Medicare

 

  • New Medicare Beneficiary Cards -  Beginning April 1, 2018, Medicare patients will be assigned new Medicare cards with the new Medicare Beneficiary Identifiers (MBI). The new MBI replaces the social security number-based Health Insurance Claim Number (HICN). Texas Medicare beneficiaries will begin receiving the new replacement cards after June 1, 2018, but beneficiaries new to Medicare will be issued cards with the new MBI beginning April 1, 2018. The old MBIs may continue to be used through the transition period April 1, 2018- December 31, 2019. More information can be found on the CMS MBI web page. The new MBI also requires that a new fax/mail cover sheet be used for submitting unsolicited PWK segments beginning April 2, 2018. 

  • The Medicare Access and CHIP Reauthorization Act of 2015 repealed the Sustainable Growh Rate (SGR) and replaced it with the Medicare Quality Payment Program (QPP).

 

  • Billing for Dual Eligibles -The Qualified Medicare Beneficiary (QMB) program is a Medicaid program that helps very low-income dual eligible beneficiaries (individuals who are enrolled in both Medicare and Medicaid) with Medicare cost-sharing. Federal law protects QMBs from any cost-sharing liability and prohibits all original Medicare and Medicare Advantage providers, including those who do not accept Medicaid, from billing QMB individuals for Medicare deductibles, coinsurance, or copayments. All Medicare and Medicaid payments that physicians receive for furnishing services to a QMB individual are considered payment in full. For additional information, see the  MLN Matters notice, MLN Booklet, and the HCMS Dual Eligibles web page.   

  • Chronic Care Management - This section provides information on how to bill for the Chronic Care Management codes, patient eligibility how to get started and more. 


  • Medicare Reiumbursement – 2018 - This section contains information on topics that impact physicians reimbursement. Topics include: payment rules for physicians, Medicare’s fee schedule (including links to RVU files), Sequester Cuts, Dual Eligibles and etc.

 

 

  • Novitas Appeals Inquiry Status Tool - This tool allows for you to search redeterminations and appeals online. Go to the Novitas website. Click on Jurisdiction H. On the left-hand side menu, hover over "Appeals", then select "Status of My Appeal".