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Posting Date: 10/06/2020
Notification of the 2020 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review
Notification of the 2020 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review The amount that must remain in controversy for ALJ hearing requests filed on or [...]
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Posting Date: 03/26/2020
New Version of PC-ACE: April 2020
New Version of PC-ACE: April 2020 PC-ACE Version 4.6 contains several CMS mandates and product enhancements including but not limited to the items listed below. CR 11353 - New Medicare Provider Specialty Code (D5) and Billing Codes [...]
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Posting Date: 01/28/2021
New Uniform Thresholds for Determining Low Medicare Utilization Providers
New Uniform Thresholds for Determining Low Medicare Utilization Providers Effective for all cost reports received on or after 6/19/2020, the MACs are instructed to use the following defined “Low Medicare Utilization Thresholds” compared to [...]
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Posting Date: 04/08/2020
New NGS Part A Redetermination Request Form
New NGS Part A Redetermination Request Form Save time and money by using of the following options instead of mailing a written redetermination request form: Initiate an adjustment in the FISS DDE for fully covered or rejected claims Use [...]
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Posting Date: 09/16/2020
National Government Services and the Public Health Emergency
National Government Services and the Public Health Emergency The health and well-being of our beneficiaries, providers, associates and communities is our top priority. We understand the uncertainty and concerns you may be experiencing during [...]
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Posting Date: 09/01/2020
National Government Services Provider Enrollment Appeals Mailbox Reminder
National Government Services Provider Enrollment Appeals Mailbox Reminder National Government Services, Inc. has seen an increase in submissions to the PE appeals mailbox (NGS-PE-Appeals@Anthem.com) that are not appropriate. The NGS PE appeals [...]
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Posting Date: 03/27/2020
National Government Services Accepting and Processing Claims for Expanded Coverage of Telehealth Services as of 3/6/2020
National Government Services Accepting and Processing Claims for Expanded Coverage of Telehealth Services as of 3/6/2020 On 3/17/2020, CMS issued MLN Connects® Special Edition for Tuesday, March 17, 2020, President Trump Expands Telehealth [...]
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Posting Date: 10/30/2020
Medicare Usage of CPT 99072
Medicare Usage of CPT 99072 National Government Services has received many questions regarding CPT 99072 for Medicare usage since the AMA announced the code on 9/8/2020. Many providers have been asking if CMS will cover this code for Medicare [...]
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Posting Date: 02/24/2020
Chiropractors Billing Medicare for Therapy Services
Chiropractors Billing Medicare for Therapy Services Chiropractors in the Medicare fee-for-service realm are only allowed to be considered for spinal manipulation via submission of CPT codes 98940‒98942. Medicare pays for these services when [...]
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Posting Date: 01/08/2020
Top Reasons for Unprocessable Claims
Top Reasons for Unprocessable Claims National Government Services has composed a list of the top reasons for returning claims as unprocessable; due to missing, incomplete, insufficient or invalid claim information. An unprocessable claim is [...]
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Posting Date: 06/22/2020
What Part B Providers Need to Know About the Prior Authorization Program for Certain Medicare Services Performed in the Hospital Outpatient Department
What Part B Providers Need to Know About the Prior Authorization Program for Certain Medicare Services Performed in the Hospital Outpatient Department Hospitals submitting claims for certain outpatient department services will be required to [...]
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Posting Date: 02/24/2020
Reminder: 2020 New Codes for Care Management
Reminder: 2020 New Codes for Care Management We are reminding you that the 2020 final rule with regard to the new care management codes is not policy at this time. CMS is considering these changes identified in the final rule. If CMS decides [...]
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Posting Date: 08/25/2020
Proper Billing for Opioid Treatment Program Weekly Bundles for HCPCS Codes G2067-G2075
Proper Billing for Opioid Treatment Program Weekly Bundles for HCPCS Codes G2067-G2075 Medicare introduced the OTP as a covered Part B benefit beginning with dates of service on and after 1/1/2020. Payment is made to Medicare-enrolled OTP [...]
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Posting Date: 10/09/2020
Prior Authorization: Part B Physician Implications
Prior Authorization: Part B Physician Implications For dates of service on and after 7/1/2020, CMS has implemented a prior authorization program for certain hospital OPD services. This has been done to ensure that Medicare beneficiaries [...]
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Posting Date: 08/25/2020
Fee Schedule Adjustments Reminder for 99441-99443
Fee Schedule Adjustments Reminder for 99441-99443 National Government Services has received several inquiries from providers regarding the adjustment of CPT codes 99441-99443. When CMS announced that they were changing the fee schedule [...]
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Posting Date: 03/05/2020
Chiropractors Billing Medicare for Therapy Services
Chiropractors Billing Medicare for Therapy Services Chiropractors in the Medicare fee-for-service realm are only allowed to be considered for spinal manipulation via submission of CPT codes 98940‒98942. Medicare pays for these services when [...]
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Posting Date: 12/11/2020
2021 E/M Prolonged Service Billing Changes for Medicare
2021 E/M Prolonged Service Billing Changes for Medicare National Government Services has received several inquiries regarding changes to office or other outpatient prolonged service coding effective 1/1/2021. When the AMA released the changes [...]
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Posting Date: 11/30/2020
Don’t Forget the CMS-588 Electronic Funds Transfer Authorization Agreement
Don’t Forget the CMS-588 Electronic Funds Transfer Authorization Agreement The CMS-588 Electronic Funds Transfer Authorization Agreement is to be submitted for billing providers upon initial enrollment, change in bank information and [...]
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Posting Date: 03/20/2020
Social Security Income Ratios
Social Security Income Ratios Attention All Part A Inpatient Prospective Payment System Hospitals, Inpatient Rehabilitation Facilities and Long-Term Care Hospitals The federal fiscal year 2018 SSI ratios for IPPS hospitals, IRFs and LTCHs [...]
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Posting Date: 01/08/2020
New EDI Service Offering for the Part A/FQHC/HHH 276/277 Claim Status Inquiry and Response
New EDI Service Offering for the Part A/FQHC/HHH 276/277 Claim Status Inquiry and Response National Government Services is pleased to announce the availability of a ‘near’ real time response to claim status inquiries submitted to EDI with the [...]
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