(Medicare Claims Processing Manual)

PART A INPATIENT AND  B OF A,   SPECIFICATIONS   CONTENT   How to Report Fraud   If you think a facility or business is involved in fraud, call us at 1- 800-MEDICARE (1 -800-633- 4227).  Some examples of fraud include offers for free medical services or billing you for Medicare services you didnt get.  If we determine that your tip led to uncovering fraud, you may qualify for a reward.  {CMS fraud message of 18 5 characters (four lines of text) The first sentence may be bold, while the remaining text is roman, with occasional bits, such as  monetary figures or important words , highlighted in bold.}  PART B (ASSIGNED AND  UNASSIGNED), HOSPIC E, AND HOME HEALTH SPECIFICATIONS   CONTENT   How to Report Fraud  If you think a provider or business is involved in fraud, call us at 1- 800-MEDICARE (1 -800-633- 4227).   Some examples of fraud include offers for free medical services or billing you for Medicare services you didnt get.  If we determine that your tip led to uncovering fraud, you may qualify for a reward.   {CMS fraud message of 185 characters (four lines of text) The first sentence may be bold, while the remaining text is roman, with occasional bits, such as  monetary figures or important words , highlighted in bold.}  DME (ASSIGNED AND UN ASSIGNED) SPECIFICAT IONS   CONTENT   How to Report Fraud   If you think a supplier or business is involved in fraud, call us at 1- 800-MEDICARE (1 -800-633- 4227).   Some examples of fraud in clude offers for free medical services or billing you for Medicare services you didnt get.  If we determine that your tip led to uncovering fraud, you may qualify for a reward.   {CMS fraud message of 185 characters (four lines of text) The first sentence may be bold, while the remaining text is roman, with occasional bits, such as  monetary figures or important words , highlighted in bold.}  D. How to Get Help with Your Questions   GLOBAL SPECIFICATION S  POSITION   This subsection contains information of a fix ed size. It does not vary in overall width or length.   This subsection begins 19 points below the How to Report Fraud subsection. It is one -column or 259 points in width and 142 points in height.    FORMATTING   [GR 2.1] black rule  [GL 11] glyph [TH 3] subsection header, center vertically to glyph  [GR 4.2] space after glyph  [TB 1.2] phone number  [TB 1.1] body text  [GR 6] space between paragraph  [TB 1.2] TTY phone number [TB 1.1] body text  [GR 6] space between paragraph  [TB 1.1] body text [TB 1.2] SHIP phone number highlight   DYNAMIC RULES   This subsection contains three pieces of dynamic content: language in the first paragraph thats variable by extended -family member; a MAC ID number; and the SHIP phone number.  Body -text content in the first paragraph varies depending on which member of the extended family the MSN belongs to -  see the content specifications below.   The first paragraph also contains the printing MACs ID number, in order to assist in tracking and routing beneficiary calls to the Medicare call center.  This ID number is referred to on the notice as a customer -service code.   The final paragraph should contain the primary phone number for the State Health Insurance Office, corresponding to the state listed in the notice mailing address in Section 1.  The phone numbers for the SHIP offices can be found on the CMS website: http://www.medicare.gov/contacts/organization -search -criteria.aspx .   NOTE :  If the mailing address is that of the legal representative and the beneficiarys address indicates that the beneficiary lives outside of the 50 U.S. states and U.S. territories, then the final paragraph should be suppressed.   PART A INPATIENT, HO SPICE, HOME HEALTH, AN D B OF A,  SPECIFICATIONS   CONTENT   How to Get Help with Your Questions  1-800-MEDICARE (1 -800-633-4227)   Ask for hospital services Your customer -service code is {5 -DIGIT A/B MAC (A) ID CODE}.   TTY 1 -877-486-2048 (for hearing impaired)   Contact your State Health Insurance Program (SHIP) for free, local health insurance counseling. Call {10- DIGIT PHONE NUMBER FOR SHIP IN RECIPIENTS STATE OF RESIDENCE }.  Or, if the MSN mailing address is outside the 50 states:  How to Get Help with Your Qu estions  1-800-MEDICARE (1 -800-633-4227)   Ask for hospital services. Your customer -service code is {5 -DIGIT A/B MAC (A) ID CODE}.   TTY 1 -877-486-2048 (for hearing impaired)   PART B (ASSIGNED AND  UNASSIGNED) SPECIFI CATIONS   CONTENT   How to Get Help with Y our Questions  1-800-MEDICARE (1 -800-633-4227)   Ask for doctors services. Your customer -service code is {5 -DIGIT A/B MAC (B) ID CODE}.   TTY 1 -877-486-2048 (for hearing impaired)   Contact your State Health Insurance Program (SHIP) for free, local health insurance counseling. Call {10- DIGIT PHONE NUMBER FOR SHIP IN RECIPIENTS STATE OF RESIDENCE }.  Or, if the MSN mailing address is outside the 50 states:  How to Get Help with Your Qu estions  1-800-MEDICARE (1 -800-633-4227)   Ask for doctors services. Your customer -service code is {5 -DIGIT A/B MAC (B) ID CODE}.   TTY 1 -877-486-2048 (for hearing impaired)   DME (ASSIGNED AND UN ASSIGNED) SPECIFICAT IONS   CONTENT   How to Get Help with Your Questions  1-800-MEDICARE (1 -800-633-4227)   Ask for medical supplies. Your customer -service code is {5 -DIGIT DME MAC ID CODE}.   TTY 1 -877-486-2048 (for hearing impaired)   Contact your State Health Insurance Program (SHIP) for free, local health insurance counseling. Call {10- DIGIT PHONE NUMBER FOR SHIP IN RECIPIENTS STATE OF RESIDENCE }.  Or, if the beneficiarys pricing state is outside the 50 U.S. states and U.S. territories:   How to Get Help with Your Questions  1-800-MEDICARE (1 -800-633-4227)   Ask for medical supplies. Your customer -service code is {5 -DIGIT DME MAC ID CODE}.  