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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.

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MLN Connects® Special Edition for Tuesday, April 20, 2021

Posted Apr 20, 2021


NGSConnex Security Requirements

Posted Apr 19, 2021


NGSConnex and Interactive Voice Response Eligibility Enhancements

Posted Apr 16, 2021


MLN Connects® for Friday, April 16, 2021

Posted Apr 16, 2021


Responding to an Additional Documentation Request

Posted Apr 14, 2021

Go to All Production Alerts

HH+H LUPA Claims Rejection Error- Reason Codes 39929 and 37363


Date Reported

4/7/21

Status

Open

Provider Type(s) Impacted

J6 and JK HH+H providers

Date Resolved

Reason Code(s)

39929 (claim level) and 37363 (line level)

Claim Coding Impact

N/A

Description of Issue

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.


National Government Services Action

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.

Provider Action

No provider action is needed, however, please continue to monitor the Production Alerts section of our website and future Email Updates.

Proposed Resolution/Fix

TBD

Home Health: Penalty for RAPs Received More Than five Days Early


Date Reported

2/24/21

Status

Open

Provider Type(s) Impacted

Home Health Agencies

Date Resolved

Reason Code(s)

N/A

Claim Coding Impact

N/A

Description of Issue

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.

National Government Services Action

We will provide updates when applicable.

Provider Action

Agencies may still submit RAPs as they choose.

Proposed Resolution/Fix

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


Date Reported

7/20/20

Status

Closed

Provider Type(s) Impacted

Part A, including HHH




Date Resolved

8/6/20

Reason Code(s)

5WEXC

Claim Coding Impact

C9803, G2023, G2024, G2025, U0001-U0004, 0099U, 86328, 86769, 87635

Description of Issue

Incorrect COVID-19 claim denials due to an internal processing issue. 

National Government Services Action

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.


Provider Action

No provider action is needed at this time.

Proposed Resolution/Fix

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



Date Reported

7/10/20

Status

Closed

Provider Type(s) Impacted

Jurisdiction 6 and Jurisdiction K Part A (including HH+H)

Date Resolved

7/14/20

Reason Code(s)

RC 31138, RC W7220 and RC W7218

Claim Coding Impact

N/A

Description of Issue

FISS issue causing incorrect claim suspensions has now been corrected.

National Government Services Action

NGS is informing Part A providers that this issue has now been resolved.

Provider Action

No additional provider action is needed at this time.

Proposed Resolution/Fix

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


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.

Go to All Upcoming Education

Apr 21

3:30 PM – 4:30 PM EDT
Let’s Chat Home Health & Hospice Public Health & Emergency COVID-19 Updates & Waivers

Apr 22

10:00 AM – 11:30 AM EDT
Home Health Top Billing Errors

Apr 22

10:00 AM – 11:00 AM EDT
Provider Enrollment: Submitting Revalidations via PECOS

Apr 22

1:00 PM – 2:00 PM EDT
Hospice General Inpatient Documentation

Apr 22

1:00 PM – 2:00 PM EDT
Let’s Chat about Provider Enrollment Revalidation
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