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 6/26/2024?

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.

Where are Medical Policies Located?

The Medical Policies area on our website houses the LCDs, Billing and Coding and Medical Policy Articles. You are also able to view draft and future policies.

If you are searching for NCDs, you will need to access the CMS website. The NCDs are located in the CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual.

Within the Medical Policies, you are able to search the LCDs and related articles by a keyword, LCD#, CPT or HCPCS via the Search option.

To locate Medical Policies either select Medical Policies on the Homepage or from the Resources dropdown.

NGSConnex: Part B Deductible Information Reminder

We have received questions about why the Part B Deductible information section under Eligibility Lookup is sometimes blank. If this section is blank or deductible information does not display for a specific year it may be because the beneficiary is or was enrolled in a QMB program.

If blank, you should verify the beneficiary’s QMB status in the ‘Qualified Medicare Beneficiary’ section of Eligibility Lookup. If the beneficiary is enrolled in a QMB program the remaining deductible information will not be provided. You should refer to the Remittance Advice to determine any payment amount applied to the Part B deductible or for coinsurance information. As a reminder, you are prohibited from billing a Medicare beneficiary enrolled in a QMB program for deductible and coinsurance.

You can find additional information and detailed step-by-step instructions in the NGSConnex User Guide.

Updating Your Medicare University Profile

Have you changed jobs? Has your email address changed? Each Medicare University student has a unique profile. You should keep your profile current and up-to-date at all times to experience all the benefits Medicare University has to offer. Use the Edit Profile form to update your personal information or change your password.

To update your Medicare University profile, follow these three steps:

Step 1: Log in to Medicare University. The Medicare University home page will display.
Step 2: Click Edit Profile. The Edit Profile window will open.
Step 3: Edit the information in the applicable fields, as necessary.

If you have created multiple Medicare University accounts, we can merge them for you. Just send an email to medicare.university@anthem.com and request we merge your accounts. Please provide your telephone number in case we need to contact you.

Using the IVR to Obtain Medicare Advantage Plan and Medicare Secondary Payer Information

Have you ever submitted a claim thinking Medicare was the primary payer just to receive a claim denial indicating that wasn't the case? Did you know that you can obtain MSP and MA plan information via the IVR system? The Eligibility Option 1 will provide the following:

• MA Plan
  • MA Plan number
  • Name
  • Option Code
  • Administering insurance company
  • Effective/termination dates
• MSP
  • MSP type
  • Insurer name
  • Effective/termination dates
  • Diagnosis code(s), if applicable - if the primary insurance is limiting coverage to specific diagnosis codes, the codes will be provided

Refer to the IVR User Guide for all components available via the Eligibility option.

• Part A
• Part B

Prior Authorization - Vein Ablation & Related Services

Watch this six-minute video to learn about Prior Authorization - Vein Ablation & Related Services.

 

Medicare BLAST - Social Determinants of Health - HCPCS Code G0136

Answers are in bold

1. The effective date for HCPCS Code G0136 for Social Determinants of Health was:
   
   •    1/1/2024
   •    1/1/2023
   •    10/1/2024
    
2. Administration of a standardized evidence-based Social Determinants of Health Risk Assessment is 5-15 minutes, and not more often than every 6 months.
   
   True
   False
    
3. When furnished as an additional element of the Annual Wellness Visit, the Social Determinants of Health Risk Assessment is optional at the discretion of the clinician and beneficiary, and separately payable
   
   •    With cost sharing
   •    With no beneficiary cost sharing
    
4. When Social Determinants of Health (SDOH) is an additional element of the Annual Wellness Visit, the SDOH Risk Assessment is subject to a modifier to waive the deductible and coinsurance.
   
   True
   False


5. When Social Determinants of Health Risk Assessment (G0136) is billed, on the same claim and the same date of service as the Initial Annual Wellness Visit (AWV) (G0438) or Subsequent AWV (G0439), what modifier is required and what code is it added to?
   
   •    Modifier 33 attached to G0438/G0439
   •    Modifier 33 attached to G0136


6. Social Determinants of Health G0136 is not billable with an evaluation and management or behavioral health visits.
   
   True
   False


7. Social Determinants of Health cannot be billed with CPT evaluation and management code 99211.
   
   True
   False


8. Social Determinants of Health can be billed with Transitional Care Management.
   
   True
   False
    
9. Who can render Social Determinants of Health Risk Assessment?
   
   •    Physician who is a Doctor of Medicine or Osteopathy
   •    Physician assistant, nurse practitioner, or clinical nurse specialist
   •    Medical professional or a team of such medical professionals, working under the direct supervision a physician
   •    All the above
    
10. Social Determinants of Health Risk Assessment is an additional element of the annual wellness visit or the initial preventive physical exam (IPPE)?
    
    True
    False

Related Content

• MLN Matters® Medicare Physician Fee Schedule Final Rule Summary: CY 2024
• CMS IOM Publication 100-04, Medicare Claims Processing Manual
  • Chapter 12, Section 190.5
  • Chapter 13, Section 20.2.4
  • Chapter 18, Section 240
• The Accountable Health Communities Health-Related Social Needs Screening Tool

Posted 7/1/2024