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The Centers for Medicare & Medicaid Services (CMS) is reviewing regulations that mandate how doctors and other practitioners document the services they provide. The focus is on the following:

  • Reducing unnecessary burden
  • Increasing process efficiencies
  • Improving the patient’s experience with their provider

CMS is beginning this process with evaluation and management services (office or outpatient visits). The goal is to increase the time providers spend with their patients and decrease the time spent documenting services. At the same time, CMS consistently seeks to reduce provider errors and unnecessary appeals.
CMS Administrator Seema Verma explained: “…we are moving the agency to focus on patients first. To do this, one of our top priorities is to ease the regulatory burden that is destroying the doctor-patient relationship. We want doctors to be able to deliver the best quality care to their patients.”
To see more information about the Patients Over Paperwork initiative, please visit the CMS website at https://www.cms.gov/About-CMS/story-page/patients-over-paperwork.html.
If you have questions about your Railroad Medicare coverage, you may call Palmetto GBA’s Beneficiary Contact Center at 800-833-4455, or for the hearing-impaired, call TTY/TDD at 877-566-3572. Customer service representatives are available Monday through Friday, from 8:30 a.m. until 7 p.m. ET. Visit Palmetto’s Facebook page at https://www.facebook.com/myrrmedicare/.
Visit Palmetto GBA’s free online beneficiary portal at www.PalmettoGBA.com/MyRRMed. This tool offers you the ability to access Railroad Medicare Part B claims data, historical Part B Medicare Summary Notices (MSN), and a listing of individuals you have authorized to have access to your personal health information.

The U.S. Railroad Retirement Board (RRB) will send out new Medicare cards that do not feature beneficiaries’ Social Security numbers in the coming weeks.
The Medicare Access and CHIP Reauthorization Act of 2015 required the Centers for Medicare and Medicaid Services (CMS) to develop a new card that does not have an individual’s Social Security number on it to cut down on the likelihood of identity theft.
The new Medicare cards instead have a randomly assigned 11-digit combination of numbers and upper-case letters and will no longer indicate the beneficiary’s gender.
When they receive their new Medicare card, beneficiaries should safely and securely destroy their old Medicare card and keep their new Medicare number confidential, the RRB said.
The new card and number will not affect Medicare benefits, and CMS has been working with medical providers to ensure a smooth transition, the RRB said..
A single exception involves people enrolled in a Medicare Advantage Plan, also known as Medicare Part C. These individuals will continue to use their plan’s identification card for access to Medicare benefits as these cards already have a unique identification number.
The RRB said it will mail the new Medicare cards to about 450,000 beneficiaries in early June. A railroad Medicare beneficiary who has a lost or damaged Medicare card can request a new one by calling the RRB at 877-772-5772 or going to the Benefit Online Services section of the agency’s website at www.rrb.gov.
Beneficiaries also can print out a new card at home by setting up an online account at www.mymedicare.gov. This feature will be available after their new card has been mailed.
For additional information, visit www.cms.gov/newcard.
An example of the new Medicare card can be accessed at this link.

Medicare is always working to fight fraud and abuse. With that, a new type of claim review has recently begun: a process called Targeted Probe and Educate, or ‘TPE’ for short.

How TPE works:

Palmetto GBA/Railroad Medicare will conduct data analysis and find providers whose billing may be very different from their peers. Palmetto will also look at providers who have been identified as having a high error rate (having filed claims that should not be paid, due to medical necessity issues, billing or coding errors, or ones that do not have sufficient documentation to support the service was rendered as billed).
Once a provider is identified, Palmetto will request records for 20 to 40 services, depending on how much the provider has billed to Railroad Medicare.
After the claims are reviewed, one of Palmetto’s clinical staff members will contact the provider by letter and by phone to go over their results and offer education on how to bill and document their services correctly. If the provider has a high error rate in the review, then Palmetto will ask for records for an additional 20-40 claims submitted for payment and follow the process outlined above. If the provider fails to improve again, then a last round of TPE is conducted. If the provider’s error rate is still unacceptable, they will be referred to Palmetto’s Benefit Integrity Unit for investigation. The same is true for providers who refuse to respond to the records requests.
However, if the provider makes an appropriate improvement, they can be removed from the TPE process for a period of time, and then rechecked later to be sure they are still in compliance.

