1st Quarter FY12 Written Correspondence FAQs

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  1. What information is needed to request a duplicate remittance advice (RA) from Medicare?
  2. We are not receiving our hardcopy remittance advices (RA), how do we get this corrected?
  3. When is it appropriate to use the AY Modifier?
  4. If there is an open Worker's Compensation screen on the Common Working File (CWF), does it need to be closed if not Worker's Compensation related?
  5. 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?
  6. How long do providers have to adjust claims to add items and charges for outpatient claims?
  7. What documentation is needed for proof of timely filing?
  8. Can providers appeal claims that have been rejected for timely filing?
  9. What documentation is needed for proof of timely on Medicare retroactive effective dates?
  10. Would it be appropriate to file an appeal on a claim that denied for overlapping a Health Maintenance Organization (HMO) period?

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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 above.
    • Requests mailed and faxed must contain the following information:
      • Provider number
      • Provider name
      • Requestor's name
      • Provider's phone number
      • RA date

      We are not able to fax the requested RA back to providers. It will be mailed to the 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. We are not receiving our hardcopy remittance advices (RA), how do we get this corrected?

    Remittance Advices are sent out to the provider's address listed on our provider file. If your facility has not been receiving RAs, please check with our Provider Enrollment department at 1-866-734-9444 to verify or correct the mailing address on file.

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  1. When is it appropriate to use the AY Modifier?

    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.

    Effective January 1, 2011, section 153b of the MIPPA requires that all End Stage Renal Disease (ESRD) related drugs and biologicals be billed by the renal dialysis facility. When a drug or biological is billed by providers other than the ESRD facility and the drug or biological furnished is designated as a drug or biological that is included in the ESRD Prospective Payment System (PPS), the claim will be rejected or denied. In the event that an ESRD related drug or biological was furnished to an ESRD beneficiary for reasons other than for the treatment of ESRD, the provider may submit a claim for separate payment using modifier AY.

    Refer to Internet Only Manual (IOM) Publication 100-4 Chapter 8Adobe Portable Document Format, Section 60.2.1.1

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  1. If there is an open Worker's Compensation screen on the Common Working File (CWF), does it need to be closed if not Worker's Compensation related?

    No, put your claim information in remarks (not related to Worker's Compensation) and the Medicare Secondary Payer (MSP) department will work the claims. If the claim is worked incorrectly, refer to MSP to have the claim adjusted.

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  2. 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 IOM 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 IOM Publication 100-4, Chapter 1Adobe Portable Document Format, Section 70

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  3. How long do providers have to adjust claims to add items and charges for outpatient claims?

    Providers that need to add items or charges after January 1, 2010, have one year (These guidelines follow the time limitation for filing of the initial claim). The date used for adjustments, to determine if the claim is timely is the paid date from the original claim that processed.

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

    Medicare will consider claims for timely processing based on the date of receipt. Improperly completed claims that are returned to the provider are not considered for timely processing purposes until they are received back in our office properly completed. Documentation showing the claim was previously submitted in our system is needed (i.e., screen print of our system, 201 report). A list of exception rules on when an extension is allowed can be found in IOM Publication 100-04, Chapter 1Adobe Portable Document Format, Section 70 through 70.7.1.

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  5. Can providers appeal claims that have been rejected for timely filing?

    No, when a claim is denied for having been filed after the timely filing period, such denial does not constitute an "initial determination". As such, the determination that a claim was not filed timely is not subject to appeal.

    IOM Publication 100-04, Chapter 1Adobe Portable Document Format, Section 70.4

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  1. What documentation is needed for proof of timely on Medicare retroactive effective dates?

    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.

    IOM Publication 100-04, Chapter 1Adobe Portable Document Format, Section 70.7.1

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  1. Would it be appropriate to file an appeal on a claim that denied for overlapping a Health Maintenance Organization (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 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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Page Last Updated: Monday, 30-Apr-2012 13:57:57 CDT