(Medicare Claims Processing Manual)

Spanish dates with be listed with numeric day, spelled -out month, and complete numeric year with de in betwee n the fields (e.g., 16 de septiembre de 2011).   B. Notice Title (10.3.3:A)   The notice descriptive tagline on Spanish MSNs run in two lines.   [The below figure is new.]   C. Notice Details (10.3.3:D)   The gray highlight box on Spanish MSNs the same width and 137 points height.  This will account for the length of the date being longer in Spanish.    D. Be Informed (10.3.3:F)   This subsection can accommodate one message from CMS of up to 375 characters (inclusive of spaces) in Spanish.  E. Foreign Language  Footer (10.3.3:J)   The Foreign Language Footer flash image on page 1 is not needed on Spanish MSNs and should be suppressed.   F. How to Report Fraud (10.3.5:C)   The third and final paragraph of this section contains a fraud- specific message from CMS. The message must be a maximum of 225 characters long (inclusive of spaces).   G. Your Messages from Medicare (10.3.5:G)   This subsection can accommodate up to four messages from CMS. First and second message fields must accommodate messages with a maximum of 20 0 characters each (inclusive of spaces) and third and fourth message fields must accommodate messages with a maximum of 250 characters each (inclusive of spaces). If there is not sufficient space to print all four messages on page 2, then just the first three messages should be printed.  H. CPT Code Descriptors   Spanish A/B MSNs shall use the HCPCS (level 1)/CPT consumer -friendly code descriptors. The service description has a maximum of 300 characters. Suppress the rest if the description runs longer.   Spanish DME MSNs shall use the HCPCS level 2 short 28- character code descriptors.   I. Claim Column Titles (10.3.6:D)   The claim column titles runs in 4 lines in the Spanish MSNs. The height is 50 points but the widths of columns stay the same. Content variati on and formatting stays the same as English.      J. Get More Details (10.3.8:B)   Due to restriction on space, the content area for this subsection begins (0, 0.97) or 8 points from the baseline of the Section Title subsection.  K. If You Need Help Filing Your Appeal (10.3.8:D)   See Exhibit 3.17 for alternate language for contact when the MSN mailing address is outside the 50 states.  L. Find Out More (10.3.8:E)   Due to space restraints, the Spanish MSNs do not have a header for Find Out More About Appeals subsection. Instead only the body content is listed as the last paragraph of the previous subsection, If You Need Help Filing Your Appeal (10.3.8.D).     M. File an Appeal in Writing (10.3.8:F)   Due to restriction on space, the content area for this subsection begins (0, 0.97).  This should top align with the Get More Details subsection in the left column.   If the contractor needs 5 lines for the mailing address, delete GR 4.1 space between step 7 and the MAC address to fit the gray box withi n the page.     FORMATTING  [GR 1] gray fill  [TH 3] subsection header  [GR 4.1] space after header  [TB 2.1] body text  [GR 4.1] space after header  [TB 2.2] step 1 [TB 2.1] body text  [GR 4.1] space after header  [TB 2.2] step 2 [TB 2.1] body text  [GR 4.1] space  after header  [TB 2.2] step 3 [TB 2.1] body text  [GR 4.1] space after header  [TB 2.1] fill in category  [GR 5] space after text  [GR 7] fill in box [GR 6] space after text  [TB 2.1] fill in category  [GR 5] space after text  [GL 7] fill in box  [GR 4.1] space after header  [TB 2.2] steps 4 -  7 [TB 2.1] body text  [TB 2.2] MAC address   N. Spanish RRB S MAC MSNs (10.3.12)   The Spanish RRB Part B MSNs follow the same content and specifications variations in this section. See Exhibit 3.9 for translations specific to RRB Part B MSNs.   30 - Exhibits  (Rev. 3210, Issued: 03- 03-15, Effective: 04- 16-15. Implementation: 04- 16-15)  Exhibits are only available electronically.  Click on this link to view them: http://www.cms.gov/Regulations -and-Guidance/Guidance/Manuals/Internet -Only -Manuals -IOMs -Items/CMS018912.html?DLPage=1&DLSort=0&DLSortDir=ascending After clicking  on the link, scroll down the webpage until you see Chapter 21 listed.  The Exhibits are directly below that.   30.1 - Exhibits of the Extended Family of MSNs in Black & White  (Rev. 3210, Issued: 03- 03-15, Effective: 04- 16-15. Implementation: 04- 16-15)  Exhibit 1.1 -  Part A, Inpatient  Exhibit 1.2 -  B of A  Exhibit 1.3 - Hospice  Exhibit 1.4 - Home Health  Exhibit 1.5 -  Part B, Assigned  Exhibit 1.6 -  Part B, Unassigned  Exhibit 1.7 -  DME, Assigned  Exhibit 1.8 -  DME, Unassigned  Exhibit 1.9 -  RRB Part B, Assigned   30.2 - Exhibits of Alternate Scenarios  (Rev. 3210, Issued: 03- 03-15, Effective: 04- 16-15. Implementation: 04- 16-15)  Exhibit 2.1 -  Duplicate MSN Header  Exhibit 2.2 -  Multiple Deductible Types on Part B MSN  Exhibit 2.3 -  Multiple Deductible Years and Benefi t Days on a Part A and Part  B of A  Combined  Exhibit 2.4 -  Provider List with Tag Exhibit 2.5 -  Provider Header Format  Exhibit 2.6 -  Multiple Dates and/or Providers Subtitle  Exhibit 2.7 -  Part A Inpatient None -Remain