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Provider Enrollment: Submitting Revalidations via PECOS

Feb 20, 2:00 PM – 3:00 PM EST

NGSConnex Open Questions and Answers

Feb 22, 11:00 AM – 12:00 PM EST

Let’s Chat About Provider Enrollment Revalidation

Feb 22, 1:00 PM – 2:00 PM EST
 
 
 

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NGSMedicare.com for Part A providers

Medicare Part A facilities offer essential healthcare services to beneficiaries on an inpatient or outpatient basis.

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(MM10489) Remittance Advice Remark Code, Claims Adjustment Reason Code, Medicare Remit Easy Print and PC Print Update          

Posted Feb 20, 2018


(MM10488) Update to the Medicare Physician Fee Schedule Database - April 2018 Update          

Posted Feb 20, 2018


(MM10402) Healthcare Provider Taxonomy Codes April 2018 Code Set Update          

Posted Feb 20, 2018


(MM10397) Modifications to the Implementation of the Paperwork Segment of the Electronic Submission of Medical Documentation System          

Posted Feb 20, 2018


Monthly Top Ten EDI Edits: January 2018

Posted Feb 19, 2018

Go to All Production Alerts

NGS is experiencing a large volume of outpatient claims for dates of service in 2018 RTP with reason code 32404 (HCPC code not on file) as a result of changes made to the Fiscal Intermediary Standard System (FISS) system in the January 2018 release.


Date Reported

1/17/18

Status

Open

Provider Type(s) Impacted

Jurisdiction 6 and Jurisdiction K Part A

Date Resolved

Reason Code(s)

32404

Claim Coding Impact

N/A

Description of Issue

NGS is experiencing a large volume of outpatient claims for dates of service in 2018 RTP with reason code 32404 (HCPC code not on file) as a result of changes made to the Fiscal Intermediary Standard System (FISS) system in the January 2018 release.

National Government Services Action

NGS will be holding claims with dates of service 1/1/2018 and greater in which line level reason code 32404 is being received incorrectly on revenue lines 0300 thru 0319.

Provider Action

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

Proposed Resolution/Fix

2/1/2018: FISS is working on a fix for this issue. We will update the alert with the date of the fix once it is known.

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.

National Government Services is informing Part A providers of an issue involving claims that are again being rejected by the FISS system for CWF reason codes U6815, U6816, U6817 and U6818. As a result, Part A providers may be receiving inappropriate claim rejections for CWF reason codes: U6815, U6816, U6817 and U6818.



Date Reported

11/20/17

Status

Open

Provider Type(s) Impacted

Part A providers.

Date Resolved

Reason Code(s)

U6815, U6816, U6817, U6818

Claim Coding Impact

N/A

Description of Issue

National Government Services is informing Part A providers of an issue involving claims that are again being rejected by the FISS system for CWF reason codes U6815, U6816, U6817 and U6818. As a result, Part A providers may be receiving inappropriate claim rejections for CWF reason codes: U6815, U6816, U6817 and U6818.

National Government Services Action

No MAC action at this time.

Provider Action

No provider action is necessary at this time.

Proposed Resolution/Fix

1/9/2018: Systems issues have delayed the previously planned fix implementation date of 1/22/2018. NGS continues to closely monitor the status of this issue and will announce a new tentative resolutions date as soon as possible. Please continue to check the Production Alerts section of our website and Email Updates for additional status information.


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

Feb 20

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

Feb 22

11:00 AM – 12:00 PM EST
NGSConnex Open Questions and Answers

Feb 22

1:00 PM – 2:00 PM EST
Let’s Chat About Provider Enrollment Revalidation

Feb 28

12:00 PM – 12:45 PM EST
Wellness Wednesday: Ultrasound Screening for Abdominal Aortic Aneurysm

Mar 7

9:00 AM – 10:00 AM EST
Let’s Chat about Provider Enrollment Revalidation
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