Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 883 Date: April 22, 2011

Transcription

1 anual ystem Pub One-Time Notification Department of ealth & uman ervices (D) enters for edicare & edicaid ervices () Transmittal 883 Date: pril 22, 2011 hange equest 7327 UBJT: T Overpayment Data ollection oordination between, and the NL. UY O NG: The purpose of this is to request the shared system maintainers ( and ) to provide additional data to the NL. This data will be populated on the monthly payment file within the NL and are necessary to the PD to ensure payment integrity and to have the correct demand address and contact information for overpayment collections. TV DT: October 1, 2011 PLNTTON DT: October 3, 2011 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. owever, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. NG N NUL NTUTON: (N/ if manual is not updated) =VD, N=NW, D=DLTD-Only One Per ow. /N/D N/ PT / TON / UBTON / TTL. UNDNG: or iscal ntermediaries (s), egional ome ealth ntermediaries (s) and/or arriers: No additional funding will be provided by ; ontractor activities are to be carried out within their operating budgets. or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements. V. TTNT: One-Time Notification *Unless otherwise specified, the effective date is the date of service.

2 ttachment One-Time Notification Pub Transmittal: 883 Date: pril 22, 2011 hange equest: 7327 UBJT: T Overpayment Data ollection oordination between, and the NL ffective Date: October 1, 2011 mplementation Date: October 3, GNL NOTON. Background: Title V of Division B of the merican ecovery and einvestment ct of 2009 () (Pub. L ) amends Titles V and of ocial ecurity ct (the ct) by establishing incentive payments for ligible Providers (Ps) and hospitals to promote the adoption and meaningful use of ealth nformation Technology (T) and qualified lectronic ealth ecord (s). The expanded use of T and s is considered essential in order to significantly improve both the quality and value of merican health care. ollectively, these provisions, together with Title of Division of, are termed the ealth nformation Technology for conomic and linical ealth ct (T ct). The incentive payments are part of a broader effort under the T ct to accelerate the adoption of T and the utilization of qualified s; importantly, the incentive programs outlined in Division B Title V of the T ct are considered to be the keys to inducing providers to actively utilize T. Ps and eligible hospitals are eligible for the incentive payments if, among other requirements, they meaningfully use certified technology. eaningful use is a term defined by and describes the use of T that furthers the goals of information exchange among health care professionals. estimates that the total number of edicare Ps that will register as meaningful users of T will be 33,800 to 115,800; up to 50,000 edicare Ps may register to participate in the first year of the T initiative. further estimates that the total number of participating hospitals and ritical ccess ospitals (s) will be approximately 4600 with up to 2136 participating in the first year. B. Policy: Due to the need for to maintain separate accounting for all appropriated T funds, has determined that T payments will be made through a Payment ile Development ontractor (PD) in coordination with one of the two current edicare banks. Tasking the PD and the edicare bank with making T payments eliminates the need to make shared system changes to manage and account for these funds. n addition, it consolidates payment, tracking, and T fund management/accounting into a single source which is necessary to effectively manage and disburse these appropriations. The provider registration and verification of eligibility for T incentive payments will be managed through the National Level epository (NL); the NL will be hosted at a nterprise Development enter (D). The NL is the designated system of records for the T initiative that will contain all provider registration/attestation documentation, banking information for each recipient, calculate the recipient payments amounts, verify meaningful use, check for duplicate payments, and maintain the incentive payment history files. The iscal ntermediaries (s), arriers, edicare dministrative ontractors (s), and various edicare systems will interface with the NL to provide information related to allowed charges, hospital payment amounts, the recipient name, National Provider dentifier (NP)/ ertification Number (N)/Taxpayer

