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 Apr 3, 2020
Posted Apr 3, 2020
Posted Apr 3, 2020
Posted Apr 2, 2020
Posted Apr 1, 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 7 days of the beneficiary’s date of death. The system maintainer is coding a correction, tentatively scheduled to be implemented on 4/20/2020. Providers are advised to hold their EOL SIA payment adjustments.
Adjustments to hospice claims with RHC days billed are overpaying, the high routine home care rate is applying even when the prior days used are greater than 60. The Medicare system maintainers are researching. Providers are advised to hold adjustments to claims with routine home care days when the prior days used are greater than 60.
NGS will continue to follow the situation with the Medicare system maintainers and advise providers of any changes in this information or further updates.
Providers are advised of the following workaround available for application of the EOL SIA payments: first adjust the discharge claim with patient status code 40, 41 and 42, allowing it to finalize; next adjust the prior month’s bill to pay the add-on.
At this time, no workaround has been identified to prevent hospice adjustments overpaying RHC days when the prior days used are greater than 60.
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
Closed
Ambulance providers that bill to Part B of A
10/24/19
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.
Implementation Date: 10/24/2019
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.
