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

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Prior Authorization Program Becomes Effective for Dates of Service on/after 7/1/2020

Posted May 22, 2020


NGS Telehealth Billing FAQs for COVID-19

Posted May 21, 2020


New PC-ACE Version Will Soon Be Available

Posted May 21, 2020


MLN Connects® for Thursday May 21, 2020

Posted May 21, 2020


MACs to Host Multi-Jurisdictional CAC Meeting Regarding Facet Joint and Medial Nerve Branch Procedures

Posted May 21, 2020

Go to All Production Alerts

Some Accelerated Payments Showing Incorrect Positive Value


Date Reported

4/22/20

Status

Closed

Provider Type(s) Impacted

J6 and JK Providers

Date Resolved

4/26/20

Reason Code(s)

N/A

Claim Coding Impact

N/A

Description of Issue

Some X12 835 ERA files are showing accelerated payments as positive values in the PLB segment (provider adjustment). The accelerated payments should be showing as a negative value which increases the payment to the provider in the remittance file only.

National Government Services Action

4/22/2020: Listserv was sent to J6 and JK provider community to alert them of positive accelerated payment amounts that are not impacting actual payments. National Government Services is actively working on a fix.

4/26/2020: NGS implemented a fix and the issue is now resolved. Accelerated payments will now show as a negative value on any X12 835 ERA files delivered 4/27/2020 and after.

Provider Action

No action is required. This issue has been resolved.


Proposed Resolution/Fix

Implementation date: 4/26/2020

Part A California Duplicate ERAs Delivered


Date Reported

4/10/20

Status

Closed

Provider Type(s) Impacted

J6 Part A California 06014 providers

Date Resolved

4/10/20

Reason Code(s)

N/A

Claim Coding Impact

N/A

Description of Issue

California Trading Partners/providers may have received duplicate 835 remittance advice files.

National Government Services Action

4/9/2020: Around 4:30 p.m. eastern time, NGS delivered duplicate 835 remittance advice files to the California Trading Partners/providers.
4/10/2020: Listserv was sent to the Part A and HH+H provider community to alert them of the duplicate files.

Please note: These files are duplicates of the 835 remittance advice files delivered on 4/4/2020. The 835 remittance advice files delivered on 4/9/2020 in the early morning hours are not duplicates. The duplicate files impact only the California files.


Provider Action

No provider action necessary. 

Proposed Resolution/Fix

4/10/2020

NCD ICD-10 Diagnosis Code Changes for 2020


Date Reported

12/19/19

Status

Open

Provider Type(s) Impacted

Part A, including HHH and FQHCs




Date Resolved

Reason Code(s)

Part A RCs, see below

Claim Coding Impact

Multiple ICD-10 codes to be added to the listed NCDs

Description of Issue

On 11/1/2019, CMS issued CR11491 and accompanying MLN11491 with an effective date of 4/1/2020. CMS has now issued additional instructions impacting the following NCDs, for which new ICD-10 diagnosis codes will not be systematically implemented until 4/6/2020.

Local editing will be temporarily implemented for the following, allowing claims to process:

  • NCD 20.9 Artificial Hearts and Related Devices – RC 59242-59243
  • NCD 20.34 Percutaneous Left-Atrial Appendage Closure – RC 59267
  • NCD 190.11 Home PT/INR – RC 59079-59080
  • NCD 260.9 Heart Transplants – RC 59180-59181

Editing will remain in place for the following, and denied claims subject to the standard appeal process:

  • NCD 110.4 Extracorporeal Photophoresis RC59019-59020, 59023-59024
  • NCD 210.3 Colorectal Cancer Screening RC 59099-59100

National Government Services Action

For NCDs 20.9, 20.34, 190.11 and 260.9, National Government Services (NGS) will now modify internal editing to allow processing for claims with the new ICD-10 diagnosis codes. For NCDs 110.4 and 210.3, denials relative new ICD-10 codes may be submitted as appeals. In addition, NGS will adjust claims already denied since 10/1/2019 relative to this issue when brought to our attention.


Provider Action

Rejected claims (59267) will be reprocessed. Any claim with a LINE LEVEL denial can be resubmitted instead of filing an appeal (please refer to Submit an Adjustment to Correct Claims Partially Denied by Automated LCD/NCD Denials). Fully denied claims may be submitted as appeals. When submitting associated appeals, providers may identify CR 11491 as a reference.

