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 6/12/2024?
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.
How to Use the 90-Day Global Period Calculator
When a major surgery is performed, it is imperative for billing practices to determine when the 90-day global period ends. The 90-Day Global Period Calculator calculates the date when a global period ends for surgical procedures with a 90-day global period.
From the Resources dropdown, select Tools & Calculators, Select the 90-Day Global Period Calculator.
To determine when the global period ends for a major surgical procedure with a 90-day global period, select the date of the surgery in from the dropdown.
Select Calculate. The date the global period will display. Select the Reset button to clear all data and submit a new query.
Please refer to the Fee Schedule Lookup tool on our website to determine whether the procedure in question has a 90 day global period.
Attention Part B Providers: NGSConnex Part B Clerical Error Reopening Helpful Tips
If you are a Part B provider who uses NGSConnex to submit your clerical error reopenings, there are five steps to complete the submission of a clerical error reopening in NGSConnex. The following information should be helpful as you complete your request.
Initiate a Clerical Error Reopening:
You can initiate a Part B clerical error reopening by selecting ‘Claim Status Lookup’ or ‘Appeals’ from the NGSConnex homepage. After you complete a claim search, and if the claim selected is eligible for a clerical error reopening, the ‘Initiate Reopening’ button will display. If the button does not display that indicates the claim selected cannot be reopened.
Step 1: Submission History
- Verify whether a request was previously submitted via NGSConnex for the claim selected in the ‘Appeal Submission History’ panel before submitting another request. Filing duplicate requests will result in processing delays and is abusive and costly to the Medicare program. We ask that you please refrain from sending duplicate appeal or clerical error reopening requests.
Step 2 and 3: Reopening Details/Claim Lines
- In the Diagnosis 1-8 fields, the diagnosis codes you submitted on your initial claim will display. If the claim you selected contains all approved or paid claim lines, the Diagnosis 1-8 are not editable. If a claim or claim line has been submitted and paid submitting a new or corrected diagnosis does not qualify as a reopening.
- If you add, change or delete a diagnosis code in Step 2, you must update the diagnosis pointer in Step 3, for all applicable claim lines. If you fail to update the diagnosis pointer in Step 3 it may result in incorrect processing of your reopening. You should NOT submit any claim line without a diagnosis pointer. If a claim or claim line has been submitted and paid submitting a new or corrected diagnosis does not qualify as a reopening.
- You can add, change or delete a modifier in the Modifier 1-4 fields at the claim line; however, Modifiers 22, 23, 52, 53, 55, 62, 66, GA, GY and GZ require documentation and cannot be processed as a clerical error reopening.
Learn About the Physician Fee Schedule
"Medicare Physician Fee Schedule: More than Just Fees" is a course to assist you in learning about the Medicare physician fee schedule, Medicare physician fee schedule payment rates, Physician Fee Schedule Lookup Tool on our website and scenarios to help you apply what you have learned. Start this course now in Medicare University and select PTB-C-0043.
Obtaining Financial Information via the IVR
Did you know you are able to obtain financial information via the IVR system? All providers are able to access the Checks (touch-tone 3) option once they have authenticated their provider information:
- Part A providers will obtain a submenu that will offer information about the Last Three Checks (touch‐tone 1) or a Specific Check (touch‐tone 2).
- Part B providers will obtain a submenu that will offer My Checks Information (touch‐tone 1) or My Earnings-to‐Date (touch‐tone 2).
Refer to the Interactive Voice Response User Guide for all available features:
Counseling to Prevent Tobacco Use
Watch this video to learn about the Medicare coverage, coding, billing, and documentation guidelines for tobacco use counseling for outpatient and hospitalized beneficiaries.
Medicare BLAST – National Correct Coding Initiative Procedure to Procedure Edits
- The Medicare National Correct Coding Initiative (NCCI) was implemented to promote national correct coding methodologies and to control improper coding leading to inappropriate payment.
a) True
b) False
- The Medicare National Correct Coding Initiative (NCCI) includes all possible combinations of correct coding edits or types of unbundling that exist.
a) True
b) False
NCCI does not include all possible combinations of correct coding edits or types of unbundling that exist. Providers are obligated to code correctly even if edits do not exist to prevent the use of inappropriate code combinations. - When reviewing the current version of the National Correct Coding Initiative (NCCI) Procedure to Procedure edits it includes all previous versions and all updates from 1/1/1996 to the present.
a) True
b) False
- The Medicare National Correct Coding Initiative (NCCI) is updated and loaded into the Medicare claims processing systems and onto the CMS web pages.
a) Monthly
b) Quarterly
c) Bi-annually
d) Annually
- The Medicare National Correct Coding Initiative (NCCI) is comprised of two provider-type choices of procedure-to-procedure (PTP) code pair edits.
a) True
b) False
- For the Medicare National Correct Coding Initiative (NCCI) edits which modifier indicator will allow a separate payment for the component service, if the criteria is met?
a) Modifier Indicator – 0
b) Modifier Indicator – 1
c) Modifier Indicator – 9
If a code combination on the NCCI table has a modifier indicator of one (1) both services may be payable as long as both are clinically appropriate.
- If both the Column 1 code and the Column 2 code are clinically appropriate you must submit the claim with the medical documentation to support the Column 2 code?
a) True
b) False
You will continue to submit the claim by your normal means and include an appropriate modifier to support the unbundling of the Column 2 service. The supporting documentation will remain in your patient’s medical record. Available on request.
- Modifier 59 is the only valid modifier to use to justify the clinical circumstances to unbundle a code pair edit.
a) True
b) False
Modifier 59 should be the last modifier of choice when there is an already more appropriate established modifier. In some cases, an anatomical modifier may be more appropriate.
- When services are denied based on an NCCI edit you can bill the beneficiary.
a) True
b) False
Denials based on an NCCI edit are considered coding denials, not a medical necessity denial therefore you would not be able to shift the liability to the beneficiary.
- Concerns/questions about the NCCI program, including those related to NCCI (PTP, MUE, and Add-on Code) edits should be sent to:
a) National Government Service
b) Centers for Medicare and Medicaid Services
c) Office of Inspector General
All concerns and questions regarding the NCCI program should be sent in writing via email to NCCIPTPMUE@cms.hhs.gov. Do not submit any Personally Identifiable Information (PII) or Protected Health Information (PHI). Any claim related denials should be handled by NGS.
Resources
- NCCI for Medicare | CMS
- Medicare NCCI Procedure to Procedure (PTP) Edits | CMS
- Medicare NCCI Add-on Code Edits | CMS
Posted 6/17/2024