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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.

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.

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.

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.

Palmetto_rgb_webFor many years, the Centers for Medicare & Medicaid (CMS) has funded programs to reduce claims payment errors (either paying too much, paying too little or payments being made when none should be).  Some of these programs are handled through systematic checks that look for anomalies and mismatched services, and some are handled through clinical reviews of specific claims. 

The program integrity initiatives pertaining to Railroad Medicare include:

Medically Unlikely Edits (MUEs) – These are systematic checks that look for claims that exceed the maximum number of services expected to be reported, in most cases, for a single patient by the same provider on a single day.

National Correct Coding Initiative (NCCI) Edits – These are also systematic checks, and they look for combinations of codes that should not be reported together in all or most situations.  Either we would not expect both services to occur in one treatment, or Medicare does not reimburse both services when performed together.  This could be two codes that represent different methods of performing the same service, such as a laparoscopic gallbladder removal and an open incision gallbladder removal.  It could also be two codes that are components of each other, such as a rhythm electrocardiograph (ECG) and a cardiovascular stress test, which by definition includes an ECG.

Medical Review Program – This initiative involves complex reviews by Medicare (including Railroad Medicare) in which documentation is requested, and then the reviews determine if the claim was correctly billed and properly documented, and that the services meet Medicare coverage criteria. 

Comprehensive Error Rate Testing (CERT) Program – This initiative involves complex reviews in the same manner as the Medical Review program.  External entities include the CERT Review Contractor, the CERT Documentation Contractor, and the CERT Statistical Contractor, and they work together to review a random sample of claims and determine an error rate for local Medicare, as well as Railroad Medicare.  They do this by:

  • Requesting medical records from providers who submitted claims
  • Reviewing claims and medical records for compliance with Medicare coverage, coding and billing rules

The CERT program calculates an improper payment rate, and it also develops an improper payment rate by claim type, to measure Medicare (and Railroad Medicare’s) performance processing claims correctly. 

Working together, these initiatives reduce the number of claims that are underpaid, overpaid or should never have been paid. 

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. Members can sign up for email updates. To do so, visit Palmetto’s website at www.PalmettoGBA.com/RR/Me and click ‘Email Updates’ on the top of the webpage to start the process. 

Visit Palmetto’s Facebook page at www.Facebook.com/MyRRMedicare.

Palmetto_rgb_webThe start of a new year is the time for resolutions. Railroad retirees covered under Medicare can receive the help they need in making some of their resolutions a reality.

According to USA.gov, the top three New Year’s resolutions are:

  1. Lose Weight
  2. Volunteer
  3. Quit Smoking

The year 2015 can be a year of change with the help of Medicare’s coverage of obesity counseling.

All Medicare patients with body mass indexes (BMI) of 30 or more are eligible for counseling if performed in a primary care setting – such as in a doctor’s office. When conducted in a doctor’s office, it can be coordinated with a personalized prevention plan. The patient will pay nothing for this service as long as the primary care provider accepts Medicare assignment. Patients should also ask questions if their doctor recommends other services to be sure that Medicare covers them.

Some of the covered counseling services include one face-to-face visit each week for the first month, one face-to-face visit every other week for months two through six, and then one face-to-face visit every month for the seventh through 12th months, as long as the patient has lost at least 6.6 pounds during the first six months.

Medicare is now covering counseling in a group setting for two to 10 people when conducted by providers in the following categories:

  1. General practice
  2. Family practice
  3. Obstetrics/Gynecology
  4. Pediatric Medicine
  5. Geriatric Medicine
  6. Nurse practitioner
  7. Certified clinical nurse specialist
  8. Physician’s assistant

Medicare is also tackling number three on the list of most popular New Year’s resolutions: quitting smoking. Smoking and tobacco-use cessation counseling is a benefit which offers up to eight face-to-face visits in a 12-month period for patients who have not been diagnosed with a smoking-related illness.

The counselor must be a qualified doctor or other Medicare-approved practitioner. The following resources are available to those considering quitting smoking:

For additional resources on smoking and tobacco cessation, visit Medicare’s webpage at http://www.medicare.gov/coverage/smoking-and-tobacco-use-cessation.html.

If you have questions about Medicare’s coverage of obesity counseling or smoking/tobacco-use cessation, call the Railroad Medicare Beneficiary Contact Center at (800) 833-4455. Representatives are available Monday through Friday from 8:30 a.m. to 7 p.m. ET.

Email updates are available on Medicare’s website at www.PalmettoGBA.com/RR/Me. To register, look for ‘email updates’ under the ‘Stay Connected’ part of the lower left-hand side of the webpage.

You may also receive updates through Twitter or Facebook called ‘My RR Medicare’ located at www.facebook.com/myrrmedicare.

Palmetto_rgb_webPalmetto GBA is conducting a Railroad Medicare Beneficiary Satisfaction Survey. The survey is designed to collect data on beneficiary satisfaction regarding its performance as Railroad Medicare’s contractor. The survey will be sent to a random sample of approximately 8,000 Railroad Medicare Beneficiaries.

The surveys will be included in an upcoming Medicare Summary Notice (MSN). Palmetto GBA is listening and wants to hear from you about the services we provide to you.

For additional information about the survey, click here.

Palmetto_rgb_webMental health conditions, such as depression or anxiety, can come at any age and can happen to anyone. They are nothing to be ashamed of. While they can occur at any time, stressful holidays and the let-down after the holidays often make these conditions worse.
With that in mind, it’s important to know that Railroad Medicare covers many mental health services (Medicare pays 80 percent while the patient pays 20 percent) after your annual deductible is met and when the service is provided by: a psychiatrist or other doctor, a physician assistant, a nurse practitioner, a clinical psychologist, a clinical social worker or a clinical nurse specialist.
Some of the covered services are

  • Annual screening for depression;
  • Individual and group psychotherapy with doctors, or certain other licensed professionals who are allowed by the state to offer these services;
  • Family counseling (if the main purpose is to help with your treatment);
  • Testing to find determine if you’re getting the services you need and/or if your current treatment is helping you;
  • Psychiatric evaluation;
  • Medication management;
  • Occupational therapy that’s part of your mental health treatment;
  • Individual patient training and education about your condition;
  • Diagnostic tests.

Talk to your doctor or health care provider if you feel you may be depressed or have any of these following symptoms (this is not an all-inclusive list):

  • Sad, empty, or hopeless feelings;
  • A lack of energy;
  • Trouble concentrating;
  • Difficulty sleeping or sleeping too much;
  • Little interest in things you used to enjoy;
  • Suicidal thoughts.

If you have questions about your Railroad Medicare coverage, you can call their toll-free Customer Service Line 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.
Visit Railroad Medicare’s Facebook page at https://www.facebook.com/myrrmedicare. Join Railroad Medicare’s listserv/e-mail updates. Just select the ‘E-Mail Updates’ in the ‘Stay Connected’ section on the lower left-hand side of our main webpage at www.PalmettoGBA.com/RR/Me.