Skip to Main Content
ngsTabIndex: 14 Content Path: NGSMedicareContentNEW/NGSMedicareNEW/Menus/Enrollment MM/Index
ngsTabIndex: 25 Content Path: NGSMedicareContentNEW/NGSMedicareNEW/Menus/ClaimsAndAppeals MM/Index
ngsTabIndex: 40 Content Path: NGSMedicareContentNEW/NGSMedicareNEW/Menus/PolicyAndMedicalReview MM/Index
ngsTabIndex: 52 Content Path: NGSMedicareContentNEW/NGSMedicareNEW/Menus/Education MM/Index
 
 
 
Web Content Viewer

Welcome to

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.

Web Content Viewer
HHH Homepage Image

Go to All News Articles

New Uniform Thresholds for Determining Low Medicare Utilization Providers

Posted Jun 5, 2020


COVID-19: Using the CR Modifier and DR Condition Code

Posted Jun 5, 2020


National Government Services Proposed LCDs for Comment

Posted Jun 4, 2020


NGS Telehealth Billing FAQs for COVID-19

Posted Jun 2, 2020


MLN Connects® for Thursday, June 4, 2020

Posted Jun 4, 2020

Go to All Production Alerts

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

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

Part A California Duplicate ERAs Delivered


Date Reported

4/10/20

Status

Closed

Provider Type(s) Impacted

J6 Part A California 06014 providers

Date Resolved

4/10/20

Reason Code(s)

N/A

Claim Coding Impact

N/A

Description of Issue

California Trading Partners/providers may have received duplicate 835 remittance advice files.

National Government Services Action

4/9/2020: Around 4:30 p.m. eastern time, NGS delivered duplicate 835 remittance advice files to the California Trading Partners/providers.
4/10/2020: Listserv was sent to the Part A and HH+H provider community to alert them of the duplicate files.

Please note: These files are duplicates of the 835 remittance advice files delivered on 4/4/2020. The 835 remittance advice files delivered on 4/9/2020 in the early morning hours are not duplicates. The duplicate files impact only the California files.


Provider Action

No provider action necessary. 

Proposed Resolution/Fix

4/10/2020

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

Jun 9

12:00 PM – 12:30 PM EDT
Lunch and Learn: Home Health Billing Q&A

Jun 9

1:00 PM – 2:30 PM EDT
Let’s Chat HHH COVID-19 Public Health Emergency Waivers, Changes & Flexibilities

Jun 9

1:00 PM – 2:00 PM EDT
Submitting Revalidation via CMS-855A Paper Application

Jun 10

10:00 AM – 11:30 AM EDT
Website Navigation for Part A Providers

Jun 10

2:00 PM – 3:30 PM EDT
Hospice Billing Basics: Part II
Complementary Content