If your provider has questions:

Your provider may have questions about this review process. If they do, please ask them to call our Provider Contact Center at 888-355-9165 and select Option 5. Customer Service Representatives can assist them in understanding the TPE process. All Medicare contractors are using the TPE process to review claims.
If you have any questions about your Railroad Medicare coverage, please call Palmetto’s Beneficiary Contact Center at 800-833-4455, Monday through Friday, from 8:30 a.m. to 7 p.m. ET. For the hearing impaired, call TTY/TDD at 877-566-3572. This line is for the hearing impaired with the appropriate dial-up service and is available during the same hours customer service representatives are available.
Palmetto also invites you to join their listserv/email updates. Just select the ‘Listservs’ link at the top of their main webpage at www.PalmettoGBA.com/RR/Me.

Palmetto GBA has introduced a new beneficiary portal, MyRRMed, where users will have access to claims data, historical Medicare Summary Notices and data on who they have authorized to have access to their private health information.

Portal Functions:

At this time, you can use the portal to access:

  • Status and details of your last 22 Railroad Medicare claims on file
  • Historical Medicare Summary Notices (MSNs)

You also can view a list of individuals with whom you have authorized Railroad Medicare to grant access to your healthcare information.

Creating an Account:

Accessing MyRRMed information is easy. Just click here to follow the link and enter the following information:

  • Your Medicare number (as printed on your Medicare card)
  • Your last name
  • Your first name
  • Your date of birth
  • The effective date for Part B (as printed on your Medicare card)

Once you have entered this information and it is verified within our files, you will create a user name and password.

Logging Into the Portal:

To enhance the security of Medicare data, the Centers for Medicare & Medicaid services (CMS) requires Palmetto GBA to adhere to several security requirements. Some of these security features require the user to verify their identity using their email address.
This is done through what’s called ‘Multi-Factor Authentication’, or ‘MFA’. MFA has the user log partially in, and then the system sends a ‘passcode’ (a unique and random set of numbers) to either your telephone by text or your email for you to enter on the portal access page. Upon each log in, users are required to enter an MFA code in addition to their password to access MyRRMed. CMS requires that Medicare contractors use MFA as a secondary level of security to protect beneficiary data.

When is the Portal Available?

MyRRMed is generally available 24 hours a day, seven days a week. However, certain functions are only available from 8 a.m. to 7 p.m. Eastern Time (ET). These include accessing claims data and MSNs.

Questions?

If you have questions about using the tool, please call Palmetto’s Beneficiary Contact Center at 800-833-4455, or for the hearing-impaired, call TTY/TDD at 877-566-3572. Customer Service Representatives are available Monday through Friday, from 8:30 a.m. until 7 p.m. EST.

Beginning Oct. 15 and running through Dec. 7, 2017, the open enrollment period allows Medicare-eligible patients the option of changing their coverage for 2018. Your 2018 Medicare & You Handbook should have arrived via the postal mail, and it’s important that you read this guide as you are making your decision. Every year, open enrollment is the chance to decide if you want to keep your current plan, or change to a Medicare Advantage Plan, or other health plans. If you were eligible for but not enrolled in Medicare Part B last year, you can sign up for coverage with Original Medicare or a Medicare Advantage Plan. Open enrollment is also the time to sign up for or change your prescription drug coverage, if you need to.
While the Part B premium and deductible have not yet been published, Part B (which includes Railroad Medicare) works as the following:

  • You pay a Part B premium each month (most people will pay a standard amount).
  • You may pay more if your adjusted gross income on your income tax return from two years ago is above a certain level.
  • For most services, you have a 20 percent copay.

If you need help determining the best plan for you, we encourage you to contact your State Health Insurance Program, also called ‘SHIP’. SHIP is available in all 50 states and U.S. territories. It may be called something slightly different in your state (California’s SHIP is called the ‘California Health Insurance Counseling & Advocacy Program’ (HICAP)). However, they function the same way. You can find the contact information for the SHIP in your state by visiting Palmetto GBA’s website at www.PalmettoGBA.com/RR/Me/SHIP.
If you have questions about SHIP, you can call Palmetto’s toll-free Beneficiary Customer Service Line at 800-833-4455, Monday through Friday, from 8:30 a.m. to 7 p.m. EST. For the hearing impaired, call TTY/TDD at 877-566-3572. This line is for the hearing impaired with the appropriate dial-up service and is available during the same hours customer service representatives are available.
Palmetto GBA invites you to join their listserv/email updates. Just select the ‘listservs’ link at the top of their main webpage at www.PalmettoGBA.com/RR/Me.

