MLN Connects® Newsletter: October 13, 2022

MLN Connects® Newsletter: October 13, 2022 News Protect Your Patients in October: Give Them a Flu Shot and COVID-19 Vaccine Vacating Differential Payment Rate for 340B-Acquired Drugs in 2022 Outpatient Prospective Payment System Final [...]

Drugs and Biologicals Frequently Asked Questions

Drugs and Biologicals Frequently Asked Questions We’ve added new frequently asked questions to our website. View answers to common questions about Drugs and Biologicals to ensure you have the information needed to properly submit claims for [...]

The Home Health and Hospice Targeted Probe and Educate Process

The Home Health and Hospice Targeted Probe and Educate Process Medical Review conducts TPE on claims from all providers under the Medicare Program. Protect your revenue by gaining more knowledge regarding TPE audits. Providers targeted for [...]

Provider Outreach and Education Events

Provider Outreach and Education Events Our Provider Outreach and Education team offers a wealth of educational sessions for a variety of Medicare topics throughout the year. Because there are so many choices, we’ve improved the Search [...]

A/B and DME Collaborative Glucose Monitors and Supplies

A/B and DME Collaborative Glucose Monitors and Supplies View the A/B and DME Collaborative Glucose Monitors and Supplies YouTube Video for coverage criteria, documentation requirements and resources for glucose monitors and supplies. Posted [...]

MLN Connects® Newsletter: October 20, 2022

MLN Connects® Newsletter: October 20, 2022 News Skilled Nursing Facility Provider Preview Reports: Review by November 14 Help Your Patients Make Informed Health Care Decisions Ambulance Fee Schedule: CY 2023 Ambulance Inflation Factor [...]

Announcing Service Specific Post-Payment Audits of Individual Psychotherapy Services for J6 A Regions: IL, WI and MN

Edit Reason Code: 5FSEP Bill Type = 13X, 85X CPT/HCPCS/Modifiers:90832- 90834 Overview The Medical Review Department of National Government Services will be performing service specific post-payment reviews for claims submitted to Medicare [...]

Tips for Documenting Homebound Status

Tips for Documenting Homebound Status Comprehensive and accurate documentation is crucial to providing safe and effective care to Medicare beneficiaries. National Government Services' medical review team reviews this documentation while making [...]

Physicians and Nonphysician Practitioners: Revised CMS-855I Medicare Enrollment Application Required November 1 (Combined CMS-855I and CMS-855R)

Physicians and Nonphysician Practitioners: Revised CMS-855I Medicare Enrollment Application Required November 1 (Combined CMS-855I and CMS-855R) If you don’t use PECOS, use the revised CMS-855I (Medicare Enrollment Application - Physicians and [...]

Update: End Stage Renal Disease Claim Adjustments Needed Due to CWF Error in Date of First Dialysis

Update: End Stage Renal Disease Claim Adjustments Needed Due to CWF Error in Date of First Dialysis As of 7/18/2023, CMS has identified that the CWF continues to have some inaccurate dates for the first date of dialysis. We will advise when [...]

I Am a Provider and “I Want to Complete an EDI Registration Form”

I Am a Provider and “I Want to Complete an EDI Registration Form” This selection will prompt you to complete the EDI Registration Form. This option is for providers who wish to submit claim files using a third party such as a billing service [...]

I Am a Provider and “I Want to Complete a Connex Registration Form”

I Am a Provider and “I Want to Complete a Connex Registration Form” This selection will prompt you to complete the Connex Registration Form. This option is for providers who wish to send claims or receive remits through the NGSConnex portal. [...]

Clearinghouse

Clearinghouse When Clearinghouse is selected as your submitter type the following objective will be displayed. Select the objective and then click Next. I am a Clearinghouse and “I want to complete an EDI Registration Form” This objective [...]

Common Questions

Common Questions What is the Entity Name? This is the EXACT provider’s name that was submitted in section 2 of the CMS-855/PECOS enrollment application when applying to participate with Medicare.   What information should be put in [...]

I Am a Provider and “I Want to Connect Directly to the Part A FISS/DDE System”

I Am a Provider and “I Want to Connect Directly to the Part A FISS/DDE System” This selection will prompt you to complete the Logon Request Form. This option is for providers who need to request, modify, reinstate, or add additional access to [...]

I Am a Provider and “I Want to Allow a 3rd Party Billing Service to Bill for Me Using the Part A FISS DDE System”

I Am a Provider and “I Want to Allow a 3rd Party Billing Service to Bill for Me Using the Part A FISS DDE System” This selection will prompt you to complete the Letter of Authorization Form. This option is for providers who wish to allow [...]

I Am a Billing Service and “I Want to Complete an EDI Registration Form”

I Am a Billing Service and “I Want to Complete an EDI Registration Form” This selection will prompt you to complete the EDI Registration Form. This objective is for billing services who need to obtain a new TPID or make a change to an [...]

