Medicare Advisory Liaison


NGS Connex Issues
Connex and web based issues email:
ngswebsupport@anthem.com.

When contacting NGS on Connex issues add a brief synopsis of what they are experiencing. The web support team will then reach them via their preferred method of communication.

CMS Takes Action to Modernize Medicare Home Health

On July 2, CMS proposed significant changes to the Home Health Prospective Payment System (PPS) to strengthen and modernize Medicare, drive value, and focus on individual patient needs rather than volume of care. Specifically, CMS is proposing changes to improve access to solutions via remote patient monitoring technology, and to update the payment model for home health care.

“Today’s proposals would give doctors more time to spend with their patients, allow home health agencies to leverage innovation and drive better results for patients,” said CMS Administrator Seema Verma. “The redesign of the home health payment system encourages value over volume and removes incentives to provide unnecessary care.”

CMS’s proposed changes promote innovation to modernize home health by allowing the cost of remote patient monitoring to be reported by home health agencies as allowable costs on the Medicare cost report form. This is expected to help foster the adoption of emerging technologies by home health agencies and result in more effective care planning, as data is shared among patients, their caregivers, and their providers. Supporting patients in sharing this data will advance the Administration’s MyHealthEData initiative.


DEDUCTIBLE AND COPAYMENT INFORMATION FOR QUALIFIED MEDICARE BENEFICIARY PROGRAM

The QMB program prohibits all Medicare providers from billing QMB individuals for all Medicare deductibles, coinsurance or copayments. Therefore, deductible, coinsurance or copayment information is not available through NGSConnex or the IVR system for beneficiaries enrolled in the QMB program. This information is also not available through the Customer Care Representatives in the Provider Contact Center.

Medicare beneficiaries enrolled in the QMB program have no legal obligation to pay Medicare Part A or Part B deductibles, coinsurance or copays for any Medicare-covered items and services. Providers who inappropriately bill individuals enrolled in QMB are subject to sanctions.

For additional information on the QMB program and your responsibility as a provider for these patients please review these resources:

  • CMS ICN 006977 – Dual Eligible Beneficiaries Under Medicare and Medicaid
  • MLN Matters Article SE1128 Revised – Prohibition Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program
  • Qualified Medicare Beneficiary Program -FAQ on Billing Requirements

Jeffrey Crowhurst DPM

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