As a result of the effects of 2019 Novel Coronavirus (COVID-19), a national emergency exists.
At National Government Services, the health and well-being of our beneficiaries, providers, our associates and communities is our top priority. We understand the concern and uncertainty you may be experiencing and we are committed to being responsive to the needs of our partners and associates as situations evolve.
We want to assure you, NGS is prepared to provide the same level of service you have come to expect from us during this national crisis. Our priority is our beneficiaries, providers, our associates and communities we serve.
MLN Connects® Special Edition for Wednesday, October 28, 2020 Trump Administration Acts to Ensure Coverage of Life-Saving COVID-19 Vaccines & Therapeutics
Current questions and answers can be found at CMS Frequently Asked Questions to Assist Medicare Providers.
Visit the CMS Current Emergencies web page for the latest COVID-19 information.
Stay informed about the latest news and information we send you from our Email Updates. Ensure all staff in your office who interact with NGS sign up for our Email Updates program today by clicking the Subscribe to Email Updates link located under the search box at the top right of our website.
| Type of Service | Description of Service | HCPCS/CPT | Patient/Provider Relationship |
|---|---|---|---|
| Medicare Telehealth Services | A visit with a provider that uses telecommunication systems between a provider and a patient. |
|
New or established patients to the extent the 1135 waiver which requires established relationship HHS will not audit due to PHE. |
| Virtual Check-in | Brief check-in with practitioner via telephone or other communication devices to determine need for a visit or other services. |
|
Established and new patients per 4/30/2020 guidance. |
| E-Visits | A communication between a patient and a provider through online portal. |
|
Established and new patients per 4/30/2020 guidance. |
The March 30 Interim Final Rule with Comment Period added coverage during the Public Health Emergency for audio-only telephone evaluation and management visits (CPT codes 99441, 99442 and 99443) retroactive to 3/1/2020. On 4/30/2020, a new Physician Fee Schedule was implemented increasing the payment rate for these codes. MACs will reprocess claims for those services that they previously denied and/or paid at the lower rate.
There are also a number of add on services (CPT codes 90785, 90833, 90836, 90838, 96160, 96161, 99354, 99355, and G0506) which Medicare may have denied during this Public Health Emergency. MACs will reprocess those claims for dates of service on or after 3/1/2020.
CMS updated the Medicare Coverage and Payment of Virtual Services YouTube video that answers common questions about the expanded Medicare telehealth services benefit during the COVID-19 public health emergency. New information includes how CMS adds services to the list of telehealth services, additional practitioners that can provide telehealth services and the distant site services that RHCs and FQHCs can provide. Further, the video includes information about audio-only telehealth services, telehealth services that hospitals, nursing homes and home health agencies can provide, along with how to correctly bill for telehealth services.
Our Provider Enrollment Hotline 888-802-3898 is available Monday through Friday from 9:00 a.m.–5:00 p.m. ET/8:00 a.m.‒4:00 p.m. CT to initiate provisional temporary Medicare billing privileges for J6 and JK providers/suppliers via telephone for:
Learn more about the provider enrollment hotline for matters related to COVID 19 on the CMS website: 2019-Novel Coronavirus (COVID-19) Medicare Provider Enrollment Relief Frequently Asked Questions (FAQs).
In the wake of the public health emergency related to COVID-19, NGS is in the process of pausing TPE medical reviews. At this time, we are unable to provide additional clarity on when or how TPE reviews will resume, but we will share information as it’s made available. We will work with providers who previously scheduled educational sessions to reschedule them.
We are contacting providers to let them know we released claims and there is no need to respond to an ADR or medical records. Effective 3/1/2020, claims that auto-denied for nonresponse or late response to the ADR will be reversed and allowed for payment unless an appeal has already been filed. In that case, the appeal will follow the normal appeals process.
Our dedicated email address remains available for questions specific to medical reviews:
On 3/13/2020, the Administrator of CMS authorized nationwide waivers under Section 1812(f) of the Social Security Act retroactive to 3/1/2020 for those people who are impacted as a result of the effect of COVID-19.
We are sending this information at the request of the QIC, C2C Innovative Solutions, Inc. (C2C). C2C conducts second-level Medicare Part A and B fee-for-service claims appeals submitted in JK Part A and B as well as J6 home health and hospice for New York, New Jersey, Puerto Rico and the U.S. Virgin Islands. If you appeal to C2C as the Part A and B East QIC, they are limiting their on-site mail room operations in response to the COVID-19 public health emergency. During this public health emergency, providers and Medicare beneficiaries falling into the above categories are encouraged to submit new second-level Medicare appeals and related correspondence via fax or the electronic portal. For additional information, including the QIC fax numbers and a link to their portal, please visit the C2C website.
National Government Services offers a variety of fast, efficient and cost-saving electronic solutions for interacting with Medicare. Go Paperless Today ‒ Protect Your Bottom Line to learn more.