Whether a person is receiving Medicare through Social Security or through the Railroad Retirement Board (RRB), the patient may be vulnerable to identity theft due to the SSN/RRB Claim number being present on their Medicare card.
Soon, you won’t need to worry about someone obtaining your personal information from your Medicare card. Starting in April 2018, the Centers for Medicare & Medicaid Services (CMS), in conjunction with the RRB, will begin issuing new cards with a ‘Medicare Beneficiary Identifier’ or MBI. These cards will be sent in phases to existing Medicare beneficiaries, and by April 2019, all Medicare/Railroad Medicare cards will be free of personally identifiable information. This includes the removal of the gender and signature line.
Here is what an MBI will look like:

  • It will have 11 characters
  • The numbers will be generated randomly. Medicare considers them ‘non-intelligent’ numbers that don’t have any hidden or special meaning
  • It will be unique to each patient
  • It will contain capital letters (all letters with the exception of S, L, O, I, B and Z) and numbers (0-9)
  • The 2nd, 5th, 8th, and 9th characters will always be a letter, while
  • Characters 1, 4, 7, 10, and 11 will always be a number, and
  • The 3rd and 6th characters will be a letter or a number
  • There will be no dashes in the numbers on the card

To learn more about the layout of an MBI, please visit this CMS webpage: https://www.cms.gov/Medicare/New-Medicare-Card/Understanding-the-MBI-with-Format.pdf.
As you may have experienced, providers can’t always tell the difference between an SSN patient and a RRB patient. They may submit your claims to regular Medicare, instead of Railroad Medicare. To help providers know what patient they have, the new cards will have the RRB logo on them when applicable, so your doctor’s office will know where to submit claims.
This October, you will receive your 2018 Medicare & You handbook, which will contain additional information about the MBI change.
If you have a question about a claim, you may call Palmetto GBA’s Beneficiary Contact Center at 800-833-4455, or for the hearing-impaired, call TTY/TDD at 877-566-3572. Customer Service Representatives are available Monday through Friday, from 8:30 a.m. until 7 p.m. ET. You’re also encouraged to visit Palmetto’s website at www.PalmettoGBA.com/RR/Me.

Palmetto_rgb_webIt’s been on the news, and you may have heard about it: the Medicare appeals process is taking longer, specifically, at the Administrative Law Judge (ALJ) level. This article explains the five levels of appeals and provides information about the wait times for an ALJ hearing.
 
To begin, let’s look at the Medicare appeals process. The five levels are:

  1. Redetermination (first-level, performed at Railroad Medicare or your local Medicare Administrative Contractor for part A or durable medical products claims)
  2. Reconsideration (second-level, performed by a Qualified Independent Contractor/QIC)
  3. Hearing before an Administrative Law Judge or ALJ (which are independent from Medicare and are governed by the US Department of Health & Human Services (HHS))
  4. Review by the Medicare Appeals Council
  5. Judicial review in the U.S. District Court

Each level of appeal has certain timeliness standards. For a redetermination and reconsideration, contractors have 60 days to process an appeal request. For a third-level appeal, the guideline is the ALJ will generally conduct a hearing and render a decision within 90 days of the receipt of the hearing request. However, backlogs at the ALJ level are causing appeals to be processed, on average, in 819.4 days for Fiscal Year 2016 (from October 2015 to the present).
This problem with the untimely processing of appeals at the ALJ level is not new; however, the growing wait time has risen greatly since Fiscal Year (FY) 2012. The following trends show the average wait times by day at the ALJ level:

  • FY 2019 = 94.9 days
  • FY 2010 = 109.6 days
  • FY 2011 = 121.3 days
  • FY 2102 = 134.5 days
  • FY 2013 = 220.7 days
  • FY 2014 = 414.8 days
  • FY 2015 = 661.1 days
  • FY 2016 Average = 819.4 days

