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Provider Enrollment: Getting Connected to PECOS

May 22, 10:00 AM – 11:00 AM EDT

Website Navigation for Part A Providers

May 22, 10:00 AM – 11:30 AM EDT

Targeted Probe and Educate for Home Health Providers

May 22, 1:00 PM – 2:00 PM EDT
 
 
 

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Welcome to

NGSMedicare.com for home health + hospice providers

Medicare home health providers bring a wide array of skilled services directly to a patient’s residence to meet the needs of beneficiaries who are homebound. 

Medicare hospice agencies are dedicated to providing the highest level of comfort and care to beneficiaries diagnosed with terminal illnesses.

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Go to All News Articles

Now Available! NGSConnex MBI Lookup Tool

Posted May 21, 2018


(MM9598 Revised) Changes to the End-Stage Renal Disease Facility Claim (Type of Bill 72X) to Accommodate Dialysis Furnished to Beneficiaries with Acute Kidney Injury          

Posted May 21, 2018


(MM10622) International Classification of Diseases, Tenth Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations          

Posted May 21, 2018


(MM10620) RARC, CARC, MREP and PC Print Update          

Posted May 21, 2018


(MM10566) Implement Operating Rules - Phase III ERA EFT: CORE 360 Uniform Use of CARC, RARC and CAGC Rule - Update from CAQH CORE          

Posted May 21, 2018

Go to All Production Alerts

NGS is informing Part A home health providers of an issue causing overpayments. MSP home health final and LUPA claims are being overpaid. Claims received after 4/2/2018 and paid after 4/27/2018 are paying without consideration of the primary payment and obligated to accept as payment in full (OTAF) amounts.






Date Reported

5/17/18

Status

Open

Provider Type(s) Impacted

Part A MSP Home Health Providers


Date Resolved

Reason Code(s)

N/A

Claim Coding Impact

Part A MSP Home Health and Low Utilization Payment Adjustment (LUPA) Claims

Description of Issue

NGS is informing Part A home health providers of an issue causing overpayments. MSP home health final and LUPA claims are being overpaid. Claims received after 4/2/2018 and paid after 4/27/2018 are paying without consideration of the primary payment and obligated to accept as payment in full (OTAF) amounts.

National Government Services Action

NGS is awaiting further information from the FISS maintainer on a correction.

Provider Action

Please continue to check the Production Alerts section of our website and Email Updates for additional status information.


Proposed Resolution/Fix

5/17/2018: The FISS maintainer is aware of the issue and currently working on a correction, which is being tracked by us.

NGS is informing HHH providers of an issue involving claims that are incorrectly rejecting in the FISS for CWF reason codes U6815, U6816, U6817, U6818 and incorrectly suspending with reason code U6803. As a result, HHH providers may be receiving inappropriate claim rejections for CWF reason codes: U6815, U6816, U6817,U6818 and inappropriate claims suspensions for U6803.




Date Reported

11/20/17

Status

Open

Provider Type(s) Impacted

Home health and hospice providers.

Date Resolved

Reason Code(s)

U6815, U6816, U6817, U6818

Claim Coding Impact

N/A

Description of Issue

NGS is informing HHH providers of an issue involving claims that are incorrectly rejecting in the FISS for CWF reason codes U6815, U6816, U6817, U6818 and incorrectly suspending with reason code U6803. As a result, HHH providers may be receiving inappropriate claim rejections for CWF reason codes: U6815, U6816, U6817,U6818 and inappropriate claims suspensions for U6803.

National Government Services Action

No MAC action at this time.

Provider Action

Please continue to check the Production Alerts section of our website and Email Updates for additional status information.

Proposed Resolution/Fix

5/16/2018: NGS is awaiting pending instructions from the CMS on a potential fix. We will continue to monitor this carefully and post new information as soon as we receive instructions from CMS.

CMS has identified an issue with the implementation of CR 9911 which modified the Medicare RA for QMB claims to indicate the QMB status of patients and reflect zero cost-sharing liability.


Date Reported

10/1/17

Status

Open

Provider Type(s) Impacted

All Part A Providers

Date Resolved

12/8/17

Reason Code(s)

OA209

Claim Coding Impact

N/A

Description of Issue

CMS has identified an issue with the implementation of CR 9911 which modified the Medicare RA for QMB claims to indicate the QMB status of patients and reflect zero cost-sharing liability.

