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NGSMedicare.com for home health + hospice providers

Medicare home health providers bring a wide array of skilled services directly to a patient’s residence to meet the needs of beneficiaries who are homebound. 

Medicare hospice agencies are dedicated to providing the highest level of comfort and care to beneficiaries diagnosed with terminal illnesses.

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Go to All News Articles

New Consolidated Home Page Coming Soon

Posted Mar 1, 2021


2021 Medicare Participating Physicians Directory

Posted Mar 1, 2021


New Home Health Video Tutorials

Posted Feb 26, 2021


Medicare Advantage Plan Beneficiaries Receiving the COVID-19 Vaccine and Monoclonal Antibody

Posted Feb 25, 2021


MLN Connects® for Thursday, February 25, 2021

Posted Feb 25, 2021

Go to All Production Alerts

Home Health: Penalty for RAPs Received More Than five Days Early


Date Reported

2/24/21

Status

Open

Provider Type(s) Impacted

Home Health Agencies

Date Resolved

Reason Code(s)

N/A

Claim Coding Impact

N/A

Description of Issue

The Home Health Pricer program is incorrectly applying a penalty to RAPs received more than five days earlier than the “From” date of the RAP. The associated claims cannot be readily identified for MAC suspension.

National Government Services Action

We will provide updates when applicable.

Provider Action

Agencies may still submit RAPs as they choose.

Proposed Resolution/Fix

A system fix is scheduled for 3/1/2021. Once the fix is implemented, National Government Services will adjust claims with a value code QF amount greater than $0 (penalty amount) and a RAP RECEIPT DT of more than five days earlier than the “From” date.

Incorrect Denials for COVID-19 Claims


Date Reported

7/20/20

Status

Closed

Provider Type(s) Impacted

Part A, including HHH




Date Resolved

8/6/20

Reason Code(s)

5WEXC

Claim Coding Impact

C9803, G2023, G2024, G2025, U0001-U0004, 0099U, 86328, 86769, 87635

Description of Issue

Incorrect COVID-19 claim denials due to an internal processing issue. 

National Government Services Action

NGS is advising providers that this incorrect denial issue has been identified and is in the process of internal resolution. Mass adjustment of incorrectly denied claims will be initiated within an estimated 14-day timeframe.


Provider Action

No provider action is needed at this time.

Proposed Resolution/Fix

Updated 8/6/2020: Providers are advised that impacted claims have been adjusted and are in the adjudication process. This issue is now resolved.

FISS Issue Causing Incorrect Suspensions with RC 31138, RC W7220 and RC W7218



Date Reported

7/10/20

Status

Closed

Provider Type(s) Impacted

Jurisdiction 6 and Jurisdiction K Part A (including HH+H)

Date Resolved

7/14/20

Reason Code(s)

RC 31138, RC W7220 and RC W7218

Claim Coding Impact

N/A

Description of Issue

FISS issue causing incorrect claim suspensions has now been corrected.

National Government Services Action

NGS is informing Part A providers that this issue has now been resolved.

Provider Action

No additional provider action is needed at this time.

Proposed Resolution/Fix

7/14/2020: RC 31138, RC W7220 and RC W7218 have now been inactivated in all production regions; these RCs will be activated in the April 2021 release. Previously impacted suspended claims will be released for processing.

NCD ICD-10 Diagnosis Code Changes for 2020


Date Reported

12/19/19

Status

Closed

Provider Type(s) Impacted

Part A, including HHH and FQHCs




Date Resolved

4/6/20

Reason Code(s)

Part A RCs, see below

Claim Coding Impact

Multiple ICD-10 codes to be added to the listed NCDs

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 editing will be temporarily implemented for the following, allowing claims to process:

  • NCD 20.9 Artificial Hearts and Related Devices – RC 59242-59243
  • NCD 20.34 Percutaneous Left-Atrial Appendage Closure – RC 59267
  • NCD 190.11 Home PT/INR – RC 59079-59080
  • NCD 260.9 Heart Transplants – RC 59180-59181

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

  • NCD 110.4 Extracorporeal Photophoresis RC59019-59020, 59023-59024
  • NCD 210.3 Colorectal Cancer Screening RC 59099-59100

National Government Services Action

For NCDs 20.9, 20.34, 190.11 and 260.9, National Government Services (NGS) will now modify 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. In addition, NGS will adjust claims already denied since 10/1/2019 relative to this issue when brought to our attention.


Provider Action

Rejected claims (59267) will be reprocessed. Any claim with a LINE LEVEL denial can be resubmitted instead of filing an appeal (please refer to Submit an Adjustment to Correct Claims Partially Denied by Automated LCD/NCD Denials). Fully denied claims may be submitted as appeals. When submitting associated appeals, providers may identify CR 11491 as a reference.

Proposed Resolution/Fix

Systematically implemented on 4/6/2020.

Hospice Claim Adjustment Issue


Date Reported

3/9/20

Status

Open

Provider Type(s) Impacted

Hospice

Date Resolved

Reason Code(s)

N/A

Claim Coding Impact

Please see “Provider Action” section below

Description of Issue

National Government Services is advising hospice providers of two recently identified issues that are impacting payments on hospice adjustments.

The issues are as follows:

  1. Hospice EOL SIA Payment

Starting in January 2020, Medicare systems stopped applying the EOL SIA payment on adjustments to hospice claims with eligible services that occurred the month prior and within seven days of the beneficiary’s date of death. The system was updated and claims are adjustments are calculating the EOL SIA payment correctly as of 4/20/2020.

  1. Hospice Adjustments Overpaying RHC days

Adjustments to hospice claims with routine home care days billed are paying the wrong routine home care rate. The CWF edit is not applying the prior days used correctly causing claims reimburse incorrectly pay at the high or low rate.

National Government Services Action

NGS will continue to follow the situation with the Medicare system maintainers and advise providers of any changes in this information or further updates.

Provider Action

At this time, no workaround has been identified to prevent improper payments for routine home care service on hospice adjustments. Providers are advised to consider holding adjustments to claims with routine home care days when the prior days used are greater than 60. Please continue to check the Production Alerts section of our website and future Email Updates for additional status information.

Proposed Resolution/Fix

Updated 5/1/2020

Go to All Upcoming Education

Mar 4

9:00 AM – 10:00 AM EST
Provider Enrollment: Getting Access to PECOS

Mar 4

10:00 AM – 11:30 AM EST
Home Health Billing Basics

Mar 4

1:00 PM – 2:00 PM EST
Provider Enrollment Revalidation Overview

Mar 4

3:00 PM – 4:00 PM EST
Understanding the Medicare Home Health Benefit

Mar 9

12:00 PM – 1:00 PM EST
Submitting Revalidation via CMS-855A Paper Application
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