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Medicare Part B providers administer medically-necessary and preventive services for beneficiaries by diagnosing and treating medical conditions or preventing illness or detecting it at an early stage.

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MLN Connects® Special Edition for Tuesday, April 20, 2021

Posted Apr 20, 2021


Register Today for the National Government Services Spring 2021 Virtual Conference

Posted Apr 20, 2021


NGSConnex Security Requirements

Posted Apr 19, 2021


NGSConnex and Interactive Voice Response Eligibility Enhancements

Posted Apr 16, 2021


MLN Connects® for Friday, April 16, 2021

Posted Apr 16, 2021

Go to All Production Alerts

NGS Medicare Physician Fee Schedule Fee Posting Error


Date Reported

10/28/20

Status

Closed

Provider Type(s) Impacted

Jurisdiction 6 and Jurisdiction K Part B providers

Date Resolved

10/28/20

Reason Code(s)

N/A

Claim Coding Impact

76496TC, 76497TC, 76498TC,78429, 78429TC,78430, 78430TC, 78431, 78431TC, 78432, 78432TC, 78433, 78433TC

Description of Issue

Effective January 2020, these identified contractor-priced CPT codes were listed incorrectly on the NGS MPFS Full Fee Schedule. Search results for these codes incorrectly displayed OPPS fees.

National Government Services Action

Despite the incorrectly posted information, claims for these codes were not impacted and were processed and paid correctly. The incorrect fee information has been removed.

Provider Action

No provider action necessary at this time.

Proposed Resolution/Fix

10/28/2020

NCD ICD-10 Diagnosis Code Changes for 2020


Date Reported

12/19/19

Status

Closed

Provider Type(s) Impacted

Part B



 

Date Resolved

4/6/20

Reason Code(s)

N/A

Claim Coding Impact

Multiple ICD-10 codes

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 temporary editing is being developed for the following, allowing claims to process:

  • NCD 20.9 Artificial Hearts and Related Devices – Edit 023L
  • NCD 20.34 Percutaneous Left-Atrial Appendage Closure – Edit 083L
  • NCD 190.11 Home PT/INR – Edit 019L
  • NCD 260.9 Heart Transplants – Update 053L

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

  • NCD 110.4 Extracorporeal Photophoresis- Edit 008L
  • NCD 210.3 Colorectal Cancer Screening – Edit 025L

National Government Services Action

For NCDs 20.9, 20.34, 190.11 and 260.9, National Government Services (NGS) is in the process of modifying 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.

Provider Action

Appeals are to be submitted in writing, not via NGSConnex. When submitting associated appeals, providers may identify CR11491 as a reference. Providers are advised to monitor the Production Alerts section of our website and future Email Updates for additional status information.

Proposed Resolution/Fix

Systematically implemented 4/6/2020.

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

POS 22 Denials for 0298T


Date Reported

3/17/20

Status

Closed

Provider Type(s) Impacted

JK and J6 Part B Providers

Date Resolved

3/24/20

Reason Code(s)

N/A

Claim Coding Impact

0298T claim denials with place of service (POS) 22 (Message 921 per Edit 144D)

Description of Issue

Claims for CPT 0298T with POS 22 were denied when received between 2/4/20203/11/2020 due to a temporary change in POS editing. CPT 0298T is now payable in POS 22.

National Government Services Action

Mass adjustments completed on 3/24/2020.

Provider Action

N/A

Proposed Resolution/Fix

3/24/2020

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

Go to All Upcoming Education

Apr 22

10:00 AM – 11:00 AM EDT
Billing for Part B Home Infusion Therapy

Apr 22

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

Apr 22

12:00 PM – 1:00 PM EDT
Medicare Physician Fee Schedule Database

Apr 22

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

Apr 22

1:30 PM – 2:30 PM EDT
Psychiatric Collaborative Care Management and Behavioral Health Integration
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