4th Quarter FY11 Written Correspondence FAQs

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  1. What information is needed to request a duplicate remittance advice (RA) from Medicare?
  2. I have had trouble getting information from the CMS Secured Network Access Portal. Is there a number I can call to get technical help?
  3. We are a Critical Access Hospital (CAH) and are providing patients with cardiac rehabilitation services. Should these services be billed monthly or daily?
  4. Common Working File (CWF) is showing the wrong date of death. How can I get this information updated?
  5. Would it be appropriate to file an appeal on a claim that denied for overlapping a Health Maintenance (HMO) period?
  6. Several claims that previously processed through the system were cancelled by CWF because of an incorrect discharge status. We indicated that the patient was being discharged to home but they actually went to a SNF. We are not always aware that the patient is being discharged to the SNF; therefore, the claim is coded as if the patient is being discharged to home. Are there steps that we can take to help reduce these cancels?
  7. I have a claim that rejected for reason code V8022 because outpatient physical therapy (PT) services were over the therapy limit. The claim should have been billed with a KX modifier indicating that continued PT services were reasonable and necessary. How can I get these claims to process?
  8. What documentation is needed for proof of timely filing?
  9. Where can we obtain a letter of Medicare eligibility for a beneficiary?
  10. If I receive a demand letter from a Recovery Audit Contractor (RAC) because a service didn't meet Medicare's medical necessity criteria for an inpatient level of service, can we re-bill all the services on an outpatient claim?

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  1. What information is needed to request a duplicate remittance advice (RA) from Medicare?

    Providers that need to obtain a duplicate remittance advice (RA) will have the following options for obtaining duplicate electronic or paper copies:

    • Providers can safely and securely request and view duplicate remittance advices on demand over the Internet using the CMS Secure Net Access Portal (C-SNAP) portal. C-SNAP will instantly display your requested remits allowing you to view, search, and locally print remits in the convenience of your office. Duplicate remits are available for remits dated March 1, 2010, and after.
    • Providers that receive their remittance advice electronically have up to thirty days from the original electronic remittance advice (ERA) date to contact the Electronic Data Interchange (EDI) Area and request a duplicate electronic copy of their ERA. They can request this by calling the J5 EDI Hotline at (866) 503-9670.

    If the ERA is over 30 days old, we will not be able to provide an electronic copy. Instead, providers on ERA will have to mail or fax a request for a paper copy of their ERA. Providers can fax their duplicate remittance advice request to (402) 995-0604 or mail their request to the following address assigned for their state:

    IA KS MO NE
    WPS Medicare Part A
    General Correspondence
    P.O. Box 7665
    Madison, WI 53707-7665    		 WPS Medicare Part A
    General Correspondence
    P.O. Box 7576
    Madison, WI 53707-7576    		 WPS Medicare Part A
    General Correspondence
    P.O. Box 8890
    Madison, WI 53708-8890    		 WPS Medicare Part A
    General Correspondence
    P.O. Box 8799
    Madison, WI 53708-8799
    • Providers that receive a paper remittance advice should mail or fax their requests for duplicate remittance advices to the same address provided for item #1 above.
    • Requests mailed and faxed must contain the following information:
      1. Provider number
      2. Provider name
      3. Requestor's name
      4. Provider's phone number
      5. RA date

    We are not able to fax the requested RA back to providers. It will be mailed to the Remittance Advice (RA) address within the Fiscal Intermediary Standard System (FISS).

    CMS regulations allow contractors 45 business days to respond to written inquiries. Depending on current workloads, your request may be handled sooner.

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  1. I have had trouble getting information from the CMS Secured Network Access Portal. Is there a number I can call to get technical help?

    Yes, CMS Secured Network Access Portal (C-SNAP) customer support is available 8:00 am to 12:00 pm and 1:00 pm to 4:00 pm CT, Monday thru Friday. Please call (866) 886-2891 with C-SNAP technical questions or C-SNAP enrollment problems.

