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 20, 2021
Posted Apr 19, 2021
Posted Apr 16, 2021
Posted Apr 16, 2021
Posted Apr 14, 2021
HH+H LUPA Claims Rejection Error- Reason Codes 39929 and 37363
4/7/21
Open
J6 and JK HH+H providers
39929 (claim level) and 37363 (line level)
N/A
LUPA claims are rejecting in error with RCs 39929 (claim level) and 37363 (line level), indicating incorrectly that RAP claims have been submitted beyond timeliness limits.
NGS is working with CMS to resolve this error. The Provider Contact Center will not be able to provide any additional information at this time.
No provider action is needed, however, please continue to monitor the Production Alerts section of our website and future Email Updates.
TBD
Home Health: Penalty for RAPs Received More Than five Days Early
2/24/21
Open
Home Health Agencies
N/A
N/A
The Home Health Pricer program is incorrectly applying a penalty to RAPs received more than five days earlier than the “From” date of the RAP. The associated claims cannot be readily identified for MAC suspension.
We will provide updates when applicable.
Agencies may still submit RAPs as they choose.
A system fix is scheduled for 3/1/2021. Once the fix is implemented, National Government Services will adjust claims with a value code QF amount greater than $0 (penalty amount) and a RAP RECEIPT DT of more than five days earlier than the “From” date.
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.
