Ask the Contractor Teleconference

December 14, 2006

Topic: Revised CMS 1500 Claim Form

Questions & Answers

 

Question 1:   Is there a way to get a copy of the new 1500 form?

 

Answer 1:  We do have a copy on our online medicarenhic.com inside our billing guide. Click on Medicare NHIC.com.  Then click either on Medicare Part B California, or Medicare Part B New England.  At that point, go the Provider’s support,  from there, another drop down, select Publications, and it will list all of our Billing Guides.,

Question 2:   Where do we find the NPI for the referring providers?  Is there going to be a list like the UPIN registry that comes for the referring providers that refer patients into our facility?

Answer 2: That’s what we call the data dissemination. CMS has not given us final regulations on how that information will be released.  At this time, you must secure the NPI from your ordering/referring physicians themselves.

Question 3: How do you define the legacy number you referred to.  Is that the W number or is that the actual PIN?

Answer 3:  The Legacy number is the Provider Identification Number that you are currently using to bill Medicare.

Question 4:   Do we use both Legacy and the NPI number?

Answer 4: You can use both the Legacy and the NPI numbers on your billings until May 23, 2007.

Question 5: I’m gathering all the NPI numbers of all our specialists. Why do we need those numbers and  what is it going to be replaced with?

Answer 5: Actually, the NPI is a standard Unique Identifier that will replace the PIN and UPIN in all electronic transactions.

Question 6: When we bill Medicare as Secondary, do we have to do any changes or would it be just normal as Medi-cal?

Answer 6: The instructions will be basically the same.  There will be items on the claim form to accommodate your new  NPI as opposed to your old Medicare Legacy number.

Question 7: I’m a Nurse Practitioner, and I have a Medicare number (I’m actually a corporation) my billing address is a group practice none of whom bill Medicare.  Do I need two NPI numbers?

Answer 7: You can get one NPI number because that is your number and whatever group you link up to, they can use that NPI number for you.

 

 

 

Question 8: Is there an upgrade that would be coming for the new 1500 form?

Answer 8:Yes there is. The share system changes that are required are out on the website www.nucc.org/images/stories/pdf/change_log.pdf.   You may also visit the  CMS website (www.cms.hhs.gov) and review CR5060 for the changes.

Question 9: What do we do if we are unable to get an NPI number for the referring physician?  Is there going to be a generic one like OTH0000 for these numbers?

Answer 9: No, there will not be a surrogate UPIN.  We are striving for a standard unique identifiers with NPI  so they are going to have to release that information to you if they are going to do business with you and secondly, CMS is still working on how they will be releasing the information ( i.e., UPIN crosswalk) to the public. 

Question 10: Will the provider not get paid if they do not have the NPI number?

Answer 10: That is correct.

Question 11: Did you say that Item 24K will not be on the new form?

Answer 11: Yes. it has been replaced by Item 24J

Question 12: I do billing for a DME provider’s office for Speech generating  devices and we have to type descriptions for a lot of our miscellaneous E2599 products. Where will they go on the new form?

Answer 12: Item 19 will still be available for local use. Check with the DMERC for more detailed instructions.

Question 13: Do we need to use the new 1500 form to use both the NPI and the Medicare number for billing?

Answer 13: That is correct.

Question 14: If the CMS 12-90 is approved, is that what we’re going to use now? When can we start using the version 08-05?

Answer 14:  Actually, the revised CMS-1500 (08-05) version is approved and is ready to be used effective January 1, 2007.  The transition period is January through March 31st.  April 2nd, we will accept only the brand new claim form.  May 23, 2007 is the  NPI implementation deadline. 

Question 15: How do we procure the new 1500 claim form that has the NPI designation. 

Answer 15: Any government printing office that you secured your forms from in the past should be aware of this change. Refer to OMB 0938-0999.

 

 

 

Question 16: Can you just review Box 24-J again regarding the supervising physician – when to use and when not to use that NPI number?