TTY 1 -877-486-2048 (for hearing impaired)   E. Your Benefit Periods   This subsection is only for Part A Inpatient MSNs.  It can also be included in combined Part A Inpatient and  B of A MSNs.  It should be suppressed for Hospice, Home Health, Part B (assigned and unassigned), and DME (assigned and unassigned).   The Your Benefit Periods subsection may contain up to three dynamically generated content units, providing beneficiary -specific information related to inpatient hospital benefit days, inpatient lifetime reserve days, inpatient mental health care in a psychiatric hospital limit, and skilled nursing facility (SNF) benefit days.   Language variations exist to describe whether a beneficiary has used all their benefit days for a given type of claim period, or if benefit days remain.   See Exhibit 2.3 for examples of different scenarios regarding benefit periods.  POSITION   This subsection begins (3.9, 0.94).  This should top align with the How to Check This Notice subsection on the left column. It is one -column or 259 points in width with a variable height, dependent on dynamic content.     FORMATTING   [GR 2.1] black rule  [GL 12] glyph [TH 3] subsection header, center vertically to glyph  [GR 4.2] space after glyph  [TB 1.1] body text of intro paragraph [TB 1.2] text in bold [GR 3.1] dotted rule  [TB 2.2] headers for benefit period types [TB 1.1] beneficiary -specific dynamic data within benefit -period info [GR 3.1] dotted rule  [TB 2.2]  headers for benefit period types [TB 1.1] beneficiary -specific dynamic data within benefit -period info [GR 3.1] dotted rule  [TB 1.2] final paragraph   INPATIENT HOSPITAL DAYS   Content in the beneficiary -specific portion of this subsection is subject to the  following variations:    If a claim on the notice is for an inpatient hospital stay, and    The benefit period associated with the claim was still active on the notice date of the MSN -  because fewer than 60 days had passed between the last claimed date of stay in the benefit period and the notice date -  then this subsection should list how many covered benefit days remain in the benefit period; or    The benefit period associated with the claim is closed -  because more than 60 days had passed since the last claimed date of stay and the notice date -  then this subsection should indicate that the benefit period has ended.    There is no benefit period associated with the claim because it was rejected, therefore no benefit days were used.   The possible dynamic statements for inpatient hospital days are as follows:   You have {#} out of 90 covered benefit days  remaining for the benefit period that began {Month DD, YYYY}.  or  You have used all of your 90 covered benefit days for the benefit period that began {Month DD, YYYY}.   or  The benefit periods for all claims on this notice have ended.   or  You didnt have an active benefit period.   LIFETIME RESERVE DAYS   Content in the beneficiary -specific portion of this subsection is subject to the following variations:    If a cl aim on the notice is for an inpatient hospital stay and all inpatient hospital benefit days for the benefit period have been exhausted, and all or a portion of the claimed days have been paid using inpatient lifetime reserve days, and    The beneficiary stil l has some number of inpatient lifetime reserve days available, then this subsection should list the remaining inpatient lifetime reserve days the beneficiary had on the date of the notice; or    The beneficiary had exhausted all of their inpatient lifetime reserve days, then this subsection should indicate that all inpatient lifetime reserve days have been used.   The beneficiary did not use any inpatient lifetime reserve days because the claim was rejected.   The possible dynamic statements for inpatient lifetime reserve benefit days are as follows:   You have {#} out of 60 lifetime reserve days  remaining.   or  You have used all of your 60 lifetime reserve days.  or  You didnt have an active benefit period.   INPATIENT MENTAL HEALTH DAYS   Content in the beneficiary -specific portion of this subsection is subject to the following variations:    If a claim on the notice is for an inpatient mental health care in a psychiatric hospital stay, and    The beneficiary still has some number of lifetime mental health care days available, then this subsection should list the remaining lifetime mental health care days the beneficiary had on the date of the notice; or    The beneficiary had exhausted all of their lifetime mental health care days, then this subsection should indi cate that all lifetime mental health care days have been used.   The beneficiary did not use any mental health care days because the claim was rejected.   The possible dynamic statements for inpatient lifetime reserve benefit days are as follows:   You have {#} out of 190 mental health care days  remaining.   or  You have used all of your 190 mental health care reserve days.   or  You didnt have an active benefit period.   SKILLED NURSING FACILITY DAYS   Content in the beneficiary -specific portion of this subsect ion is subject to the following variations:    If a claim on the notice is for a skilled nursing facility (SNF) stay, and    The benefit period associated with the claim was still active on the notice date of the MSN -  because fewer than 60 days had passed bet ween the last claimed date of stay in the benefit period and the notice date -  then this subsection should list how many covered benefit days remain in the benefit period; or    The benefit period associated with the claim is closed -  because more than 60 days had passed since the last claimed date of stay and the notice date -  then this subsection should indicate that the SNF benefit period has ended.