3 dentification Number (TN), and banking/payment details for each recipient [account/routing numbers for lectronic unds Transfer (T) deposits and an address for paper checks]. The NL will compile a single file from these data with complete payment information on all eligible recipients for each monthly payment cycle in an agreed upon format that can be downloaded from the NL. The PD will develop two separate files from this NL file: 1) the National utomated learinghouse ssociation (N) standard 820 format ( Payment Order/emittance dvise) payment file that shall be sent to the edicare bank for processing T payments; and 2) a positive pay paper check payment file that the PD shall use to disburse paper checks. estimates that approximately 25,000 of the 50,000 edicare Ps registering in the first year do not have electronic banking information on file with and are currently receiving edicare payments by paper check. is requiring the PD to issue paper check payments to providers that do not receive their T payments through T deposits during the first year of eligibility. The PD will make payments on a monthly cycle (scheduled to occur on or about the 15 th day of each month) to all eligible edicare hospitals, s, and Ps that are listed on the payment file downloaded from the NL. fter the payments are made, the PD will update the payment history file in the NL with the payment status for all recipients on the monthly payment file. The purpose of this is to request the shared system maintainers ( and ) to provide additional data to the NL. These data shall be populated on the monthly payment information file within the NL and are necessary to the PD to both ensure payment integrity and to have the correct demand address and contact information for overpayment collections.. BUN QUNT TBL Number equirement esponsibility (place an in each applicable column) / D hared- ystem OT B aintainers The hared ystems aintainers shall provide additional information that is sent back to the NL when the edicare ontractors receive an ncentive U file from the NL identifying Ps and hospitals who are meaningful users of technology The hared ystems aintainers shall send the following correspondence data as available to the NL: V W orrespondence ddress 1 orrespondence Phone Number Practice ax Number Practice mail The hared ystems aintainers shall send the Payee Demand Letter ddress to the NL following the G flag hierarchy in determining where to address demand

4 Number equirement esponsibility (place an in each applicable column) / D hared- ystem OT B aintainers letters. V W The system shall first read the Pay-to- ddress section on the Provider aster file for the 'G' flag and performs the following logic: When the 'G' flag contains the value of 1 on the Pay-to-ddress, print the Pay-to-ddress on the T letter in the Provider ddress section. When the 'G' flag contains the value of spaces on the Pay-to-ddress and the Physical/Practice contains the value of 1, print the Physical/Practice ddress on the Provider aster file. When the 'G' flag contains the value of spaces, on both the Physical/Practice ddress and the Pay-to-ddress, print the Physical/Practice ddress on the T letter in the Provider ddress section The hared ystems aintainers shall send the following data to be sent to the NL: Do Not orward (DN) indicator The system shall send a Y/N flag to the NL for DN files. Y- Provider on DN N- Provider not on DN The hared ystems aintainers shall add the following statuses to the payment type field to be sent to the NL: - nitial djustment - inal eopen P - ppeal eopen. POVD DUTON TBL

5 Number equirement esponsibility (place an in each applicable column) / B D hared- ystem aintainers OT None V W V. UPPOTNG NOTON ection : or any recommendations and supporting information associated with listed requirements, use the box below: -ef ecommendations or other supporting information: equireme nt Number n updated schema will be provided to the prior to development ddress Line 1 (55) equired - inimum 1 character ddress Line 2 (55) Optional - f entered minimum 1 character ity Name (30) equired inimum 1 character tate (2) equired 2 character tate abbreviation Zip5 (5) equired 5 character Zip ode Zip4 (4) Optional f entered require 4 characters Phone Number Optional aximum 15 characters Phone Number xtension Optional aximum 15 characters DN (1) equired 1 character ection B: or all other recommendations and supporting information, use this space: N/ V. ONTT Pre-mplementation ontact(s): Theresa Jones-arter, T Overpayment Lead theresa.jones-carter@cms.hhs.gov Wayne. laughter, PD OT/PO wayne.slaughter@cms.hhs.gov (410) Post-mplementation ontact(s): ontact your ontracting Officer s Technical epresentative (OT) or ontractor anager, as applicable. V. UNDNG ection : or iscal ntermediaries (s), egional ome ealth ntermediaries (s), and/or arriers: No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets.

6 ection B: or edicare dministrative ontractors (s), include the following statement: The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.