Local Coverage Determination Open Meeting

Local Coverage Determination Open Meeting National Government Services is hosting a Local Coverage Determination Open Meeting on 3/13/2025. Details are available by accessing the Local Coverage Determination Open Meeting Announcement. [...]

Medicare Part B Drugs and Biologicals

Medicare Part B covers certain drugs and biologicals, which require specific billing guidelines. During this webinar, we’ll assist NGS Part B providers in navigating proper billing for these services. There will be time following the [...]

NCCI Lookup Tool

Reminder: New Medicare Part B Redetermination Notice Initiative

Reminder: New Medicare Part B Redetermination Notice Initiative Beginning 3/3/2025, NGS will only issue electronic versions of the MRN when a Medicare Part B Redetermination request is electronically submitted through our portal, NGSConnex. [...]

Pre-Exposure Prophylaxis Using Antiretroviral Therapy to Prevent HIV Infection

Preventive Services Guide Pre-Exposure Prophylaxis Using Antiretroviral Therapy to Prevent HIV Infection PrEP involves the use of antiretroviral drugs to decrease the risk of acquiring HIV. Under Section 1861(ddd)(1) of the Social Security [...]

Important Update for Part B Providers – New NCCI Lookup Tool

Important Update for Part B Providers – New NCCI Lookup Tool The Medicare NCCI promotes accurate coding and prevents improper payments. We have added the NCCI Lookup Tool to our Part B Tools and Calculators page. This tool helps providers [...]

Common Working File Host Dark Days for April 2025 Release

Common Working File Host Dark Days for April 2025 Release For Production, CWF will be observing the Gray Day on Thursday, April 3rd, and Dark Days starting Friday, April 4th through Sunday, April 6th to accommodate the anticipated duration of [...]

The National Correct Coding Initiatives Procedure-to-Procedure and Medically Unlikely Edits

The Centers for Medicare & Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) program to promote national correct coding. Incorrect coding often leads to improper payment and increases the paid claims error rate. If [...]

Inactivity

Inactivity Medicare will routinely deactivate the billing privileges of those providers who fail to bill the Medicare Program for six consecutive months or more. Each billing account is considered separately for the deactivation criteria. This [...]

Do Not Forward “DNF”

Do Not Forward “DNF” With implementation of the DNF initiative, contractors were required to use “return service requested” envelopes for hard copy RAs, hard-copy checks and returned EFT payments. If you are a provider that receives hard [...]

Site Visit Failure

Site Visit Failure CMS reserves the right, when deemed necessary, to perform onsite review of a provider or supplier to verify that the enrollment information submitted to CMS or its agents is accurate and to determine compliance with Medicare [...]

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 [...]

Failure to Report a Critical Change

Failure to Report a Critical Change Providers and suppliers enrolled in Medicare are required to ensure strict compliance with Medicare regulations by submitting updates and changes to enrollment information in accordance with specified [...]

Failure to Complete Revalidation

Failure to Complete Revalidation Avoid claims being rejected or termination of Medicare billing privileges by responding: by the revalidation due date timely to additional information requested Related Content Medicare Revalidation [...]

Stay of Enrollment

Stay of Enrollment The individual provider or authorized/delegated official of a group/facility agrees to adhere to all Medicare requirements when enrolling. CMS implemented a preliminary, interim status representing a pause in enrollment [...]

Global Period Services - HCPCS Code G0559

Global Period Services - HCPCS Code G0559 As of 1/1/2025, CMS has implemented HCPCS Code G0559 to capture work performed by a provider other than the performing surgeon during the global period associated with most surgical procedures. The [...]

Jurisdiction K State Licensing and Certification Websites

State Licensing and Certification Websites The following list contains helpful links to websites of some organizations within JK that can be used to verify your status. Table of Contents Connecticut Maine Massachusetts New [...]

Deactivation of Billing Privileges/Suspension of Payment

Reasons for Deactivation of Medicare Billing Privileges/Suspension of Payment (not all inclusive) Inactivity Failure to complete revalidation within required time frame Unreported provider address and/or bank information Inactivity [...]

Outpatient Psychotherapy Services: A Focus on Coverage and Documentation Requirements

Outpatient psychotherapy services are being reviewed as part of our Part A Medical Review Targeted Probe and Educate program. This session will provide a high-level overview of outpatient psychotherapy services with a focus on coverage and [...]