Answer 16: In the case of the service provided incident to the service of the physician – non physician practitioner when the person who ordered the services is not supervising, enter the PIN of the supervisor in the shaded portion in item 24J.

Effective May 23, 2007 and later, do not use the shaded portion, enter the rendering provider’s NPI number in the lower portion. In the case of a service provided incident to the service of a physician or non-physician practitioner, when the person who ordered the service is not supervising, enter the NPI of the supervisor in the lower portion.

Question 17: If I had a referring physician listed in Item 17 who is not the supervising physician, then I would use the supervising in Box 24-J.

Answer 17: That is correct

Question 18: Is Item 19 used to indicate “date last seen” by referring doctor

Answer 18: In the case of therapy services  we do not require that information any longer.

Question 19: What is the Qualifier 1 C that goes in Item 24I?

Answer 19: The ID 1 C Qualifier is for Medicare and it tells our system to expect a PIN number to follow.  Remember, we are in a transition period when we will be allowing you to use your old Medicare legacy number as well as your NPI until May 23, 2007

Question 20: I heard rumors that we will not be able to use paper claims anymore and everything will be electronic.  Is that true and if so, when is the deadline for paper claims?

Answer 20: So far, we still have exceptions to the electronic billing requirements and therefore accept paper claims from those providers who meet the exception requirements.

Question 21: Did you say that none of the shaded areas are to be used on the revised form after May 23rd?

Answer 21: Yes that is correct.

Question 22: Is Item 24- C to be used at all?

Answer 22: No we do not use that space currently.

Question 23: When billing for laboratory services, do we need to require the UPIN number from the referring physician in box 24-J?

Answer 23: No.  Item 17 is for the name of the referring/ordering provider, Item 17A is for the UPIN and Item 17B is for the NPI. Remember Item 17A is obsolete after May 23rd and should be left blank .

Question 24: Is it necessary to have the phone number in Item 33 on the claim form?

Answer 24: It is not a requirement if your software cannot accommodate it, however, it does make it easier to have a phone number if we have to contact you. 

Question 25: In regards to Podiatry billing requirements-Is the primary care physician’s name and date last seen still required in Items 19 and 17?

Answer 25: Yes.  Billing instructions have not changed. We’re just switching to the NPI number as opposed to the PIN numbers.

Question 26: Item 32 refers to a service facility.  Will that confuse the submission of my claims if I do not have a service facility?

Answer 26: Any time you are rendering the services in a place other than the patients home that would be the service facility and the address should be indicated in Item 32. However, you don’t an NPI number in Box 32 for individual physicians. This only applies to certain facilities and mammography centers.

Question 27: Are they going to revise the form again to remove the shaded areas after May 23?

Answer 27: We have not heard of plans to revise the shaded areas.  If you go to www.nucc.org/images/stories/pdf/change_log.pdf- the organization that revised the form has indicated that the OMB approval is valid through June 2007. After that date, anything is possible.

Question 28: On Item 33 we put our facility name and we bill with our tax ID number.  Is that not going to be required in the shaded area?

Answer 28: You put your tax id in Item 25.  In Item  33, the shaded area should not be used after May 23, 2007.  Item Box 33-A should contain the NPI.

Question 29: It was mentioned earlier that there was an on-line course on the 1500 claim form.

Answer 29: Yes, there is an online course on http://www.medicarenhic.com/cal_prov/education_online.shtml

Question 30: I have two NPI numbers, one for my corporation, another one for my individual.  On the new form, I should put my corporation NPI in Box 33-A and  where do I put my individual NPI number? 

Answer 30: Put the individual NPI number in Item 24-J to show you are the rendering provider. 

Question 31: We use physical therapy assistants under the supervision of a physical therapist, Where would the supervising NPI number go on the form?

Answer 31: The physical therapy assistant should bill under the supervising physical therapist. The NPI number should be placed in Item 33A on the claim form.. 

3/08/2007