Mission and Charter

​​National Government Services Provider Outreach and Education Advisory Group Charter National Government Services serves as the MAC for J6 and JK Part A, Part B and Home Health and Hospice. We maintain four POE AGs: Part A POE [...]

Medicare Part B Electronic Claims that Exceed the Threshold for Charges and Units of Service

Medicare Part B Electronic Claims that Exceed the Threshold for Charges and Units of Service  Medicare Part B electronic claims (ANSI X12 837P) with total charges exceeding $99,999.99 cannot be processed in the MCS. If a single claim [...]

MLN Connects® Newsletter: October 31, 2024

MLN Connects® Newsletter: October 31, 2024 News Medicare Shared Savings Program Continues to Deliver Meaningful Savings and High-Quality Health Care Compliance Major Hip & Knee Replacement or Reattachment of Lower Extremity: [...]

11/4/2024

This is Our Last Self-Service Pulse We sincerely thank you for being a loyal reader of our Self-Service Pulse each week. To continue receiving updates on our latest self-service tools and services, please subscribe to our general Email [...]

Report a Change of Ownership, Acquisition/Merger or Consolidation

Table of Contents Step 1: Determine You Are in the Right Place Step 2: Understand Type of CHOW Change of Ownership Acquisition/Merger Consolidation CHOW Reminders Step 3: Make Changes via Enrollment Application Change of [...]

Two Weeks to Prepare to use NGSConnex for Beneficiary Eligibility Information

Two Weeks to Prepare to use NGSConnex for Beneficiary Eligibility Information As we’ve communicated, beginning 11/18/2024, Beneficiary Eligibility information will not be offered on the IVR. This includes all beneficiary eligibility [...]

Instructions for Unfinished PECOS Enrollment Application(s)

Table of Contents Instructions for Unfinished PECOS Enrollment Application(s) Instructions for Unfinished PECOS Application(s) Instructions for Application Status “Pending E-Signature” Submitted Enrollment Application(s) on Behalf of an [...]

Report a Change of Information

Report change of enrollment information timely. Changes can be either submitted electronically via PECOS or by mail with the paper CMS-855A and/or CMS-588 EFT agreement. A change in the Tax ID with no ownership change will need to submit [...]

Report a Change of Information

Report change of enrollment information timely. Changes can be either submitted electronically via PECOS or by mail with the paper CMS-855A and/or CMS-588 EFT agreement. A change in the Tax ID with no ownership change will need to submit [...]

Report a Change of Information

Table of Contents Report a Change of Information PECOS Submission Related Content Paper Submission Related Content [Return to Top] Report a Change of Information Report change of enrollment information [...]

Coming Soon ‒ The CY 2025 Medicare Physician Fee Schedule

Coming Soon ‒ The CY 2025 Medicare Physician Fee Schedule The CY 2025 MPFS will soon be available on the Fee Schedule Lookup tool located on NGSMedicare.com, after the CY 2025 physician fee schedule regulation is put on display. Once the Fee [...]

Ambulance Transports Excluded from SNF Consolidated Billing

Ambulance Transports Excluded from SNF Consolidated Billing When a Medicare beneficiary is a resident in a SNF under a Part A stay, not all ambulance transports are included in the PPS (prospective payment system) payment for a SNF. SNF [...]

Ambulance Medical Necessity Reminder for ESRD Patients

Ambulance Medical Necessity Reminder for ESRD Patients National Government Services receives a significant amount of dialysis facility ambulance transports that do not meet medical necessity criteria. Documentation must explicitly describe the [...]

Related Content

Related Content Ambulance Services Center MLN® Booklet: Medicare Ambulance Transports Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, [...]

Billing for A0426 or A0428

Billing for A0426 or A0428 National Government Services has been receiving electronic claims with the 2300 REF segment (G1 qualifier) for prior authorization, however, the value entered in REF02 is a ZIP code. This segment is intended for the [...]

Medical Necessity of Ambulance Services

Medical Necessity of Ambulance Services Table of Contents Medical Necessity of Ambulance Services What You Can Do Nearest Appropriate Facility: GY Modifier What You Can Do Related Content [Return to Top] Medical [...]

Prior Authorization of Repetitive Scheduled Non-Emergent Ambulance Transport

Ambulance Medical Necessity

Ambulance Medical Necessity According to the Centers for Medicare & Medicaid Services’ (CMS) Internet Only Manual (IOM) 100-02, Medicare Benefit Policy Manual, Chapter 10, Ambulance Services; (400 KB) 10.2 - Necessity and Reasonableness [...]

Responsibility of Providing a Properly Executed Physician Certification Statement/Certificate of Medically Necessity

Responsibility of Providing a Properly Executed Physician Certification Statement/Certificate of Medically Necessity Recent National Government Services educational efforts have highlighted an issue between facilities and the ambulance [...]

Proper Claim Submission for Repetitive, Scheduled, Non-Emergent Ambulance Transports

Proper Claim Submission for Repetitive, Scheduled, Non-Emergent Ambulance Transports The CMS implemented the prior authorization of RSNAT. NGS J6 states Illinois, Minnesota, and Wisconsin were added to the RSNAT Model effective with dates [...]