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Medicare Secondary Payer – Setting Up or Correcting a Beneficiary’s MSP Record

Apr 7, 10:00 AM – 12:00 PM EDT

Home Health Eligibility: Clinical Documentation Requirements

Apr 7, 1:00 PM – 2:00 PM EDT

Home Health Billing Under Patient-Driven Groupings Model

Apr 7, 2:30 PM – 4:00 PM EDT
 
 
 
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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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New Version of PC Print: April 2020

Posted Apr 3, 2020


MLN Connects® Special Edition for Friday, April 3, 2020

Posted Apr 3, 2020


April 2020 EDI Front End Quarterly Release

Posted Apr 3, 2020


MLN Connects® for Thursday, April 2, 2020

Posted Apr 2, 2020


COVID-19 Update: Important Information Regarding Part A and B Second Level Appeals

Posted Apr 1, 2020

Go to All Production Alerts

Hospice Claim Adjustment Issue


Date Reported

3/9/20

Status

Open

Provider Type(s) Impacted

Hospice

Date Resolved

Reason Code(s)

N/A

Claim Coding Impact

Please see “Provider Action” section below

Description of Issue

National Government Services is advising Hospice providers of two recently identified issues that are impacting payments on hospice adjustments.

The issues are as follows:

  1. Hospice EOL SIA Payment

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.

  1. Hospice Adjustments Overpaying RHC days

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.

National Government Services Action

NGS will continue to follow the situation with the Medicare system maintainers and advise providers of any changes in this information or further updates.

Provider Action

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.

Proposed Resolution/Fix

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


Date Reported

12/19/19

Status

Open

Provider Type(s) Impacted

Part A, including HHH and FQHCs




Date Resolved

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

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.


Date Reported

10/22/19

Status

Closed

Provider Type(s) Impacted

Ambulance providers that bill to Part B of A


Date Resolved

10/24/19

Reason Code(s)

N/A

Claim Coding Impact

An error in Part A skilled nursing facility (SNF) consolidated billing (CB) edit logic is causing incorrect denials for Part B ambulance claims.

Description of Issue

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.

National Government Services Action

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.

Provider Action

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. 

Proposed Resolution/Fix

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.


Date Reported

10/9/19

Status

Closed

Provider Type(s) Impacted

Part A claims will be resolved as stated below. NGS is now announcing a correction for Part B claims.

Date Resolved

10/22/19

Reason Code(s)

U5200

Claim Coding Impact

N/A

Description of Issue

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.

National Government Services Action

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.

Provider Action

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.

Proposed Resolution/Fix

10/23/2019

Hospice NOE RTPs for ZIP Codes


Date Reported

7/12/19

Status

Closed

Provider Type(s) Impacted

Hospice

Date Resolved

8/19/19

Reason Code(s)

32114

Claim Coding Impact

Hospice Notice of Elections (NOEs) Returned to Provider (RTP)

Description of Issue

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.

National Government Services Action

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.

Provider Action

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.

Proposed Resolution/Fix

Fix installed 8/19/2019.

Go to All Upcoming Education

Apr 7

10:00 AM – 12:00 PM EDT
Medicare Secondary Payer – Setting Up or Correcting a Beneficiary’s MSP Record

Apr 7

1:00 PM – 2:00 PM EDT
Home Health Eligibility: Clinical Documentation Requirements

Apr 7

2:30 PM – 4:00 PM EDT
Home Health Billing Under Patient-Driven Groupings Model

Apr 9

1:00 PM – 2:30 PM EDT
Hospice Admission Through Discharge Documentation

Apr 9

2:00 PM – 3:30 PM EDT
NGSConnex New User Orientation
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