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Provider Enrollment: Getting Connected to PECOS

Sep 20, 10:00 AM – 11:00 AM EDT

Collaborative Oxygen Webinar

Sep 20, 11:00 AM – 12:30 PM EDT

Provider Enrollment: Submitting Revalidations via PECOS

Sep 20, 1:00 PM – 2:00 PM EDT
 
 
 
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Medicare Part A facilities offer essential healthcare services to beneficiaries on an inpatient or outpatient basis.

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MLN Connects® Special Edition for Monday, September 17, 2018

Posted Sep 18, 2018


October 2018 Release Dark Days for the Common Working File Hosts

Posted Sep 17, 2018


October 2018 FISS DDE Screen Updates Notification_Part A

Posted Sep 14, 2018


MLN Connects® Special Edition for Friday, September 14, 2018

Posted Sep 14, 2018


Outpatient Hospital Overpayment Recoupment Project and Related Claim Recoupments

Posted Sep 13, 2018

Go to All Production Alerts

Some adjustment claims are receiving claim level reason code EA002 in error and are RTP in error.    


Date Reported

7/27/18

Status

Open

Provider Type(s) Impacted

JK and J6 Part A Providers

Date Resolved

Reason Code(s)

EA002

Claim Coding Impact

N/A

Description of Issue

Some adjustment claims are receiving claim level reason code EA002 in error and are RTP in error.   
 

National Government Services Action


No MAC action at this time.

 

Provider Action

Please do not PF 9 RTP claims. After October 1st, providers will need to submit a new adjustment claim. Please continue to check the Production Alerts section of our website and Email Updates for additional status information.

Proposed Resolution/Fix

7/27/2018: The FISS has confirmed the issue and is currently working on a resolution that will be installed into production on October 1st.

Hospice notice of change (TOB 8XC) is incorrectly returning to provider (RTP) with CWF utilization edit U514A.


Date Reported

8/9/18

Status

Open

Provider Type(s) Impacted

Hospice Providers

Date Resolved

Reason Code(s)

U541A

Claim Coding Impact

N/A

Description of Issue

Hospice notice of change (TOB 8XC) is incorrectly returning to provider (RTP) with CWF utilization edit U514A.

National Government Services Action

Currently, National Government Services is working to correct hospice notices that incorrectly RTP'd with reason code U514A.

Provider Action

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

Proposed Resolution/Fix

8/10/2018: CWF has confirmed the issue and is currently working on a resolution.

NGS is informing Part A 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, Part A providers may be receiving inappropriate claim rejections for CWF reason codes: U6815, U6816, U6817,U6818 and inappropriate claims suspensions for U6803.

 


Date Reported

5/16/18

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

NGS is informing Part A 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, Part A 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

See Proposed Resolution/Fix.

 

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.

8/2/2018: As per recent CMS instructions, NGS has taken the following actions:

  • The hold on some MSP claims has been removed and we have reset the RCs back to their prior status for U6803, U6816, U6817, U6818, U6819, U681E, U681L. Condition code “15” has been added prior to adjudicating the held MSP claims. These claims are being released and target date for final release is 8/10/2018.
  • RC 39074 will continue to suspend pending research on a potential issue.
  • The hold on MSP claims will continue for RC U681D until a fix is implemented on 8/20/2018.
  • The hold on HH RAPs with RC E61#H will continue until a fix implemented on 9/4/2018.
  • NGS is awaiting further CMS instructions on mass adjustment for claims impacted prior to the instruction on claim suspense.

9/4/2018: The FISS maintainer is still working on a resolution for this issue.

Claims submitted with PET scan codes are RTP for reason code 32440 when submitted with radiopharmaceutical HCPCs A9515, A9586, A9587 and A9588.


Date Reported

5/3/18

Status

Open

Provider Type(s) Impacted

Part A Providers

Date Resolved

Reason Code(s)

32440

Claim Coding Impact

Part A claims containing tracer codes for PET scan services

Description of Issue

Claims submitted with PET scan codes are RTP for reason code 32440 when submitted with radiopharmaceutical HCPCs A9515, A9586, A9587 and A9588.

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

5/31/2018: We will continue to monitor this carefully and post new information as soon as we receive instructions from the CMS.

7/26/2018: This issue is scheduled for a fix with implementation of CR 10622 in 10/2018.

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.

7/26/2018: FISS has scheduled a fix which is scheduled with the 8/20/2018 release.


Go to All Upcoming Education

Sep 20

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

Sep 20

11:00 AM – 12:30 PM EDT
Collaborative Oxygen Webinar

Sep 20

1:00 PM – 2:00 PM EDT
Provider Enrollment: Submitting Revalidations via PECOS

Sep 20

3:00 PM – 4:00 PM EDT
NGSConnex: Initiating and Checking Status of Appeals

Sep 20

4:00 PM – 5:30 PM EDT
Collaborative Oxygen Webinar
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