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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® for Thursday, July 18, 2019

Posted Jul 18, 2019


MLN Connects® Special Edition - Thursday, July 11, 2019

Posted Jul 12, 2019


MLN Connects® for Thursday, July 11, 2019

Posted Jul 11, 2019


Genetic Testing Fraud Scam Directed at Medicare Beneficiaries

Posted Jul 2, 2019


Revised Fee for Indium In 111 Capromab Pendetide

Posted Jun 28, 2019

Go to All Production Alerts

Provider Enrollment Alert ‒ Issues resulting from recent Provider Enrollment, Chain and Ownership System (PECOS) release.



Date Reported

6/30/19

Status

Open

Provider Type(s) Impacted

All Provider Types

Date Resolved

Reason Code(s)

N/A

Claim Coding Impact

N/A

Description of Issue

On 6/30/2019, PECOS Release 7.37 was implemented. This release was prescheduled and designed to bring efficiencies to Medicare Administrative Contractors (MACs) and providers who use PECOS. While many aspects of the release were successful, a small component associated to changes made to existing and new group reassignments, was found to be problematic post-implementation. As a result, data flows from PECOS to the Multi-Carrier System (MCS) for these changes have been delayed for all MACs to proactively correct the identified issue.

CMS has assembled a team with accountability for resolving this issue. The team is working tirelessly to resolve the issue by July 16, 2019.

Potential Questions and Answers that you may have:

Q: Can I continue to submit enrollment applications?

A: Yes, please continue to submit applications as you do today. Internet-based PECOS applications are the quickest method of submission and processing, although you may submit either via Internet-based PECOS web or paper applications. Application processing will continue at each of the MACs as normal. Please also continue to respond to requests for additional information.

Q: My PECOS enrollment record has been approved, but when I attempt to enroll with EDI they indicate my provider/supplier is not present in the claims system. Is additional action needed on my part?

A: No, we will update this article when a fix has been deployed and at that time you can enroll with EDI.

Q: My PECOS enrollment record has been approved but when I submit claims, they cannot be processed because the NPI/PTAN is not present in the claims system. Is additional action needed on my part?

A: No, we will update this article when a fix has been deployed and at that time you can resubmit claims for processing.

National Government Services Action

  NGS has implemented the system fix devised by CMS.

Provider Action

Providers may now resubmit impacted claims for processing.

Proposed Resolution/Fix

CMS has assembled a team with accountability for resolving this issue. The team is working tirelessly to resolve the issue by 7/16/2019.

7/22/2019: A fix was implemented on Thursday, 7/18/2019. As above, providers may now resubmit impacted clams for processing.

Claims for Nonparticipating Services processed from 4/1/2017 through 2/2019 paid at the incorrect rate.


Date Reported

7/9/19

Status

Open

Provider Type(s) Impacted

Jurisdiction K and Jurisdiction 6 Part B Providers

Date Resolved

Reason Code(s)

N/A

Claim Coding Impact

N/A

Description of Issue

Based on CR9812 a processing issue in the MCS claims processing system was identified by CMS. This CR removes the payment adjustment for certain NPPs, thereby allowing these NPPs to receive the same payment rate as physicians for these services. This resulted in claims for nonparticipating services processed from April 1, 2017 through February 2019 and paid at the incorrect allowed charges resulting in overpayments. Please note the services in question are those not paid on the Medicare Physician Fee schedule as there are certain provider specialties, procedures which are not subject to the nonparticipating reduction (e.g. certain drug codes, DMEPOS, clinical lab, services billed by specialties 50, 97, and 89 are some examples). This does not affect all providers or all services.

National Government Services Action

National Government Services will be processing adjustments on these claims which may result in a refund request due to an overpayment.

Adjustments will be initiated by NGS throughout the month of July 2019

Provider Action

If you receive an overpayment letter as a result of these adjustments, please follow the overpayment refund process found on our website at Overpayments.

Proposed Resolution/Fix

As above, providers who receive overpayment letters relative to this issue are advised to follow the Overpayment Refund Process posted on the NGS website at www.ngsmedicare.com

Some Claims Submitted Electronically Between 6/14/2019 and 6/17/2019 via NGS EDI Gateway and NGSConnex Did Not Process [RESOLVED]


Date Reported

6/19/19

Status

Closed

Provider Type(s) Impacted

Jurisdiction K, Jurisdiction 6, Part A, HHH, FQHC and Part B


Date Resolved

6/20/19

Reason Code(s)

N/A

Claim Coding Impact

N/A

Description of Issue

Some claims that were submitted electronically between 5:00 p.m. ET Friday, 6/14/2019 through 5:00 p.m. ET Monday, 6/17/2019 via the NGS EDI Gateway and NGSConnex did not reach the claims systems for processing.


National Government Services Action

These claims were resubmitted 6/19/2019. As a result of the resubmission, new 277CAs were generated containing a new claim number (ICN/DCN).


Provider Action

Please do not resubmit claims sent during the affected time frame. If you receive a second 277CA for the claims submitted during the affected time frame, please disregard the original 277CA and the associated ICN/DCN. The resubmitted claims will have the original receipt date for processing.



Proposed Resolution/Fix

This issue has been resolved. All impacted claims have been successfully submitted for claims processing.


Claim Rejections Associated with Reference Lab and Anti-Markup Payment Limitations



Date Reported

3/11/19

Status

Open

Provider Type(s) Impacted

Jurisdiction K and Jurisdiction 6 Part B Providers

Date Resolved

Reason Code(s)

N293

Claim Coding Impact

Laboratory service claims associated with reference lab and anti-markup payment limitation services

Description of Issue

CMS has become aware of an issue concerning invalid rejections of some laboratory service claims associated with reference lab and anti-markup payment limitation services.

National Government Services Action

CMS has instructed the MACs to disable edits associated with these services effective 3/12/2019.

Provider Action

Providers and suppliers who have claims that rejected in error for this editing may resubmit their previously returned claims after 3/12/2019.


Proposed Resolution/Fix

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

Edit Causing Claims to Reject Containing Procedure Codes 88300, 88302, 88304, 88305, 88307, 88309, 88331, 88332, 88341, 88342 and 88344


Date Reported

3/4/19

Status

Closed

Provider Type(s) Impacted

Jurisdiction K and Jurisdiction 6 Part B Providers

Date Resolved

3/26/19

Reason Code(s)

CO 97

Claim Coding Impact

Procedure codes 88300, 88302, 88304, 88305, 88307, 88309, 88331, 88332, 88341, 88342 and 88344

Description of Issue

A system edit has erroneously rejected claims containing the procedure codes shown above.

National Government Services Action

CMS has asked all MACs to reprocess all affected claims.

Provider Action

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

Proposed Resolution/Fix

3/4/2019: National Government Services will identify and reprocess all claims that were denied in error. Please do not submit appeal requests. This alert will be updated to notify providers when the claims are being reprocessed.  

Affected claims were reprocessed on 3/26/2019.


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