How to Find and Respond to Post Payment Review ADR

How to Find and Respond to Post Payment Review ADR Table of Contents How to Find and Respond to Post Payment Review ADR Responding to Post Payment Review ADR Steps to View and Print ADRs from FISS/DDE Provider Online System Related [...]

Patient Driven Payment Model

Patient Driven Payment Model Table of Contents Assessment Schedule Administrative Presumption Lookback Period (Observation Period) Examples General PDPM Resources [Return to Top] Assessment Schedule Learn more about the [...]

NGS Medical Review Process

NGS Medical Review Process Medicare contractors, like NGS, operate the medical review program to prevent improper payments and protect the Medicare Trust Fund. Medical reviews involve the collection and clinical review of medical records and [...]

LCD and Article Updates for June/July 2024

LCD and Article Updates for June/July 2024 Articles Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms A56867  Due to the quarterly CPT/HCPCS code update, PLA code 0204U was deleted from CPT/HCPCS Codes [...]

MLN Connects® Newsletter: June 27, 2024

MLN Connects Newsletter: June 27, 2024 News CY 2025 Home Health Prospective Payment System Proposed Rule PrEP Using Antiretroviral Therapy to Prevent HIV Infection: Technical FAQs for Pharmacies Claims, Pricers, & Codes Medicare [...]

July 2024

In This Issue National Government Services Articles for Part A and Part B Providers National Government Services Proposed LCDs for Comment - July 18, 2024 Improving Customer Experience New Version of PC-ACE: July 2024 Common Working File [...]

Medical Documentation Requirements

Medical Documentation Requirements When filing a claim to Medicare for payment, please include all applicable diagnosis codes to the highest level of specificity to establish the medical necessity of the services provided. National Government [...]

Daily Treatment Notes Requirement for Inpatient SNF Services

Therapy Treatment Note Requirement for Inpatient SNF Services The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-2, Medicare Benefit Policy Manual, Chapter 15 is the primary source for therapy [...]

National Government Services Proposed LCDs for Comment - July 18, 2024

National Government Services Proposed LCDs for Comment - July 18, 2024 The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 6/27/2024 through [...]

Additional Development Request Letters Guide

Outpatient Institutional Providers Reimbursed Under MPFS: When to Split Claims for Updated Rates

Outpatient Institutional Providers Reimbursed Under MPFS: When to Split Claims for Updated Rates If you have monthly outpatient and/or inpatient ancillary claims with DOS 3/1/2024 – 3/31/2024, you may take the following steps to ensure correct [...]

2024 CMS Health Equity Services

2024 CMS Health Equity Services The 2024 Physician Fee Schedule Final Rule expanded Medicare coverage by adding four services to the Medicare program for coverage. These services are to help further address the priorities of reducing [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Please note the following county assignments for downstate and upstate New York. Downstate: Bronx, Columbia, Delaware, Dutchess, Greene, Kings, Nassau, New York, Orange, Putnam, Queens County, Richmond, Rockland, [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Business Function State Mailing Address Administration Simplification Compliance Act Waiver Request Forms All states National Government Services, Inc. Attn: ASCA P.O. Box 7022 [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Business Function State Mailing Address Additional Documentation Requests CT, MA, ME, NH, NY, RI, VT National Government Services, Inc. P.O. Box 7108 Indianapolis, IN [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Business Function Mailing Address Additional Development Requests National Government Services, Inc. Attn: Medical Review P.O. Box 6474 Indianapolis, IN 46206-6474 ASCA [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Business Function Mailing Address Additional Development Requests National Government Services, Inc. Attn: Medical Review P.O. Box 6474 Indianapolis, IN 46206-6474 ASCA [...]

Failure to Report Address Changes

Failure to Report Address Changes Providers who fail to report an address change will result in suspension of Medicare payment.   All Medicare providers are responsible for providing their Medicare contractor with their current and [...]

Failure to Report a Change in Bank Account Information

Failure to Report a Change in Bank Account Information Providers who fail to report a change in bank account information will result in suspension of Medicare payment and termination of Medicare billing privileges. All changes initiated by [...]

Revocation

Revocation CMS may revoke a currently enrolled provider or supplier's Medicare billing privileges and any corresponding provider or supplier agreement for the following reasons: Abuse of billing privileges Failure to document or provide [...]