Tutorial

Part B Medicare Administrative Contractor Overview and Coverage for Dental Services

Medicare covers a limited number of dental services. The purpose of this webinar is to familiarize dental providers with National Government Services (NGS) and Medicare Part B dental coverage. Discussion will include an overview of the NGS [...]

Provider Enrollment: Completing the CMS-855B Paper Application

During this webinar, we'll provide an understanding of how to complete the CMS-855B provider enrollment paper application for a clinic, group or supplier.

Submitting Revalidation via PECOS

During this webinar, we’ll provide an understanding of how to utilize the Centers for Medicare & Medicaid Services (CMS) Internet-based Provider Enrollment Chain & Ownership System (PECOS) to be comfortable in navigating the system to submit a [...]

Annual Wellness Visit Screening

Preventive Services Guide Annual Wellness Visit Screening Table of Contents Annual Wellness Visit Screening Coverage Criteria Two Types of AWV Elements Elements of Initial AWV Personalized Prevention Plan Services – [...]

Maine, Massachusetts, New Hampshire, Rhode Island and Vermont

Maine, Massachusetts, New Hampshire, Rhode Island, Vermont Member Name Professional Title Association Business Name/Address Email Bedard, Brenda Insurance Compliance & Training Supervisor Maine [...]

Meeting Minutes

Meeting Minutes Jurisdiction 6 Illinois, Minnesota, Wisconsin Jurisdiction K Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont Jurisdiction 6 and Jurisdiction K Combined Meeting 12/5/2024 8/8/2024 4/4/2024

Steps to Claim Corrections

This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

Medicare Change of Status Notice

Medicare Change of Status Notice Attention: Hospitals, including CAHs and other providers billing Medicare for inpatient services. The Medicare Change of Status Notice (MCSN) became effective 10/11/2024 and implemented 2/15/2025. Hospitals, [...]

Alcohol Misuse and Counseling

Preventive Services Guide Alcohol Misuse and Counseling Table of Contents Alcohol Misuse and Counseling Two-Part Benefit Cost Sharing Reimbursement Nonparticipating Providers Common Claim Denial Reasons Related Content [Return [...]

Initial Preventive Physical Examination

Preventive Services Guide Initial Preventive Physical Examination The IPPE is also known as the “Welcome to Medicare Preventive Visit.” The goals of the IPPE are health promotion and disease detection and prevention. Table of Contents [...]

Medicare Part B Preventive Services: Bone Mass Measurements, Colorectal and Prostate Cancer Screenings

During this webinar, we'll review the coverage, coding and billing guidelines for bone mass measurements, colorectal and prostate cancer screenings.

MLN Connects® Newsletter: February 24, 2025

MLN Connects® Newsletter: February 24, 2025 Compliance Mechanical Ventilation: Bill Correctly for Inpatient Claims Claims, Pricers, & Codes Discarded Drugs & Biologicals: Orphan Drugs with Increased Applicable Percentage for [...]

Ambulance Services and Establishing Medical Necessity for Part B Providers

This webinar will help the ambulance community understand the importance of medical necessity as it pertains to Medicare’s coverage guidelines.

Chiropractic Billing and Documentation

During this webinar, we will discuss chiropractic coverage, coding guidelines and the importance of documentation in order to support billing for these services.

Standard Companion Guides

Standard Companion Guides Standard Companion Guide Trading Partner Information (275) Standard Companion Guide Trading Partner Information (277) Standard Companion Guide Trading Partner Information (278/275) Standard Companion Guide Health [...]

Institutional Providers: Revised CMS-855A Version (09/24) Medicare Enrollment Application

Institutional Providers: Revised CMS-855A Version (09/24) Medicare Enrollment Application  Available now is the revised CMS-855A (09/24) paper application that includes a section for SNF to comply with the 2023 Final rule in reporting [...]

The Annual Wellness Visit: Promoting Good Health Through Disease Prevention and Detection

Medicare covers many preventive services to keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep your patients from getting certain diseases. Register today for an [...]

Accreditation of Advanced Diagnostic Imaging and FDA Mammography Equipment

Accreditation of Advanced Diagnostic Imaging and FDA Mammography Equipment Reminder, if a hospital, clinic/group or Independent Diagnostic Treatment Facility has ADI screening equipment, certification from a designated ADI accrediting [...]