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  1. We are a Critical Access Hospital (CAH) and are providing patients with cardiac rehabilitation services. Should these services be billed monthly or daily?

    Only facilities that are subject to OPPS are required to bill repetitive services monthly, Since CAH are not subject to OPPS they do not have to bill monthly.

    Publication 100-4, Chapter 1Adobe Portable Document Format, Section 50.2.2.

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  1. Common Working File (CWF) is showing the wrong date of death. How can I get this information updated?

    If the beneficiary is still alive, the beneficiary or a family member would need to contact the Social Security Administration (SSA). The phone number for Social Security Administration (SSA) is 1-800-772-1213.

    If the beneficiary is deceased, the provider should submit a certified copy of the death certificate to our office. Our office will then contact the Social Security Administration (SSA) and/or the Common Working File (CWF) as appropriate.

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  2. Would it be appropriate to file an appeal on a claim that denied for overlapping a Health Maintenance (HMO) period?

    An appeal is not appropriate. When a patient has chosen an HMO option C, their regular Medicare coverage is completely replaced by coverage provided under the HMO option C coverage. Providers must bill the beneficiary's correct insurance for payment. If a patient states that the HMO is terminated but Common Working File (CWF) still shows the HMO is valid, the beneficiary will need to contact the HMO to have the information updated on CWF before Medicare can process any claims as Medicare Primary.

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  3. Several claims that previously processed through the system were cancelled by CWF because of an incorrect discharge status. We indicated that the patient was being discharged to home but they actually went to a SNF. We are not always aware that the patient is being discharged to the SNF; therefore, the claim is coded as if the patient is being discharged to home. Are there steps that we can take to help reduce these cancels?

    Providers should attempt to exhaust all resources in order to find out where a patient is being discharged from their facility prior to billing their claim. Unfortunately there will always be instances where a patient/provider may not know they will be admitted to another facility upon leaving the prior facility. In these cases there are no steps that can be taken without knowledge of the admission to the other facility. If you become aware of the admission to another facility, provider should correct their claim.

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  4. I have a claim that rejected for reason code V8022 because outpatient physical therapy (PT) services were over the therapy limit. The claim should have been billed with a KX modifier indicating that continued PT services were reasonable and necessary. How can I get these claims to process?

    If the claim meets criteria for an automatic exception, please submit an adjustment to add the KX modifier to the applicable line items on the claim.

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  5. What documentation is needed for proof of timely filing?

    The documentation that is required for timely is, a statement from the beneficiary, his/her representative or the provider, depending on whom the error directly affected, as to how he/she learned of the error, and when it was corrected, and one of the following:

    • A written report by the agency (Medicare, SSA, carrier, FI) based on agency records, describing how its error caused failure to file within the usual time limit; or
    • Copies of an agency letter or written notice reflecting the error, or
    • A written statement of an agency employee having personal knowledge of the error. Publication 100-4, Chapter 1Adobe Portable Document Format, Section 70.7.1.

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  1. Where can we obtain a letter of Medicare eligibility for a beneficiary?

    WPS Medicare does not send out letters containing beneficiary eligibility. Providers or beneficiaries will have to contact Social Security (SSA) for information regarding eligibility in writing.

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  1. If I receive a demand letter from a Recovery Audit Contractor (RAC) because a service didn't meet Medicare's medical necessity criteria for an inpatient level of service, can we re-bill all the services on an outpatient claim?

    Providers can re-bill for Inpatient Part B services, also known as ancillary services, but only for the services on the list in the Benefit Policy Manual. That list can be found in Publication 100-2, Chapter 6Adobe Portable Document Format, Section 10.

    Rebilling for any service will only be allowed if all claim processing rules and claim timeliness rules are met. There are no exceptions to the rules in the national program. Normal timely filing rules can be found in Publication 100-4, Chapter 1Adobe Portable Document Format, Section 70.

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Page Last Updated: Monday, 30-Apr-2012 13:57:56 CDT