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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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MLN Connects® Newsletter for Thursday, July 29, 2021

Posted Jul 29, 2021


LCD and Associated Billing and Coding Article Updates for July/August 2021

Posted Jul 23, 2021


MLN Connects® Newsletter for Thursday, July 22, 2021

Posted Jul 22, 2021


Correct Coding of Molecular Testing Panels

Posted Jul 22, 2021


MLN Connects® Special Edition for Monday, July 19, 2021

Posted Jul 20, 2021

Go to All Production Alerts

Cost Sharing for COVID-19 Vaccine and Monoclonal Antibodies Claims


Date Reported

7/22/21

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

CMS has been made aware of an issue with cost sharing incorrectly applying on Coronavirus (COVID-19) vaccine and monoclonal antibodies claims with condition codes MA and 78 when HCPCS codes 0001A, 0002A, 0011A, 0012A, 0031A, M0239, M0243, M0244, M0245 and M0246 are present on TOB 12X, 13X or 34X. Coinsurance or deductible should not be  applied to these HCPCS codes.


National Government Services Action

Claims will be held until the correction is implemented in the October 2021 quarterly release. 

Provider Action

No provider action is necessary at this time, however, please continue to check the Production Alerts section of our website and future Email Updates.

Proposed Resolution/Fix

Claims will be released in the October 2021 quarterly release. 

RTPs for Part A Claims for Prior Authorization Services



Date Reported

4/6/21

Status

Closed

Provider Type(s) Impacted

Jurisdiction 6 and Jurisdiction K Part A providers

Date Resolved

7/6/21

Reason Code(s)

39621

Claim Coding Impact

Codes may viewed on the Prior Authorization Program for Certain Hospital Outpatient Department Services article posted on our website.

Description of Issue

On Part A prior authorization claims impacted by Medical Policy editing, the FISS processing is not matching and applying valid program IDs. As a result, claims with valid UTNs on which there is no matching program ID are returning to providers in error.


National Government Services Action

System fix implemented 7/6/2021

Provider Action

None

Proposed Resolution/Fix

System fix implemented 7/6/2021

Part A Processing Issues Relative to January, 2021 Quarterly Release


Date Reported

2/24/21

Status

Closed

Provider Type(s) Impacted

Jurisdiction 6 and Jurisdiction K Part A inpatient and outpatient claims

Date Resolved

7/1/21

Reason Code(s)

36381, 39910, 34931

Claim Coding Impact

N/A

Description of Issue

National Government Services has identified a number of issues affecting the timely processing of Part A claims due to issues associated with the January 2021 quarterly release. These issues have impacted processing for all national MACs. NGS is working with CMS and the shared system maintainer toward resolution.

The specific issues relative to the above mentioned reason codes are as follows:

  • Reason code 36381: Claims are suspending for reason code 36381 that contain multiple lines of therapy services such as CPT codes 97129 or 97130 billed with modifier GN, GO, or GP. Reason code 36381 assigns to claims for TOB 12X, 13X, 22X, 23X, 34X, 74X, 75X, 83X, 85X and revenue code 42X, 43X or 44X when billed with Modifier GN, GO, or GP. Although the charges are covered, there is no associated fee amount present for some of the services.
  • Reason code 39910: Claims are suspending for reason code 39910 due to no fee and/or no CLFS indicator associated with the HCPCS code resulting in no reimbursement. Claims containing clinical laboratory codes are unable to process due to the associated fee not assigning.
    • 3/18/2021 Update for both Reason Code 36381 and 39910 above: CMS has authorized a temporary manual process to expedite processing, which will allow claims to be released to CWF for processing once per week. A permanent fix is expected in mid-April, 2021.
      Update: System fix completed 4/21/2021.
    • 4/16/2021 Update: CMS has instructed the MACs to initiate mass adjustments for impacted claims. NGS is in the process of initiating these adjustments with a target completion date of mid-June, 2021.
  • Reason code 34931: Claims are suspending for reason code 34931 when diagnosis codes Z11.52 and Z86.16 are reported on inpatient claims for discharges occurring on or after 1/1/2021. The FY 2021 POA exempt list was updated in the January 2021 release. However, inpatient claims for discharges occurring on or after 1/1/2021 are suspending with reason code 34931 when the claim includes diagnosis codes Z11.52 and Z86.16.
    • 3/18/2021 Update for Reason Code 34931: This issue has been resolved and all impacted claims have been released.

National Government Services Action

NGS is fully compliant with CMS instructions, all associated adjustments completed.


Provider Action

No provider action is necessary at this time, however, NGS anticipates further adjustments pertaining to the January release. Please continue to monitor the Production alerts section of our website and future Email Updates.

Proposed Resolution/Fix

Mass adjustments complete 7/1/2021.

Part A DRG Weight-Claim Adjustment Error


Date Reported

6/22/21

Status

Open

Provider Type(s) Impacted

Jurisdiction 6 and Jurisdiction K Part A Inpatient Hospital Providers

Date Resolved

Reason Code(s)

37549

Claim Coding Impact

N/A

Description of Issue

Adjustment claims are receiving 37549 edit stating the DRG weight on the adjustment is greater than the DRG weight on the claim being adjusted.

National Government Services Action

Pending implementation of Change Request (CR) C12216 (see details below), reason code 37549 will be overrode on the adjustment when the DRG has not changed from what is on the claim being adjusted.

Provider Action

No provider action is necessary at this time, however, please continue to check the Production Alerts section of our website and future Email Updates.

Proposed Resolution/Fix

CR C12216 will be implemented in October, 2021 to create a FISS bypass on these claims.

Exemption for Provider Authorization Demonstration Project


Date Reported

4/28/21

Status

Closed

Provider Type(s) Impacted

Jurisdiction K and Jurisdiction 6 Part A providers

Date Resolved

7/14/21

Reason Code(s)

N/A

Claim Coding Impact

Services included in a CMS Prior Authorization Demonstration Project

Description of Issue

Providers who are currently participating in a CMS-approved Demonstration Project are exempt from the prior authorization request requirement. Providers should not be submitting prior authorization requests if they are currently participating in a Demonstration Project.

National Government Services Action

NGS is currently receiving such requests in error. Claims for providers who are on a Demonstration Project that are submitted with a UTN will be RTP to remove the UTN. Incorrect submission of prior authorization requests by providers on Demonstration Project may result in development (ADR) for providers who are exempt from this requirement.

Provider Action

Providers should not be submitting prior authorization requests for the hospital outpatient department prior authorization program.

Proposed Resolution/Fix

Claims for providers who are on a Demonstration Project that are submitted with a UTN will be RTP to remove the UTN.

Go to All Upcoming Education

Jul 29

1:00 PM – 3:00 PM EDT
Rescheduled: Medicare Secondary Payer Claims That Have Returned to the Provider

Jul 29

2:00 PM – 3:30 PM EDT
Part A July 2021 CMS Quarterly Update

Aug 3

10:00 AM – 11:00 AM EDT
Provider Enrollment Revalidation Overview

Aug 4

12:00 PM – 12:45 PM EDT
Wellness Wednesday - Intensive Behavioral Counseling for Obesity

Aug 5

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