Benefit Days  Exhibit 2.8 -  Adjusted C laim Exhibit 2.9 -  Continued Claims with Continuation Box  Exhibit 2.10 -  Breaking Claims with Long Notes  Exhibits 2.11 -  Combined Claims, Part A Inpatient and  B of A  Combined  Exhibit 2.12 -  Combined Claims, Part B Assigned and Unassigned  Exhibit 2.13 -  Pay MSN  Exhibit 2.14 -  Non -Pay Envelopes  Exhibit 2.15 -  Pay Envelope & Envelope Liner  Exhibit 2.16 -  Part A Inpatient Claims with no claims on page 3  Exhibit 2.15 -  Part B Claims with no claims on page 3   30.3 - Exhibits of MSNs in Spanish  (Rev. 3210, Issued: 03 -03-15, Effective: 04- 16-15. Implementation: 04- 16-15)  Exhibit 3.1 -  Spanish Part A, inpatient  Exhibit 3.2 -  Spanish B of A  Exhibit 3.3 -  Spanish Hospice  Exhibit 3.4 -  Spanish Home Health (A)  Exhibit 3.5 -  Spanish Part B, assigned  Exhibit 3.6 -  Spanish Part B, unassigned  Exhibit 3.7 -  Spanish DME, assigned  Exhibit 3.8 -  Spanish DME, unassigned  Exhibit 3.9 -  Spanish RRB Part B, assigned  Exhibit 3.10 -  Spanish duplicate MSN header  Exhibit 3.11 -  Spanish m ultiple deductible types on Part B MSN  Exhibit 3.12 -  Spanish multiple deductible years and benefit days on a Part A Inpatient and  B of A  combined  Exhibit 3.13 -  Spanish provider list with tag Exhibit 3.14 -  Spanish fee line with large amount and none remain benefit days  Exhibit 3.15 -  Spanish adjusted claim  Exhibit 3.16 -  Spanish Pay MSN  Exhibit 3.17 -  Alternate language for SHIP Contact Info   30.4 - Exhibits of the Extended Family of MSNs in Color  (Rev. 3210, Issued: 03- 03-15, Effective: 04- 16-15. Implementation: 04- 16-15)  This chapters specifications are detailed for black & white printing.  Color printing is not being implemented at this time.  However, it is possible that MACs may be encouraged to print in color in the future.   In regards to the MSN, color refers to the usage of blue and black ink only.  The approved blue ink color for Centers for Medicare & Medicaid Services publications is PMS 300, in the Pantone Matching System.   For additional color specifications, please refer to the exhibits below.   Exhibit 4.1 -  Part A, Inpatient Color  Exhibit 4.2 -  Part B, Assigned Color  Exhibit 4.3 -  DME, Assigned Color   40 - General Information, Explanatory, and Denial Messages  (Rev. 3210, Issued: 03- 03-15, Effective: 04- 16-15. Implementation: 04- 16-15)  General Information (GI) messages are used on pages 1 and 2 of the MSN, under the Be Informed!  How to Report Fraud , and Your Messages from Medicare sections.  GI messages are messages that communicate important information about the Medicare program or that serve as important reminders to benefi ciaries.  CMS communicates which messages to use, and when to use them, via Technical Direction Letters (TDLs) or Change Requests (CRs).   Explanatory and Denial messages appear under the claims section of the MSN.  Their purpose is to concisely communicate  essential information to the beneficiary regarding claim determinations or to serve as an educational tool.  The MSN message file is found at the  hyperlink at the bottom of this section.  Messages are grouped in categories for ease of reference only.  Unl ess specific messages are specified in instructions by CMS, MACs should select and use the most appropriate message(s) for each situation to explain the action taken on a service, item, or claim.  MACs are instructed to use the most appropriate message for  each situation regardless of message category.   Use multiple messages as appropriate including ones grouped within different categories.  Use the message(s) which best explains the situation(s) in the claim.   All denied or reduced services must have an ex planation.  The BBA of 1997 requires the amount of Medicare payment for each service be included on all Part A Benefit notices, including the MSN and Notice of Utilization  (NOU.)  MACs use message 16.53 on all A/B MAC (A) or (HHH) generated notices with payments.  The MAC may combine add -on messages with existing messages to create a single message within its file.   Each message on the file is tied to an alphabetic code o n the MSN.  Print no more than three alphabetic codes per claim level and three alphabetic codes per service line.   Messages containing fill- in blanks may be left as blanks for filling in by the system or may be entered into the system with blanks pre -filled to create as many specific messages as there are fill -in situations.  The message numbering in this section does not have to be used in MAC message generating systems.   Certain messages are mandated.  These messages and the situations for which they are mandated are identified in the MSN message file at the hyperlink at the end of this section.  This does not eliminate the need to use other messages required by instructions elsewhere in the manual.   Beneficiary liability Add -on messages should be print ed in addition to denial and reduction messages for charges which the beneficiary is determined not liable.  Liability Add -on messages should print for denials or reductions such as:    Services that are part of another service or bundled code;