National Government Services Action

No MAC action at this time.

Provider Action

CMS has advised that Part A providers should no longer hold QMB-related claims. Claims previously held from 10/2/2017 through 12/7/2017, should now be submitted for processing. You are advised to take no further action on claims previously impacted by this issue; additional CMS instructions are pending and will be released as soon as possible.

Proposed Resolution/Fix

1/26/2018:  As per the above information, Part A impacted claims, previously held from 10/2/2017 through 12/7/2017, should now be submitted for processing. Providers are advised to take no further action on claims previously impacted by this issue, pending additional CMS instructions. Please continue to monitor this site for updated information, to be posted as soon as possible.

CMS has updated several NCDs, but these updates will not be effective within the FISS or the MCS until April, 2018. This alert applies to NCD 220.4 for Diagnostic Mammograms and also NCD 220.13 for Percutaneous Image-Guided Biopsy of the Breast, but other NCDs may be potentially impacted by coding updates. As we learn additional details, we will share more information.



Date Reported

11/30/17

Status

Open

Provider Type(s) Impacted

Part A and Part B Providers

Date Resolved

Reason Code(s)

N/A

Claim Coding Impact

N/A

Description of Issue

CMS has updated several NCDs, but these updates will not be effective within the FISS or the MCS until April, 2018. This alert applies to NCD 220.4 for Diagnostic Mammograms and also NCD 220.13 for Percutaneous Image-Guided Biopsy of the Breast, but other NCDs may be potentially impacted by coding updates. As we learn additional details, we will share more information.

National Government Services Action

NGS will initiate adjustments for impacted claims as of 4/2/2018 and adjustments will be completed within 45 days. NGS will complete deactivation of these edits by 12/29/2017.

Provider Action

Please continue to check the Production Alerts section of our website and Email Updates for further updates regarding this issue.

Proposed Resolution/Fix

12/22/2017: CMS has issued instructions for A/B MACs to temporarily deactivate the shared system edits associated with NCD 220.4 (Mammograms) and NCD 220.13 (Percutaneous Image-Guided Breast Biopsy) from 10/1/2017 through 4/1/2018. Edits will be reactivated on 4/2/2018. Any erroneously processed claims with dates of service 10/1/2017 through 4/1/2018 (processed on or after 10/1/2017) which contained the ICD-10 codes N63.11-N63.14, N63.21- N63.24, N63.31, N63.32, N63.41, N63.42 as the only payable diagnoses on the claims will be reprocessed.


National Government Services is informing Part A providers of an issue involving claims incorrectly returning to the provider with reason code 31162 when diagnosis Z006 is present in any diagnosis code field other than the second field.


Date Reported

4/5/17

Status

Open

Provider Type(s) Impacted

Outpatient providers

Date Resolved

Reason Code(s)

31162

Claim Coding Impact

N/A

Description of Issue

National Government Services is informing Part A providers of an issue involving claims incorrectly returning to the provider with reason code 31162 when diagnosis Z006 is present in any diagnosis code field other than the second field.

Part A claims may RTP in error with reason code 31162 if diagnosis Z006 is present in any diagnosis code field other than the second field.

National Government Services Action

No MAC action is required at this time.

Provider Action

No provider action is required at this time.

Proposed Resolution/Fix

11/28/2017 Update: National Government Services is updating Part A providers of an ongoing issue involving claims incorrectly RTP with reason code 31162 when diagnosis Z006 is present in any diagnosis code field other than the second field. CMS is working on a resolution; in the interim providers are advised to enter Z006 in the second field to facilitate claim processing.

Please watch the Production Alerts section of our website and Email Updates for additional information regarding this issue.

4/11/2017: A correction is in process and will be forthcoming.

Go to All Upcoming Education

May 22

10:00 AM – 11:00 AM EDT
Provider Enrollment: Getting Connected to PECOS

May 22

10:00 AM – 11:30 AM EDT
Website Navigation for Part A Providers

May 22

1:00 PM – 2:00 PM EDT
Targeted Probe and Educate for Home Health Providers

May 22

2:00 PM – 3:00 PM EDT
Provider Enrollment: Submitting Revalidations via PECOS

May 23

10:00 AM – 11:00 AM EDT
NGSConnex New User Orientation
Complementary Content