National Government Services Part A 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.

Newsletters will 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 service areas under review, required documentation 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 may be your initial visit to the NGS website. You will see a red box that says Continue as a Guest. Select your Part A 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. Upon entering the site, choose the Medical Policy & Review tab, Medical Review, Medical Review Focus Areas.

Service Specific Post-Payment Review Announcements

JK Part A

Physical Therapy Reevaluations

• CPT 97164 – Reevaluation of physical therapy established plan of care.

Wound Debridement

• HCPCS 97597 - Active wound care management for selective wound debridement (typically recurrent debridement), performed with minimal anesthesia.
• HCPCS 97598 - Active wound care management for selective wound debridement (typically recurrent debridement), performed with minimal anesthesia, total wound(s) surface area greater than 20 square centimeters.

Wheelchair Management

• 97542 - Wheelchair management (e.g., assessment, fitting, training) each 15 minutes.

Group Psychotherapy

• HCPCS: 90853 – Outpatient group psychotherapy including interpersonal interactions and support with several patients; typically 45 to 60 minutes in length.

Individual Psychotherapy

• 90832 - Individual psychotherapy services rendered for 30 minutes by a licensed mental health provider, with patient.
• 90834 - Individual psychotherapy services rendered for 45 minutes by a licensed mental health provider, with patient.

Trastuzumab/Herceptin

• HCPCS:  J9355 - Injection, trastuzumab (Herceptin), excludes biosimilar, 10 mg.

Fosaprepitant Injection

• HCPCS: J1453 Injection, Fosaprepitant, 1 mg.

J6 Part A

Cardiac Rehabilitation Services

• 93797 (Physician services for outpatient cardiac rehabilitation; without continuous electrocardiographic [ECG] monitoring [per session]).
• 93798 (Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring [per session]).

Physical Therapy Reevaluations

• 97164 – Physical therapy reevaluation.

Individual Psychotherapy

• 90832 - Individual psychotherapy services rendered for 30 minutes by a licensed mental health provider, with patient.
• 90834 - Individual psychotherapy services rendered for 45 minutes by a licensed mental health provider, with patient.

Group Psychotherapy

• HCPCS: 90853 – Outpatient group psychotherapy including interpersonal interactions and support with several patients; typically 45 to 60 minutes in length.

Hyperbaric Oxygen Services

• HCPCS G0277 – HBO under pressure, full body chamber, per 30 minute interval.

Trastuzumab/Herceptin

• HCPCS:  J9355 - Injection, trastuzumab (Herceptin), excludes biosimilar, 10 mg.

Have you Received a Comparative Billing Report from NGS?

• A comparative billing report is referred to as a CBR.
• CBRs are free
• CMS defines a CBR as an educational resource and a tool for possible improvement.
• CBRs are often used to alert providers if their billing statistics appear unusual compared to their peers.
• The CBR is an educational tool to support the effort of safeguarding the Medicare Trust Fund.

CMS Takes Steps to Ensure Medicare Beneficiaries Have Wide Access to COVID-19 Antibody Treatment. Read about it in the Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction article.

Helpful Tips

• NGS recommends responding to ADRs within 35‒40 days of letter date (CMS allows providers 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. Keep reading for more information on NGSConnex.
• If you are mailing in your ADR, please send each response separately and attach a copy of the corresponding ADR. It is acceptable to send multiple responses in a single mailing; however, each response must be individually bundled with a copy of the corresponding ADR within the mailing to facilitate proper handling and review of the ADR response.
• Include all records necessary to support the services for the dates requested.
• Do not include additional correspondence with documentation submissions. Unrelated correspondence should be mailed separately.
• 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 CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.4, “Signature Requirements”

NGSConnex

NGSConnex is our free, secure, web-based application developed by National Government Services just for you! NGSConnex provides access to a wide array of self-service functions that save you time and money, with the ability to:

• Obtain beneficiary eligibility information
• Query for your claims status
• Initiate and check the status of redetermination and reopening requests
• View your provider demographic information
• Query for your financial data
• Submit documents for an ADR
• Submit Credit Balance Reports
• And more!

Why Use NGSConnex?

As a registered NGSConnex user, you will have instant online access to invaluable detailed Medicare claim information and the ability to perform secure Medicare transactions, saving you time and money.

You no longer need to tie up your phone line as NGSConnex offers the same eligibility information and claim status information you previously were only able to obtain via the IVR system. You can also use the MBI Lookup tool available only in NGSConnex, if you have attempted to obtain it from the Medicare beneficiary but have been unsuccessful.

NGSConnex also allows you to print and save information for your records. NGSConnex gives you the opportunity to document this research for your records by either printing the eligibility information or electronically capturing the information and entering it into your records.

You can also save time and money by using NGSConnex when responding to Medical Review 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.

If you are new to NGSConnex, you will need to complete the registration process. There are multiple steps in the registration process. You must complete the entire registration process during the same session. You will not be able to complete part of the steps and save the information and return to complete the process. Each step is important in the registration process and must be completed in its entirety for you to gain access to NGSConnex.

In order to register, you will need:

• NPI
• PTAN
• Last five digits of the TIN
• Check number and check amount for an NGS Medicare check issued within the past 90 days (LSOs only)

Each person must register for their own NGSConnex User ID. The sharing of NGSConnex accounts is prohibited and may result in revocation of your account.

Here are some valuable resources to get you started today:

• NGSConnex
• NGSConnex YouTube Video
• Part A NGSConnex User Guide
• Part B NGSConnex User Guide

Availability and Contact Information

To optimize your NGSConnex experience, you are encouraged to complete your NGSConnex transactions between the following hours:

• Monday–Friday from 6:00 a.m.-7:00 p.m. ET
• Saturday from 7:00 a.m.-3:00 p.m. ET

If NGSConnex is accessed outside of these hours, you may not be able to complete your transactions.

Check our Education page for upcoming NGSConnex trainings, question and answer sessions and other educational opportunities.

Contact Us

If you have received an ADR or CBR from NGS and have questions, you may contact the Case Management Team at the following email addresses:

Posted 3/9/2021