-4202) to set up the EFT payments. The form is available online at: www.ime.state.ia.us/Providers/Forms.html or by calling 800-338-7909 or locally in Des Moines at 256-4609. These forms, once complete can be faxed to 515-725-1155 or e-mailed to the address on the form.

Paper remittances will also disappear as well and will have to be downloaded from the IME website. Contact provider service at the numbers above for more information.

The "Informational Letters" that notify providers about various programs and policy changes will also have to be retrieved online at: www.ime.state.ia..us/Providers/Bulletins.html You can also sign up for theirs list serve which is very helpful

IME is telling providers if they don't have computer access, they can go to their local public library to access the internet...

WPS to start allowing providers to fax in re-openings and

re-determinations...

I have been working with WPS and CMS since early last fall on fax capabilities.

I am pleased to announce that Iowa is the first state in the WPS J5 Mac that will be able to fax in re-openings and re-determinations instead of mailing them. There are some guidelines that must be followed:

1. You MUST use the approved WPS fax cover sheet which can be obtained from the "forms" section of the WPS website, or at:

http://www.wpsmedicare.com/j5macpartb/forms/_files/ia_appealsfaxform.pdf

2. You MUST also submit either the re-determination or re-opening submission form as well.

3. You MUST only submit ONE item per form. The fax number is listed on the fax cover sheet and differs by State.

This is up and running currently.

Medicare to begin releasing payments:

On Friday, CMS notified carriers to start making payments on claims held with DOS 4/1/10 that had met the floor payment criteria.

There were massive amounts of claims being held. Carrier systems are unable to process these all at once, so they will begin processing claims at the system capacity on a daily basis until all claims have been processed. It could take up to a week to clear our some of the held claims, but all carriers are processing claims to capacity as of Friday.