Proposed Resolution/Fix

Will be systematically implemented on 4/6/2020.

Modified 1/8/2020

Part B ambulance claims submitted for emergency ambulance transport services for beneficiaries in SNFs are incorrectly denying due to an error in the Part A SNF CB edit logic. This error is impacting Part B claims for beneficiaries in covered Part A SNF stays when Part B claims are submitted for emergency ambulance transport. Impacted Part B claims included HCPCS codes: A0427, A0429 or A0433, billed with or without A0425.


Date Reported

10/22/19

Status

Closed

Provider Type(s) Impacted

Ambulance providers that bill to Part B of A


Date Resolved

10/24/19

Reason Code(s)

N/A

Claim Coding Impact

An error in Part A skilled nursing facility (SNF) consolidated billing (CB) edit logic is causing incorrect denials for Part B ambulance claims.

Description of Issue

Part B ambulance claims submitted for emergency ambulance transport services for beneficiaries in SNFs are incorrectly denying due to an error in the Part A SNF CB edit logic. This error is impacting Part B claims for beneficiaries in covered Part A SNF stays when Part B claims are submitted for emergency ambulance transport. Impacted Part B claims included HCPCS codes: A0427, A0429 or A0433, billed with or without A0425.

National Government Services Action

As per a CMS directive, NGS is manually bypassing the SNF CB edit for incoming Part B emergency ambulance transportation claim lines containing HCPCS code A0427, A0429, A0433, billed with or without A0425, when the beneficiary is in a SNF Part A covered stay.

Provider Action

Update 11/14/2019: Part B Providers who identify claims denied in error may request written reopening to have the claim reprocessed. Use the In Writing instructions on the Appeals page of our website to ensure your request is processed accurately. Please continue to check the Production Alerts section of our website and future Email Updates for additional status information. 

Proposed Resolution/Fix

Implementation Date: 10/24/2019

NGS, along with all MACs, is experiencing an issue with the Medicare eligibility contractor, resulting in incorrect claim denials. On 10/9/19, we informed providers of this claims processing error involving invalid entitlement dates for all beneficiary entitlement periods. CMS has now issued a corrective process for impacted Part A claims. NGS is now advising Part B providers that CMS has approved a corrective process for impacted Part B claims.


Date Reported

10/9/19

Status

Closed

Provider Type(s) Impacted

Part A claims will be resolved as stated below. NGS is now announcing a correction for Part B claims.

Date Resolved

10/22/19

Reason Code(s)

U5200

Claim Coding Impact

N/A

Description of Issue

NGS, along with all MACs, is experiencing an issue with the Medicare eligibility contractor, resulting in incorrect claim denials. On 10/9/19, we informed providers of this claims processing error involving invalid entitlement dates for all beneficiary entitlement periods. CMS has now issued a corrective process for impacted Part A claims. NGS is now advising Part B providers that CMS has approved a corrective process for impacted Part B claims.

National Government Services Action

Update 10/14/2019: CMS has announced a resolution for impacted Part A claims, effective on 10/10/19. Part A claims previously suspended with RC U5200 will now be reprocessed by NGS.

Update 10/10/2019: NGS is now anticipating a correction for this issue. Providers are advised that impacted claims will be held and released once the correct entitlement data is available.

Provider Action

Part A providers are now advised to resubmit impacted claims rejected with reason code U5200, after verifying that the beneficiary was eligible on the date of service and the reason code was assigned incorrectly.

Update 10/18/2019: Part B providers are advised no further action is needed, we are requesting you refrain from contacting the NGS Provider Contact Center on this issue. NGS will reprocess previously denied Part B claims impacted by this issue. Reprocessing for Part B claims will be initiated by NGS on Monday, 10/21/2019.

Update 10/22/2019: Part B claim adjustments initiated.

Proposed Resolution/Fix

10/23/2019

Go to All Upcoming Education

May 27

12:00 PM – 12:45 PM EDT
Wellness Wednesday: Human Immunodeficiency Virus Screening

May 28

11:00 AM – 12:00 PM EDT
Let’s Chat about Medicare Secondary Payer - Part A

May 28

2:00 PM – 3:30 PM EDT
COVID-19 Updates for FQHC and RHC Providers

Jun 2

12:00 PM – 1:00 PM EDT
Understanding the Levels of Appeal

Jun 3

12:00 PM – 1:00 PM EDT
Provider Enrollment Getting Access to PECOS
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