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.
Posted Jan 16, 2020
Posted Jan 16, 2020
Posted Jan 9, 2020
Posted Jan 9, 2020
Posted Jan 9, 2020
NCD ICD-10 Diagnosis Code Changes for 2020
12/19/19
Open
Part A, including HHH and FQHCs
Part A RCs, see below
Multiple ICD-10 codes to be added to the listed NCDs
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:
Editing will remain in place for the following, and denied claims subject to the standard appeal process:
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.
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.
Will be systematically implemented on 4/6/2020.
Modified 1/8/2020
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.
10/22/19
Open
Ambulance providers that bill to Part B of A
N/A
An error in Part A skilled nursing facility (SNF) consolidated billing (CB) edit logic is causing incorrect denials for Part B ambulance claims.
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.
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.
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.
To be announced.
NGS, along with all MACs, is experiencing an issue with the Medicare eligibility contractor, resulting in incorrect claim denials. On 10/9/19, we informed providers of this claims processing error involving invalid entitlement dates for all beneficiary entitlement periods. CMS has now issued a corrective process for impacted Part A claims. NGS is now advising Part B providers that CMS has approved a corrective process for impacted Part B claims.
10/9/19
Closed
Part A claims will be resolved as stated below. NGS is now announcing a correction for Part B claims.
10/22/19
U5200
N/A
NGS, along with all MACs, is experiencing an issue with the Medicare eligibility contractor, resulting in incorrect claim denials. On 10/9/19, we informed providers of this claims processing error involving invalid entitlement dates for all beneficiary entitlement periods. CMS has now issued a corrective process for impacted Part A claims. NGS is now advising Part B providers that CMS has approved a corrective process for impacted Part B claims.
Update 10/14/2019: CMS has announced a resolution for impacted Part A claims, effective on 10/10/19. Part A claims previously suspended with RC U5200 will now be reprocessed by NGS.
Update 10/10/2019: NGS is now anticipating a correction for this issue. Providers are advised that impacted claims will be held and released once the correct entitlement data is available.
Part A providers are now advised to resubmit impacted claims rejected with reason code U5200, after verifying that the beneficiary was eligible on the date of service and the reason code was assigned incorrectly.
Update 10/18/2019: Part B providers are advised no further action is needed, we are requesting you refrain from contacting the NGS Provider Contact Center on this issue. NGS will reprocess previously denied Part B claims impacted by this issue. Reprocessing for Part B claims will be initiated by NGS on Monday, 10/21/2019.
Update 10/22/2019: Part B claim adjustments initiated.
10/23/2019
Hospice NOE RTPs for ZIP Codes
7/12/19
Closed
Hospice
8/19/19
32114
Hospice Notice of Elections (NOEs) Returned to Provider (RTP)
NOEs submitted beginning 7/1/2019 are being RTP for the provider ZIP Code. The reason code the NOEs are receiving is 32114. It has been determined the issue is in the FISS and only impacting EMC submitted transactions.
After additional research, the problem was identified and NGS is working with FISS to ensure the Internal Facility Zip Code Switch is not set to validate the Facility Zip Code field for TOBs 8XA, 8XD and 8XE.
NGS offers this workaround, for the time being. Providers can add the FAC ZIP to the claim in FISS using DDE.
8/19/2019: Providers may now submit their RTPd claims.
Fix installed 8/19/2019.
Provider Enrollment Alert ‒ Issues resulting from recent Provider Enrollment, Chain and Ownership System (PECOS) release.
6/30/19
Closed
All Provider Types
7/19/19
N/A
N/A
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.
NGS has implemented the system fix devised by CMS.
Providers may now resubmit impacted claims for processing.
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.
