Event Summary

Event/Question and Answer Summary

Event Summary

National Government Services conducted an Ask-the-Contractor Teleconference (ACT) for hospice providers in Jurisdiction 6 and K on August 10, 2021. The session provided an opportunity for the hospice provider community to ask questions of any department within National Government Services. The J6/JK hospice agencies were also able to ask questions prior to the call and send follow-up questions after the call by emailing J6.provider.training@anthem.com.

Question and Answer Summary

The following questions and responses are those asked during the session.  We did not have any presubmitted questions. Please note that questions and answers may have been rewritten for clarity.

  1. Can Part A HHH providers submit information for ADR request through NGSConnex.?

    Answer: Yes, HHH ADRs may be submitted through NGSConnex.
  2. Is Medicare or the hospice provider responsible for the professional component of a radiology or cardiology service. For example, patient gets a monthly EKG which is related to their EOL diagnosis... the technical charge of the EKG is the responsibility of the hospice provider... what about the PRO read if the provider in not employed by the hospice?

    Answer: In the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 11, Section 40.1.3 – Independent Attending Physician Services, it states the following:

    Services provided by an independent attending physician must be coordinated with any direct care services provided by hospice physicians. Only the direct professional services of an independent attending physician, to a patient may be billed; the costs for services such as lab or x-rays are not to be included in the bill.

    Professional services related to the hospice patient’s terminal condition that were furnished by an independent attending physician are billed to the A/B MAC (B) through Medicare Part B. When the independent attending physician furnishes a service related to the patient’s terminal illness and related conditions that includes both a professional and technical component (e.g., x-rays), he/she bills the professional component of such services to the A/B MAC (B) on a professional claim and looks to the hospice for payment for the technical component. Likewise, the independent attending physician would look to the hospice for payment for services furnished that have no professional component (e.g., clinical lab tests). The remainder of this section explains this in greater detail.
  3. Can Kathy confirm that even nonmedical ADRs can be submitted via NGSConnex? That has not always been the case.

    ​​​​​​​Answer: According to the NGSConnex User Guide, only Medical Review ADRs can be submitted through the NGSConnex portal. Please respond to nonmedical ADRs following the guidance on the ADR letters.
  4. I entered an 81C with an incorrect cert date. Can I correct this like we correct 81A?

    Answer: The only two things a provider does not have to change if billed incorrectly on the 81A is the diagnosis codes or the attending physician number, if it is an incorrect certification date the NOE has to be resubmitted. For an 81C bill, if an admit date needs to be corrected you must use the occurrence code (OC) 56 and condition code (CC) D0. The date used with the OC 56 will be the incorrectly reported date of admission. The correct admission date should be entered in the “From” field and the discharge date should be entered in the “Through” field.

Posted 9/8/2021