National Government Services Part B Medical Review Newsletter March 2021

The National Government Services Medical Review department would like to welcome you to our newest service; a regular newsletter. It is our hope that you will find this newsletter helpful in providing you the resources you need to help you stay up-to-date on the MR activities performed here at NGS .

Our plan is to include:

• • Updates and News
  • Educational Resources
  • Helpful Tips and Reminders
  • Contact Information

What’s New?

Please Note: TPE reviews remain suspended due to the PHE related to COVID-19. However, the NGS MR Department is currently performing service specific post-payment reviews for a random selection of claims billed to Medicare Part A and B.

Providers are encouraged to visit the Medical Review Focus Areas on our website. This dedicated area will identify which services are being selected, what type of documentation is required and provide more details on these service specific post-payment reviews.

Note: If the link above does not take you directly to the MR focus area topic, it is often due to it being your initial visit to the NGS website. If this occurs, you may see a red box that says Continue as a Guest. Select your Part B provider information. Once you do this and continue, you will be prompted to verify you read a short attestation statement. After completing this information once, you should not have to do it a second time as long as you choose Remember my choice when putting in your provider information. Once you do this, click on the Medical Policy & Review tab near the top.

Service Specific Post-Payment Review Announcements

JK Part B

• • Ambulance Transport and Mileage
  • Nail Debridement
  • Paring or Cutting of Benign Hyperkeratotic Lesions
  • Botulinum Toxins
  • Vitamin D Assay Testing
  • Breast Ultrasound
  • Trigger Point Injections
  • Prolia (Denosumab) Injection

J6 Part B

• • Psychotherapy, 60 Minutes with Patient
  • Ambulance Transport and Mileage When Billed with Modifiers RJ, JR, RG, GR, NJ, JN, NG, GN
  • Hyaluronan or Derivative
  • Artacent Wound, Per Square Centimeter
  • Nonemergency Ambulance Transport and Mileage
  • Grafix Prime
  • Floweramnioflo, 0.1 cc
  • Botulinum Injection, Onabotulinumtoxina, 1 unit

Comparative Billing Reports

A CBR provides comparative data on how an individual health care provider compares to other providers by looking at utilization patterns for services, beneficiaries and diagnoses billed. You may have received this letter because your billing was identified as being significantly different compared to your peers. CBRs can serve as a helpful self-audit tool for providers. NGS has mailed CBRs for the following services:

JK Part B

• • Chiropractic Services (98940-98942)
  • Hospital Outpatient Observation Services (99224-99226)
  • Subsequent Hospital Visits (99231-99233)
  • Chronic Care Management Service (99490 & 99487)
  • Nursing Home Visits (99309-99310)
  • Urine Drug Test(s) (80307)
  • Physical and Occupational Therapy (97161-97163) and (97165-97167)

J6 Part B

• • Chiropractic Services (98940-98942)
  • Hospital Outpatient Observation Services (99224-99226)
  • Subsequent Hospital Visits (99231-99233)

Want to learn more about CBRs?

Watch our short video Comparative Billing Reports (CBRs) Making the CBR work for you to learn more.

This CBR training is also available on our Medical Review web page.

Questions? If you have received a CBR and have questions or would like to request education please contact the Medical Review Case Management team using the email address in the “Contact Us” section located at the end of this newsletter.

Helpful Tips

If you have been selected for review, visit the Medical Review Focus Areas on our website for educational resources relating to these services being reviewed.

NGS recommends responding to ADRs within 35‒40 days of the letter date (CMS allows providers to respond within 45 days of the ADR date). See the ADR Timeline Calculator available on our website for help with determining the target date that the requested medical records must be received by NGS.

Be sure to forward the requested documentation using the preferred method of submission.

No longer do you need to fax us your records. The NGS self-service portal, NGSConnex, allows both Part A (including home health, hospice and FQHC) and Part B providers to respond to ADRs electronically with no need to mail or fax a response to complete the ADR process. Further details are available on our website. If you are a current user of NGSConnex, click on the link for the NGSConnex User Guide for step-by-step instructions on how to submit an ADR. If you are not a current user, sign up and get started.

• • NGSConnex is the preferred method for submitting responses to ADRs.
  • Documentation is submitted directly to the MR department.
  • You can save time and money by using NGSConnex when responding to ADRs. You no longer have to worry about postage, or your response getting lost in the mail or not arriving on time. You can simply upload your documents and hit submit. Using NGSConnex to respond to ADRs also provides you with an electronic record of the documentation submitted and when the response was sent.

Include all records necessary to support the services for the dates requested.

Records must be complete and legible. Be sure to include both sides of double-sided documents.

All services must include necessary signatures and credentials of professionals. See the Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.4, “Signature Requirements”.

Contact Us

If you have received an ADR or CBR and have questions, you may contact the MR department at the following email address:

Posted 2/24/2021