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 15, 2021
Posted Jan 15, 2021
Posted Jan 14, 2021
Posted Jan 13, 2021
Posted Jan 13, 2021
Incorrect Denials for COVID-19 Claims
7/20/20
Closed
Part A, including HHH
8/6/20
5WEXC
C9803, G2023, G2024, G2025, U0001-U0004, 0099U, 86328, 86769, 87635
Incorrect COVID-19 claim denials due to an internal processing issue.
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.
No provider action is needed at this time.
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
7/10/20
Closed
Jurisdiction 6 and Jurisdiction K Part A (including HH+H)
7/14/20
RC 31138, RC W7220 and RC W7218
N/A
FISS issue causing incorrect claim suspensions has now been corrected.
NGS is informing Part A providers that this issue has now been resolved.
No additional provider action is needed at this time.
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
12/19/19
Closed
Part A, including HHH and FQHCs
4/6/20
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.
Systematically implemented on 4/6/2020.
Hospice Claim Adjustment Issue
3/9/20
Open
Hospice
N/A
Please see “Provider Action” section below
National Government Services is advising hospice providers of two recently identified issues that are impacting payments on hospice adjustments.
The issues are as follows:
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.
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.
NGS will continue to follow the situation with the Medicare system maintainers and advise providers of any changes in this information or further updates.
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.
Updated 5/1/2020
Some Accelerated Payments Showing Incorrect Positive Value
4/22/20
Closed
J6 and JK Providers
4/26/20
N/A
N/A
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.
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.
No action is required. This issue has been resolved.
Implementation date: 4/26/2020
