-
Posting Date: 08/04/2022
Modifier 52 Claim Submission Billing Reminder
Modifier 52 Claim Submission Billing Reminder National Government Services found that on many occasions, providers are billing for reduced services with modifier 52 appended to the CPT code; however, they are billing the regular charged amount [...]
Read More -
Posting Date: 08/08/2022
Comprehensive Error Rate Testing Redetermination Deadline 9/27/2022
Comprehensive Error Rate Testing Redetermination Deadline 9/27/2022 The CERT RY 2022 is quickly coming to an end. The deadline for redetermination completion is 9/27/2022 to be considered for the CERT RY. National Government Services requests [...]
Read More -
Posting Date: 08/08/2022
Comprehensive Error Rate Testing Documentation Deadline 8/22/2022
Comprehensive Error Rate Testing Documentation Deadline 8/22/2022 The CERT RY 2022 is quickly coming to an end. In order to give sufficient time for the CERT RC to complete the review of your claims, all documentation and additional [...]
Read More -
Posting Date: 08/10/2022
October 2022 Release "Dark Days" for the Common Working File Hosts
October 2022 Release "Dark Days" for the Common Working File Hosts For the upcoming October 2022 Release: For Production, CWF will be observing the Gray Day on Thursday, September 29th and Dark Days starting Friday, September 30th through [...]
Read More -
Posting Date: 08/11/2022
MLN Connects® Newsletter for Thursday, August 11, 2022
MLN Connects® Newsletter for Thursday, August 11, 2022 Monkeypox & Smallpox Vaccines: New Product Codes News Monkeypox & Smallpox Vaccines: New Product Codes Payment Allowance Update for COVID-19 Monoclonal Antibody Therapy [...]
Read More -
Posting Date: 06/25/2021
Outpatient Department Prior Authorization UTN Alert
Each UTN is Valid for One-Time Use The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient department procedures: Panniculectomy, Rhinoplasty, Vein Ablation, Blepharoplasty [...]
Read More -
Posting Date: 06/25/2021
Outpatient Department Prior Authorization Type of Bill Alert
Providers Who Submit a Type of Bill 13X Are Required to Submit a Prior Authorization Request for the OPD PA Services The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient [...]
Read More -
Posting Date: 09/10/2021
UTN Alert: Implanted Spinal Neurostimulator Trial and Permanent UTN
UTN Alert: Implanted Spinal Neurostimulator Trial and Permanent UTN The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient department procedures: Panniculectomy, [...]
Read More -
Posting Date: 03/30/2023
Type of Bill Code is a Requirement for All Prior Authorization Requests
Type of Bill Code is a Requirement for All Prior Authorization Requests The National Government Services PA Department has seen an increase in cases that are submitted without a TOB code. PA staff conducts outreach to obtain this code; [...]
Read More -
Posting Date: 02/21/2022
Outpatient Department Prior Authorization Implanted Spinal Neurostimulators Alert
Outpatient Department Prior Authorization Implanted Spinal Neurostimulators Alert Implanted Spinal Neurostimulator Prior Authorization National Government Services Medical Review initiated a prior authorization review outpatient department [...]
Read More -
Posting Date: 09/14/2023
MLN Connects® Newsletter: September 14, 2023
MLN Connects® Newsletter: September 14, 2023 News Inflation Reduction Act Continues to Lower Out-of-Pocket Prescription Drug Costs for Drugs with Price Increases Above Inflation CMS Roundup (Sept 8, 2023) New Provider [...]
Read More -
Posting Date: 10/31/2019
Billing for Originating Site
Billing for Originating Site Originating Site An originating site is the location of an eligible Medicare beneficiary at the time the telehealth services is being furnished via a telecommunications system. Medicare beneficiaries are eligible [...]
Read More -
Posting Date: 10/31/2019
Distant Site
Distant Site The term “distant site” means the site where the physician or practitioner providing the professional service is located at the time the service is provided via a telecommunications system. Medicare distant site practitioners who [...]
Read More -
Posting Date: 10/31/2019
General Information
General InformationTelehealth services require use of an interactive audio and video telecommunications system that permits real-time communication between the provider at the distant site and the Medicare beneficiary at the originating [...]
Read More -
Posting Date: 10/31/2019
Originating Site
Originating Site An originating site is the location of an eligible Medicare beneficiary at the time the telehealth services is being furnished via a telecommunications system. Medicare beneficiaries are eligible for telehealth services only [...]
Read More -
Posting Date: 10/31/2019
Facility Fee for Originating Site
Facility Fee for Originating Site The originating site facility fee is a separately billable Part B payment. The payment amount to the originating site is the lesser of 80 percent of the actual charge or 80 percent of the originating site [...]
Read More -
Posting Date: 10/31/2019
Billing and Payment for Distant Site Professional Fee
Billing and Payment for Distant Site Professional Fee Claims for distant site telehealth services are submitted to the Part B MAC that processes claims for the performing physician/practitioner’s service area. Physicians/practitioners submit [...]
Read More -
Posting Date: 10/31/2019
List of Covered Medicare Telehealth Services
List of Covered Medicare Telehealth Services Several conditions must be met for Medicare to make payments for telehealth services under the Physician Fee Schedule. The service must be on the list of Medicare telehealth services and meet [...]
Read More -
Posting Date: 10/31/2019
G0 Modifier Required for Telehealth for Individuals with Acute Stroke
G0 Modifier Required for Telehealth for Individuals with Acute Stroke Effective for claims with dates of service on and after 1/1/2019, Medicare will accept HCPCS modifier G0 to identify telehealth services furnished for purposes of diagnosis, [...]
Read More -
Posting Date: 10/31/2019
GT Modifier
GT Modifier Effective 10/01/2018, the GT modifier (via interactive audio and video telecommunications systems) is only required on institutional claims for distant site services billed under CAH Method II (claim type 085X). The GT modifier is [...]
Read More