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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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Go to All News Articles

MLN Connects® for Thursday, August 6, 2020

Posted Aug 6, 2020


Alert: Postcard Disguised as Official OCR Communication 8/6/2020

Posted Aug 6, 2020


MLN Connects® Special Edition for Tuesday, August 4, 2020

Posted Aug 5, 2020


MACs Resume Medical Review on a Post-Payment Basis

Posted Aug 5, 2020


Comprehensive Error Rate Testing Program

Posted Aug 4, 2020

Go to All Production Alerts

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.

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 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.

  1. Hospice Adjustments Overpaying RHC days

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.

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

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.

Proposed Resolution/Fix

Updated 5/1/2020

Some Accelerated Payments Showing Incorrect Positive Value


Date Reported

4/22/20

Status

Closed

Provider Type(s) Impacted

J6 and JK Providers

Date Resolved

4/26/20

Reason Code(s)

N/A

Claim Coding Impact

N/A

Description of Issue

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.

National Government Services Action

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.

Provider Action

No action is required. This issue has been resolved.


Proposed Resolution/Fix

Implementation date: 4/26/2020

Go to All Upcoming Education

Aug 11

10:00 AM – 12:00 PM EDT
Medicare Secondary Payer – Adjustments Involving MSP

Aug 11

1:00 PM – 2:00 PM EDT
NGSConnex Optimizing the Eligibility Mega Tab

Aug 13

1:00 PM – 2:30 PM EDT
NGSConnex New User Orientation

Aug 13

2:00 PM – 3:00 PM EDT
Submitting Revalidation via CMS-855A Paper Application

Aug 18

10:00 AM – 11:00 AM EDT
Let’s Chat about Provider Enrollment Revalidation
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