While the wait times average more than two years, HHS has been making beneficiary-submitted appeals a priority, “given that they often present emergent circumstances that must be promptly addressed,” as written on the Office of Medicare Hearings and Appeals (OMHA) Adjudication Timeframes webpage at http://www.hhs.gov/omha/important_notice_regarding_adjudication_timeframes.html.
It’s important to note that Medicare contractors, such as Palmetto GBA Railroad Medicare, do not have any connection to the ALJs and cannot assist in fast-tracking any appeals at the ALJ level.
For more information on this issue, you can visit the OMHA website at http://www.hhs.gov/omha.
If you have questions about your Medicare coverage, you may call Palmetto’s toll-free Beneficiary Customer Service Center at 800-833-4455, Monday through Friday, from 8:30 a.m. until 7 p.m. ET. For the hearing impaired, call TTY/TDD at 877-566-3572. You are also encouraged to visit the Palmetto GBA Railroad Medicare website at www.PalmettoGBA.com/RR/ME and their beneficiary Facebook page at www.Facebook.com/MyRRMedicare.

Palmetto_rgb_webThe Centers for Medicare & Medicaid Services (CMS) has released the 2016 Part B premium and deductible costs for 2016. Railroad Medicare processes claims for Part B services. 

The 2016 monthly premiums will remain unchanged for approximately 70 percent of Medicare beneficiaries. However, the remaining 30 percent will pay a different amount based on the following criteria:

  • those enrolling for the first time in 2016
  • individuals not receiving Railroad Retirement/Social Security benefits
  • those who are directly billed for their Part B premiums
  • those who have Medicare and Medicaid and Medicaid pays the premiums, or
  • individuals whose modified gross incomes from two years ago is above a certain threshold

For beneficiaries who meet one of those criteria, Part B premiums for 2016 will be based on their annual income in 2014.

Those filing individual tax returns with annual incomes (in 2014) noted here will pay the following in 2016:

  • less than or equal to $85,000 will pay $121.80 in 2016
  • greater than $85,000 and less than or equal to $107,000 will pay $170.50
  • greater than $107,000 and less than or equal to $160,000 will pay $243.60
  • greater than $160,000 and less than or equal to $214,000 will pay $316.70
  • greater than $214,000 will pay $389.80

Those filing joint tax returns with annual incomes (in 2014) noted here will pay the following in 2016:

  • less than or equal to $170,000 will pay $121.80  
  • greater $170,000 and less than or equal to $214,000 will pay $170.50
  • greater than $214,000 and less than or equal to $320,000 will pay $243.60
  • greater than $320,000 and less than or equal to $428,000 will pay $316.70
  • greater than $428,000 will pay $389.80

The rates are slightly different for married beneficiaries who lived with their spouse (at any time during the year) and file separate tax returns. Those filing separate tax returns with annual incomes (in 2014) noted here will pay the following in 2016:

  • Less than or equal to $85,000 will pay $121.80
  • Greater than $85,000 and less than or equal to $129,000 will pay $316.70
  • Greater than $129,000 will pay $389.80.

The Medicare Part B deductible will be increasing from $147 per year in 2015 to $166 per year in 2016. 

If you have questions about your Part B Premium, you can call the Railroad Retirement Board toll free at 877-772-5772 or for the hearing impaired (TTY) call 312-751-4701. General information can also be found at the RRB’s website at www.rrb.gov.

If you have questions about your Railroad Medicare coverage, you can call the Beneficiary Contact Center at 800-833-4455, or for the hearing impaired, call TTY/TDD at 877-566-3572. Customer Service Representatives are available Monday through Friday, from 8:30 a.m. until 7 p.m. ET.

RRB_seal_150pxThe Centers for Medicare & Medicaid Services has announced that the standard monthly Part B premium will be $121.80 in 2016. However, most Medicare beneficiaries will not see an increase in their monthly Part B premiums because of a “hold harmless” provision in the law. Under that provision, Part B premiums cannot increase for current enrollees if there is no cost-of-living increase in social security benefits.

As a result, those individuals will continue to pay a monthly premium of $104.90, the same amount as in 2015. About 70 percent of Medicare beneficiaries will not see their Part B premiums increase due to this provision. However, the higher premium amount will apply to new enrollees in the program, and certain beneficiaries will continue to pay higher premiums based on their modified adjusted gross income.

