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Provider Enrollment: Submitting Revalidations via PECOS

Apr 23, 10:00 AM – 11:00 AM EDT

Let’s Chat About Provider Enrollment Revalidation

Apr 23, 1:00 PM – 2:00 PM EDT

Understanding the Levels of Appeal

Apr 24, 9:00 AM – 10:00 AM 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® for Thursday, April 18, 2019

Posted Apr 18, 2019


Registration is Now Open for the NGS May 2019 Virtual Conference

Posted Apr 16, 2019


National Government Services Now on Twitter!

Posted Apr 11, 2019


MLN Connects® for Thursday, April 11, 2019

Posted Apr 11, 2019


CAC Meeting Information

Posted Apr 5, 2019

Go to All Production Alerts

HCPCS Code 33249 Rejection Error RC 31160


Date Reported

3/20/19

Status

Open

Provider Type(s) Impacted

Jurisdiction K and Jurisdiction 6 Part A Providers

Date Resolved

Reason Code(s)

Fiscal Intermediary Standard System (FISS) Reason Code (RC) 31160

Claim Coding Impact

Implantable Cardiac Defibrillators (ICDs), Healthcare Common Procedure Coding System (HCPCS) Code 33249

Description of Issue

CMS has identified an error for HCPCS 33249 for RC 31160. This has been referred to FISS and action is now underway.

National Government Services Action

NGS will initiate a  solution for RC 31160 to stop these claims from rejecting by 3/25/2019.

Provider Action

No additional provider action is necessary at this time. Please continue to check the Production Alerts section of our website and Email Updates for additional status information. 

Proposed Resolution/Fix

As above, steps have been initiated to stop these claims from rejecting.

CPT Code 84153 Has Been Inappropriately Denied



Date Reported

12/31/18

Status

Open

Provider Type(s) Impacted

All Part A and Part B Providers

Date Resolved

Reason Code(s)

N/A

Claim Coding Impact

CPT code 84153

Description of Issue

CPT code 84153 which is included in the biomarker testing (prior to initial biopsy) for Prostate Cancer Diagnosis LCD (L37733) has been inappropriately denied as a result of a system issue for dates of service 12/1/2018 through 12/30/2018. The issue has now been corrected.


National Government Services Action

Update 1/7/2019:A mass adjustment is planned for impacted claims but has not yet been initiated.

Update 1/9/2019: Mass adjustment for impacted claims has been delayed and is now expected to be completed in early February. Please continue to monitor this site for further details as they become available.

Update 1/22/2019: CPT 84153 continues to edit on NCD 190.31. Providers are advised to consult the NCD guidelines on this code, rather than the NGS LCD.

Update 02/01/2019: Mass adjustment on denied claims has been initiated. Please continue to monitor this site for a notice indicating completed adjustments.

Update 2/4/2019: Adjustments have been completed on impacted claims; the issue is now closed.

Update 2/5/2019: Previous notice of completed adjustments was incorrect; adjustments are now pending initiation. Please continue to monitor this site for notice of completion on the adjustment process.

Update 2/11/2019: Mass adjustment on denied claims have now been initiated. Please continue to monitor this site for a notice indicating completed adjustments.

Provider Action

No provider action is necessary at this time.

Proposed Resolution/Fix

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

We have identified sporadic instances of negative reimbursement on inpatient claims with Demonstration 86, BPCI Advanced SNF Waiver.


Date Reported

1/9/19

Status

Open

Provider Type(s) Impacted

Jurisdiction 6 and Jurisdiction K Part A Providers

Date Resolved

Reason Code(s)

N/A

Claim Coding Impact

N/A

Description of Issue

We have identified sporadic instances of negative reimbursement on inpatient claims with Demonstration 86, BPCI Advanced SNF Waiver. A FISS system issue is causing the Value Code Y1-Y4 to be incorrectly added to these claims.

National Government Services Action

We are working with CMS and the FISS maintainer to fix this system issue.

Provider Action

Until a fix is implemented, providers may adjust claims and remove the Y1-Y4 value codes.

Proposed Resolution/Fix

We are working with CMS and the FISS maintainer to fix this system issue. Please continue to monitor the website and email updates for additional updates.

We have identified persistent instances of incorrect denials for these impacted codes (which are included in the Transthoracic Echocardiography [TTE] LCD L33577).


Date Reported

1/10/19

Status

Open

Provider Type(s) Impacted

Jurisdiction 6 and Jurisdiction K Part A Providers

Date Resolved

Reason Code(s)

N/A

Claim Coding Impact

CPT and HCPCS codes 93306, 93307, 93308, C8923, C8924 and C8929

Description of Issue

We have identified persistent instances of incorrect denials for these impacted codes (which are included in the Transthoracic Echocardiography [TTE] LCD L33577). These denials are an ongoing result of an issue with the October ICD-10 code update.

National Government Services Action

We are reviewing the impacted claims.

Provider Action

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

Proposed Resolution/Fix

1/10/2019: As stated above, a mass adjustment will be initiated once the issue is resolved.

Go to All Upcoming Education

Apr 23

10:00 AM – 11:00 AM EDT
Provider Enrollment: Submitting Revalidations via PECOS

Apr 23

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

Apr 24

9:00 AM – 10:00 AM EDT
Understanding the Levels of Appeal

Apr 24

1:00 PM – 2:00 PM EDT
Let’s Chat About Intensity-Modulated Radiation Therapy (IMRT) Planning Services

Apr 25

11:30 AM – 1:00 PM EDT
Medicare Secondary Payer – Correctly Using the Condition Code 08
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