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 7/24/2024?
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.
Electronic Data Interchange Help Desk and Self-Service Tools
Did you know the EDI Help Desk has several self-service tools available on our website?
You are able to:
- Check EDI Enrollment Status
- EDI Front End Rejection Code Lookup Tool
- NPI/PTAN Crosswalk
- EDI Email Inquiry Process
Visit EDI Enrollment on our website to learn more.
Targeted Probe and Educate Results Letter Available in NGSConnex
The Targeted Probe and Educate Results Letter can now be viewed in NGSConnex, here’s how:
To locate them, use NGSConnex User Guide to navigate the portal.
Select ADR on the homepage and follow the user guide instructions starting with "Check Status of Additional Documentation Request" then simply follow the instructions in "TPE Decision Letter". This is where your results letter will be found.
Does Medicare University Offer Credits or Degrees?
Yes, MU offers each person the opportunity to earn MUCs for each training event that is attended. MUCs are offered for every teleconference, webinar and computer-based training.
Each teleconference and webinar is assigned a training event number which is sent in an email from GoToWebinar about an hour after the event ends. Sometimes, the email from GoToWebinar will end up in your spam/junk folder or will be returned as undeliverable. If you expect to receive an email with the self-reporting attendance information but don't receive it, remember to check your spam/junk folders. In addition, you can add GoToWebinar to your safe sender list.
NGS awards you with an associate certificate from MU once you have completed and recorded 60 MUCs. When you complete and record 120 hours of MUCs, you earn a bachelor’s certificate from MU.
To check your credits log into Medicare University and select My Courses, then select the Transcript tab. From the Transcript page, select Download Generated Report.
The report will download and will open in Excel. On the spreadsheet you will see the Credit Hours displayed.
To obtain your certificate, you must email Medicare University with your user name and the requested certificate.
Qualified Medicare Beneficiary Program Dates Available via the IVR
The IVR system allows you to obtain enrollment dates for Medicare beneficiaries that are enrolled in a QMB program. Once you select the Eligibility option (touchtone 1), if the date of service falls within a QMB program, you will be provided with the QMB effective dates. Please note, when a beneficiary is in a QMB program, the beneficiary is not responsible for deductibles or co-payments.
Refer to the IVR User Guide for all features available in the IVR:
Principal Illness Navigation (Part 3)
Principal Illness Navigation using auxiliary personnel, patient navigators and peer support specialists are payable by Medicare beginning in 2024. This video will take you through the new coverage, what may be provided and performed for the patient along with the appropriate billing information for the service.
Medicare BLAST - Principal Illness Navigation Services
Answers are in bold
- Principal illness navigation (PIN) services are to help people with Medicare who are diagnosed with high-risk conditions (for example, dementia, HIV/AIDS, and cancer) identify and connect with appropriate clinical and support resources.
a) True
b) False
- All Medicare patients are eligible to receive PIN services.
a) True
b) False – PIN services are to address a serious high-risk condition, illness, or disease, with these characteristics:
- One serious, high-risk condition and for principal illness navigation-peer support (PIN-PS), a serious, high-risk behavioral health condition expected to last at least 3 months that places the patient at significant risk of:
- Hospitalization
- Nursing home placement
- Acute exacerbation or decompensation
- Functional decline or death
- A condition that requires development, monitoring, or revision of a disease-specific care plan, and may require frequent adjustment in the medication or treatment regimen, or substantial assistance from a caregiver.
- PIN services require an initiating E/M visit.
a) True
b) False
- The billing practitioner personally performs an initiating visit which may be:
a) An E/M visit. (other than a low-level E/M visit done by clinical staff)
b) A Medicare annual wellness visit provided by a practitioner who meets the requirements to furnish subsequent principal illness navigation services.
c) CPT code 90791 (psychiatric diagnostic evaluation) or the Health Behavior Assessment and Intervention services CPT codes 96156, 96158, 96159, 96164, 96165, 96167, and 96168.
d) Any one of the above
- Frequency and duration limitations apply to PIN services.
a) True
b) False
Currently, there are no frequency or duration limitations on PIN services. However, utilization will be monitored.
- Navigators and peer support specialists may be paid directly from Medicare.
a) True
b) False
There is not a Medicare benefit for paying navigators and peer support specialists directly, these services will be paid incidental to the services of the health care practitioner who directly bills Medicare.
- Since care management services focus heavily on clinical, rather than social aspects of care, you may furnish PIN services in addition to other care management service.
a) True
b) False
- Subsequent services will be provided by auxiliary personnel incident to the services of the practitioner who billed the PIN initiating visit.
a) True
b) False
- These services are payable in all inpatient and outpatient place of service locations.
a) True
b) False
- Patients consent is not required for PIN services.
a) True
b) False – Patients verbal or written consent is required and must be documented in the medical record.
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Posted 7/29/2024