ESRD Claims Are Paying Incorrectly

National Government Services has been made aware of ESRD claims with HCPCS code 90999 processing at rates that are cents instead of hundreds of dollars. This is causing the claims to pay incorrectly. This issue appears to have started mid-July, 2023.

Home Health 32G Adjustment Issue for Separation Periods of < 60 Days

A segment of home health claims with 32G type of bills are incorrectly being re-coded to earlier periods during processing, instead of the correct later periods. This error is occurring when the separation between the two periods is 60 days or [...]

Hospice Informational Unsolicited Response Adjustments - Type of Bill 8XG

Due to original informational unsolicited responses (IURs) processing not occurring between the timeframe of 8/1/2017 and 4/1/2021, a significant volume of hospice IUR adjustments have been initiated by the common working file (CWF) to [...]

Optical Character Recognition Misreading Referring Provider Names

OCR software is misreading the referring/ ordering provider name (item 17) on some Part B claims.

Letter of Authorization for EDI

Letter of Authorization for EDI We’ve extended our Letter of Authorization PIN expiration period based on user feedback. Letter of Authorization PINs are now valid for 30 days and there is no limit on the number of times a PIN can be used. [...]

Interim Rate Review Documentation Request Form for Hospitals

Billing Overlap/Dispute Resolution Process Effective 3/1/2023

Billing Overlap/Dispute Resolution Process Effective 3/1/2023 An overlapping situation may occur between hospitals for inpatient stays, home health agencies, outpatient services and hospice agencies. Overlapping situations may also occur due [...]

Hospice Claims Edit Issue RC W7048

National Government Services has noted an increase in hospice claims editing incorrectly for RC W7048 following the July 2023 system release. This is occurring for revenue codes 0250 (non-injectable prescription drugs), 0290 and/or 0294 [...]

Guidelines for Submitting Prior Authorization Certain Hospital Outpatient Department

General PAR Documentation Requesters must include the following data elements in all PARs to avoid potential delays in processing. Your MAC may request additional, optional elements for submission of the PAR. Initial Submission Documentation: [...]

Dispute Request for Assistance (RFA) Form

CMS Links

  Administrative Simplification Overview Ambulatory Surgical Centers (ASC) Center  Clinical Laboratory Improvement Amendments (CLIA)  Beneficiary Notices Initiative (BNI)  CMS.gov Email Updates CMS.gov Open [...]

Proper Medicare Part B Claim Submissions Due to the Change Healthcare Security Incident

Proper Medicare Part B Claim Submissions Due to the Change Healthcare Security Incident With many providers submitting paper claims due to the Change Healthcare security incident, it is important to submit your claims correctly. Failure to do [...]

MLN Connects® Newsletter: April 11, 2024

MLN Connects® Newsletter: April 11, 2024 Proposed Payment Rules CMS Proposes New Policies to Support Underserved Communities, Ease Drug Shortages, and Promote Patient Safety News CMS Roundup (Apr. 5, 2024) Medicare Shared Savings [...]

NGSConnex Medicare Part B Remittances

NGSConnex Medicare Part B Remittances We’ve added an enhancement that offers providers the option to view/print remittance advices in NGSConnex for up to 24 months from the date of search. You are required to complete the EDI enrollment to [...]

Social Security Income Ratios

Social Security Income Ratios The federal fiscal year 2022 SSI ratios for IPPS hospitals, IRFs and LTCHs were posted on the CMS website. IPPS IRF LTCH We will update the latest published 2022 SSI ratios in the Provider Specific File of [...]

Reimbursing Place of Service 10 at the Nonfacility Rate for Medicare Telehealth Services

In CY 2024, CMS issued a change to processing for telehealth services billed with POS 10. As of 1/1/2024, these claims are to be paid at the nonfacility PFS rate. A system processing issue resulted in incorrect payments at the facility rate and [...]

Submit Supporting Documentation

Submit Supporting Documentation We encourage you to submit cost reports and supporting documentation electronically whenever possible. In addition to the environmental benefits of this approach, it is also more time and cost efficient. The [...]

Part B Top Claim Errors Updated

Part B Top Claim Errors Updated Using data analysis we update the Top Claim Errors on a quarterly basis and provide: the error reason code; a description of the error; the error type; details that include steps you can take to [...]

Hospice Pricer Tool

Hospice Pricer Tool The CMS Web Pricer will assist in evaluating your hospice claim reimbursement. Revised 4/18/2024

MLN Connects® Newsletter: April 18, 2024

MLN Connects® Newsletter: April 18, 2024 News PrEP for HIV: Prepare for Potential Medicare Part B Coverage Events Clinical Laboratory Fee Schedule Upcoming Meetings: Register to Present, Speak, or Attend in Person by June 1 [...]