Self-Service Pulse: What You Need To Know This Week
As your MAC, National Government Services wants to provide you with a comprehensive source containing the most current information available for our self-service tools.
Medicare BLAST is a quick, ten-question game that will challenge the Medicare knowledge of you and your peers. Who were our victorious winners on 2/7/2024?
Note: Some names may be blurred.
Congratulations to our winners! If you weren't able to play Medicare BLAST, don't worry. We will offer more opportunities to play in the near future.
Curious on the questions that were asked during this Medicare BLAST? Scroll to the bottom of this edition to obtain the questions and correct answers.
Watch your Email Updates for your next opportunity to emerge victorious with Medicare BLAST.
Contact Us
Do you need to contact NGS? If so, we have a listing of available phone numbers, inquiry forms and addresses on our website. On the top of every page of our website you can select Contact Us or from the Resources dropdown, select Contact Us for available contact information.
NGSConnex: Part A Prior Authorizations Request Reminders
Did you know that you can submit PARs , check status of those requests and view the prior authorization decision letters via NGSConnex?
If you submit a Prior Authorization request for Botulinum Toxin Injection you must submit paired codes (procedure (64612, 64615) and drug codes (J0585, J0586, J0587, J0588) otherwise your request will be rejected. In addition, Prior Authorization requests for administration sites other than 64612 or 64615 are not accepted for review.
If you submit a Prior Authorization request for any of these procedure types you must provide the laterality indicator (Left, Right, or Bilateral) to indicate which side of the body the procedure will be performed. CMS defines a bilateral service as one in which the same procedure is performed on both sides of the body during the same operative session or on the same day.
- Blepharoplasty, Blepharoptosis Repair and Brow Ptosis Repair
- Vein Ablation
- Facet Joint Interventions
If you aren’t sure whether the service you are providing requires prior authorization you can utilize the Prior Authorization HCPCS Code Inquiry Tool available on ngsmedicare.com to verify.
Related Content
Are You New to the Medicare Program? This Computer-Based Training Course is For You
The ABC's and D's of Medicare is a CBT course to help you gain an understanding of the different parts of the Medicare Program and what coverage is provided. Start this course now at Medicare University and select PTB-C-0054.
How to Determine When an Additional Documentation Request Was Mailed
Did you know the IVR system will advise you when an ADR has been sent? By selecting Claims Status (touch-tone 2), you will hear the date the ADR was sent.
Refer to the IVR User Guide for all components available via the Eligibility option.
Medicare University: Create a New User Account
Watch this three-minute tutorial video to learn how to create your new Medicare University account.
Medicare BLAST - Facet Joint Interventions for Pain Management
Answers are in bold
- A request for subsequent RFA requires proof that two diagnostic procedures were completed, prior to the initial radiofrequency ablation, at the same levels intended for treatment.
True
The documentation must support that two diagnostic procedures were completed, at the same levels intended for treatment, prior to initiating RFAs. Each spinal level must be diagnosed with an initial and confirmatory block, to verify facet pathology, prior to proceeding with RFA.
- At least 50% consistent pain improvement for five months supports the medical necessity of a subsequent RFA.
False
For subsequent thermal facet joint radiofrequency ablation at the same anatomic site, documentation must support at least 50% consistent pain improvement for at least six months or at least 50% improvement in the ability to perform previously painful movements and ADL, compared to baseline measurement using the same scale.
- For each covered spinal region, no more than ______ radiofrequency sessions will be reimbursed per rolling 12 months.
- Four
- Two
- Three
- One
For each covered spinal region, no more than two radiofrequency sessions will be reimbursed per rolling 12 months. Providers that choose to perform each laterality on separate dates of service should be aware that this frequency limitation will still be in place.
- If there is an extended time, two years or more since the last radiofrequency ablation and/or there is a question as to the source of the recurrent pain then diagnostic procedures must be repeated.
True
If there is an extended time, two years or more since the last radiofrequency ablation and/or there is a question as to the source of the recurrent pain then diagnostic procedures must be repeated. If the beneficiary has been receiving radiofrequency ablation with relief lasting greater than two years, it is not always required that diagnostics be repeated, as long as the documentation supports the extended duration of relief.
- After the first diagnostic facet joint procedure, there must be a consistent positive response of at least _____% relief of primary (index) pain.
- 50%
- 75%
- 80%
- 100%
After the first diagnostic facet joint procedure, there must be a consistent positive response of at least 80% relief of primary (index) pain (with the duration of relief being consistent with the agent used).
- Diagnostic procedures should be performed with the intent that if successful, ______ procedures would be considered the primary treatment goal at the diagnosed level.
- IA procedures
- MBB procedures
- RFA
- Any of these procedures
Diagnostic procedures should be performed with the intent that if successful, a RFA procedure would be considered the primary treatment goal at the diagnosed level(s).
- How long must the axial pain be present and conservative treatments have been tried prior to initiating a facet joint intervention?
- one month
- two months
- three months
Pain present for minimum of three months with documented failure to respond to noninvasive conservative management (as tolerated).
- What is required documentation that should be included after each diagnostic intervention to show the patient experienced a consistent positive response during the anesthetic phase to support the percentage of relief reported?
- Pre-procedure pain assessment using the same pain scale
- Post-procedure pain assessment using the same pain scale
- Improvement in the ability to perform ADLs post procedure
- Both A. and B.
Pain assessments must be performed and documented at baseline, after each diagnostic procedure using the same pain scale for each assessment.
- Subsequent therapeutic facet joint procedures at the same anatomic site must result in at least ______% consistent pain relief for at least three months from the prior therapeutic procedure or at least _____% consistent improvement in the ability to perform previously painful movements and ADLs as compared to baseline measurement using the same scale.
- 80%
- 50%
- 75%
- 100%
Subsequent therapeutic facet joint procedures at the same anatomic site results in at least consistent 50% pain relief for at least three months from the prior therapeutic procedure or at least 50% consistent improvement in the ability to perform previously painful movements and ADLs as compared to baseline measurement using the same scale.
- Therapeutic intraarticular facet injections are not reasonable and necessary unless there is justification in the medical record as to why RFA cannot be performed.
True
Therapeutic intraarticular facet injections are not reasonable and necessary unless there is justification in the medical documentation on why RFA cannot be performed.
Related Content
- LCD L35936 Facet Joint Interventions for Pain Management
- Facet Joint Interventions for Pain Management Best Practices
Posted 2/12/2024