The monthly premiums that include income-related adjustments for 2016 will be $170.50, $243.60, $316.70, or $389.80, depending on the extent to which an individual beneficiary’s modified adjusted gross income exceeds $85,000 (or $170,000 for a married couple). The highest rate applies to beneficiaries whose incomes exceed $214,000 (or $428,000 for a married couple). The Centers for Medicare & Medicaid Services estimates that less than 5 percent of Medicare beneficiaries pay the larger income-adjusted premiums.

Beneficiaries in Medicare Part D prescription drug coverage plans pay premiums that vary from plan to plan. Beginning in 2011, the Affordable Care Act required Part D beneficiaries whose modified adjusted gross income exceeds the same income thresholds that apply to Part B premiums to also pay a monthly adjustment amount. In 2016, the adjustment amount ranges from $12.70 to $72.90.

The Railroad Retirement Board (RRB) withholds Part B premiums from benefit payments it processes. The agency can also withhold Part C and D premiums from benefit payments if an individual submits a request to his or her Part C or D insurance plan.

The following tables (click here) show the income-related Part B premium adjustments for 2016. The Social Security Administration (SSA) is responsible for all income-related monthly adjustment amount determinations. To make the determinations, SSA uses the most recent tax return information available from the Internal Revenue Service. For 2016, that will usually be the beneficiary’s 2014 tax return information. If that information is not available, SSA will use information from the 2013 tax return.

Those railroad retirement and social security Medicare beneficiaries affected by the 2016 Part B and D income-related premiums will receive a notice from SSA by December 2015. The notice will include an explanation of the circumstances where a beneficiary may request a new determination.  Persons who have questions or would like to request a new determination should contact SSA after receiving their notice.

Additional information about Medicare coverage, including specific benefits and deductibles, can be found at www.medicare.gov.

Palmetto_rgb_webWe all know the joke: if you have poor penmanship, you should become a doctor. 

Unfortunately, poor penmanship on patient notes and records can lead to claim denials, because if Medicare can’t read what the doctor wrote, we can’t know if the services were reasonable and necessary and meet all guidelines for coverage.

Medicare requires that the patient’s medical record be complete and legible, and it should include the readable identity of the provider and the date of service. With the inception of electronic records (the likely reason your doctor is now toting around a laptop computer), issues such as this are declining. However, they still present a problem when a claim is subjected to medical review.

What a doctor can do about this issue (if they have illegible handwriting):

  1. Have notes transcribed and then electronically signed by the doctor, when necessary
  2. Add amendments/corrections and delayed entries (only when needed) into medical documentation in the following way:
    •     Clearly and permanently identify the changes or corrections
    •     Clearly indicate the date and author of these changes or corrections
    •     Do not delete the original content in the record
  3. Provide an acceptable handwritten signature that meets Medicare guidelines.  These guidelines allow Medicare to look at the records and consider a ‘signature log’ or ‘attestation statement’ that identifies the author of the record, and there are specific ways a doctor who signs their name in a ‘scribble’ can meet the signature requirements.  These specific ways are identified on the CMS website, as well as the Palmetto GBA website for providers. If your doctor needs to know more about these methods, we encourage them to call our Provider Contact Center at 888-355-9165.

What you can do about the issue:

  1. If a claim denies due to illegible records, and your Medicare Summary Notice (MSN) indicates that you owe $0.00, do not pay your doctor for the service. If your doctor insists that you pay for a service in this situation (when the MSN says you don’t owe anything), call our Beneficiary Contact Center at 800-833-4455.
  2. If a claim denies and your MSN shows that you owe $0.00, it is not necessary to file an appeal. You can still file an appeal because it is your right to do so; however, you are not required when you are not liable.

If you have any questions about your Railroad Medicare coverage, please call our Beneficiary Contact Center at 800-833-4455, Monday through Friday, from 8:30 a.m. to 7 p.m. ET. We encourage you to sign up for email updates. To do so, click ‘E-Mail Updates’ on the top of our beneficiary website at www.PalmettoGBA.com/rr/me  to start the process. 

We also encourage you to visit our Facebook page at www.Facebook.com/MyRRMedicare.