Search Results - NGSMEDICARE

Posting Date: 10/26/2022

Modifier Usage

Podiatry Billing Guide Modifier Usage 25 – Significant, Separately Identifiable E/M Service by the Same Physician on the Same Day of the Procedure or Other Service Medicare allows payment for an E/M service performed on the same [...]

Posting Date: 10/26/2022

Podiatry Coding Tips

Podiatry Billing Guide Podiatry Coding Tips Coding Information Procedure codes may be subject to NCCI edits or OPPS packaging edits. Refer to CCI and OPPS requirements prior to billing Medicare. For services requiring a [...]

Posting Date: 10/26/2022

Advance Beneficiary Notice of Noncoverage/National Correct Coding Initiative

Podiatry Billing Guide Advance Beneficiary Notice of Noncoverage/National Correct Coding Initiative ABN Services denied as not reasonable and medically necessary, under Section 1862(a) (1) of the Social Security Act, are subject to [...]

Posting Date: 10/26/2021

Biopsy to Prove Onychomycosis in Routine Foot Care

Biopsy to Prove Onychomycosis in Routine Foot Care National Government Services has been made aware of a situation where podiatrists have been approached by laboratories stating that they need to biopsy their patients to make sure they have [...]

Posting Date: 06/01/2023

How to Avoid and Correct Duplicate Claim Denials

How to Avoid and Correct Duplicate Claim Denials A duplicate claim submission occurs when a physician or other qualified healthcare professional resubmits a claim either on paper or electronically for a single encounter and the service is [...]

Posting Date: 09/16/2024

Third Quarter Top Ten EDI Part B Edits

Third Quarter Top Ten EDI Part B Edits Using data analysis we’ve updated the Top Ten EDI Edits for the third quarter. Visit Quarterly Top Ten EDI Part B Edits to view the edits and their description, and learn how you can quickly identify the [...]

Posting Date: 09/16/2024

Third Quarter Top Ten EDI Institutional Edits

Third Quarter Top Ten EDI Institutional Edits Using data analysis, we’ve updated the Top Ten EDI Edits for the third quarter. Visit Quarterly Top Ten EDI Institutional Edits to view the edits and their description, and learn how you can [...]

Posting Date: 01/02/2024

Medicare Part B Final Rule 2024

Medicare Part B Final Rule 2024 CMS announced finalized policy changes for Medicare payments under the PFS, and other Medicare Part B topics, effective on or after 1/1/2024. The CY 2024 PFS final rule is one of several final rules that [...]

Posting Date: 11/07/2022

Who Can Bill for Diabetes Self-Management and Medical Nutrition Therapy?

Who Can Bill for Diabetes Self-Management and Medical Nutrition Therapy? Table of Contents Who Can Bill for Diabetes Self-Management and Medical Nutrition Therapy? Who Can Bill for DSMT Billable Codes for Diabetes Self-Management Training [...]

Posting Date: 11/07/2022

Common Questions for Diabetes Self-Management Program Accreditation

Common Questions for Diabetes Self-Management Program Accreditation Does my organization need to be accredited to bill for DSMT services? Answer: Yes. In order to bill Medicare for DSMT services, your organization’s DSMT program must be [...]

Posting Date: 11/07/2022

Medical Nutrition Therapy Tool for Billing

Medical Nutrition Therapy Tool for Billing CMS considers DSMT and MNT complementary services. This means Medicare will cover both DSMT and MNT without decreasing either benefit as long as the referring physician determines that both are [...]

Posting Date: 06/13/2022

Remote Physiological Monitoring and Cardiovascular Monitoring Service and Billing Information

Remote Physiological Monitoring and Cardiovascular Monitoring Service and Billing Information Table of Contents Remote Physiological Monitoring Services CPT Codes: 99091, 99453, 99454, 99457, 99458 Remote Physiological Monitoring [...]

Posting Date: 09/17/2024

National Government Services Contractor Advisory Committee Meeting

National Government Services Contractor Advisory Committee Meeting There will be a multi-jurisdictional CAC meeting held on Thursday 10/17/2024 at 3:00-5:00 p.m. ET, 2:00-4:00 p.m. CT. Meeting details can be found on the National Government [...]

Posting Date: 09/19/2024

Laboratory and Diagnostic Services: Documentation Responsibilities

Laboratory and Diagnostic Services: Documentation Responsibilities When National Government Services is conducting a pre-pay or post-pay review of claims and services, we may request additional documentation. The billing provider must obtain [...]

Posting Date: 11/01/2021

Global Surgery

Global Surgery Table of Contents Definition of a Global Surgical Package Where can I find the postoperative periods for covered surgical procedures? What services are included in the global surgery payment? What services are not [...]

Posting Date: 08/10/2023

Duplicate Claim Editing Information

Duplicate Claim Editing Information Part B Duplicate Claim Edit National Government Services implemented a Part B duplicate claim edit in our EDI front-end processing system for Part B providers. Providers are notified that a claim is a [...]

Posting Date: 10/15/2021

Physician Dialysis Services

Physician Dialysis Services Table of Contents Physician Dialysis Services Monthly Capitation Payment Coding Claim Submission Tips Billing for a Partial Month Documentation Requirements Related Content [...]

Posting Date: 11/23/2021

Oncology Care Model

Oncology Care Model Note: If you did not register for the CMS OCM during the open application and selection period, then you are not a part of this program. The names of those practices and payers participating in OCM can be found on the OCM [...]

Posting Date: 11/29/2021

Spinraza (nusinersen) Billing

Spinraza (nusinersen) billing Spinraza (nusinersen) is a medication that was approved in December 2016 by the U.S. FDA for the treatment of all forms of SMA. HCPCS code J2326 - Inj, nusinersen, 0.1mg should be used to report Spinraza. [...]