Hierarchy of Medicare Regulations

Hierarchy of Medicare Regulations Have you wondered how Medicare determines what is covered? Below you will find the hierarchy of how Medicare regulations are created. Social Security Act Title XVIII of the Social Security Act is [...]

MLN Connects® Newsletter: October 19, 2023

MLN Connects® Newsletter: October 19, 2023     News 2024 Medicare Parts A & B Premiums and Deductibles Help CMS Improve Provider Resources — Respond by November 9 CMS Health Information Handler Helps You Submit [...]

PC-ACE Software Instructions, Resources and Guides

PC-ACE Software Instructions, Resources and Guides Creating a 276 Claim Status Request in PC-ACE and Importing and Reading the 277 Claim Status Report PC-ACE - For Institutional Users: Importing and Reading the 999 and 277CA Files PC-ACE [...]

Browser Compatibility

Browser Compatibility Access NGSConnex using one of the supported browsers below. Microsoft Edge version 88.0 and above Google Chrome version 45.0 and above  Mozilla Firefox version 31.0 and above Apple Safari version 9 and [...]

Mental Health Services

Mental Health Services Medicare Part B provides benefits for psychiatric services, which are medically necessary for the diagnosis or treatment of diagnostic and/or behavioral health treatment. Medicare recognizes the following Part B [...]

Register Today! National Government Services Fall 2023 Medicare Virtual Conference: Understanding Medicare Compliance for Part B Providers

Register Today! National Government Services Fall 2023 Medicare Virtual Conference: Understanding Medicare Compliance for Part B Providers This three full-day virtual conference will offer a variety of Part B sessions geared toward Medicare [...]

Medicare Billing Fact Sheet for Electronic (837P) and Paper (Form CMS-1500) Claims

Credit Balance Report Reminder

Credit Balance Report Reminder CBRs for the quarter ending 9/30/2023 are now due. CBRs must be submitted within 30 days of the end of the quarter to be considered timely. FISS DDE users who submit the 838 detail page directly over the [...]

Medicare Overpayments Are Not Redeterminations

Medicare Overpayments Are Not Redeterminations Our records indicate some providers are incorrectly submitting redetermination request forms for MSP overpayment issues. Please use this notification as educational instruction from National [...]

MLN Connects® Newsletter: October 26, 2023

MLN Connects® Newsletter: October 26, 2023 News Help CMS Improve Provider Resources — Respond by November 9 CMS Roundup (Oct 20, 2023) Nursing Facility Evaluation and Management Visits: Comparative Billing Report in October Claims, [...]

Part B Top Claim Errors Are Updated

Part B Top Claim Errors Are Updated Our top claim errors are updated on a quarterly basis to reflect current information. Visit Top Claim Errors to learn what you can do to avoid claim processing delays. We’ve listed the error reason code, a [...]

Prior Authorization Outpatient Department Exemption Additional Documentation Requests

Prior Authorization Outpatient Department Exemption Additional Documentation Requests National Government Services Prior Authorization initiated the process of issuing ADRs to exempt providers. Please monitor your facility’s ADR location [...]

Coming Soon ‒ The CY 2024 Medicare Physician Fee Schedule

Coming Soon - The CY 2024 Medicare Physician Fee Schedule The CY 2024 MPFS will soon be available on the Fee Schedule Lookup tool located on NGSMedicare.com, after the CY 2024 physician fee schedule regulation is put on display. Once the Fee [...]

Electronic Cost Report Exhibit Templates

Who May File an Appeal

Who May File an Appeal? Table of Contents Who May File an Appeal? Appointment of Representative When Is an Appointment Not Necessary? Who May Be a Representative How to Make and Revoke an Appointment When Is an Appointment Not [...]

Reopenings for Minor Errors and Omissions

Reopenings for Minor Errors and Omissions Table of Contents Reopenings for Minor Errors and Omissions What is a Clerical Error? Clerical Error and Omission Reopening Request Request a Reopening- NGSConnex Request a Reopening- In Writing [...]

Review Bad Debt Listing

Table of Contents Review Bad Debt Listing Identifying Fee Schedule Services Fee Schedules Included in Bad Debt Policy Related Content [Return to Top] Review Bad Debt Listing Bad debts are unrecovered costs due to uncollectible [...]

Hospice Cap

Hospice Cap Table of Contents The Inpatient Day Limitation Aggregate Cap Calculation Beneficiary Count Proportional Method (applies to most hospices) Streamlined Method  [Return to Top] The Inpatient Day Limitation [...]

Proper Use of Modifiers JW and JZ

Proper Use of Modifiers JW and JZ National Government Services Provider Contact Center has received several inquiries regarding claim denials related to the use of the JW and JZ modifier for drugs/biologicals. As a reminder, effective [...]

Claim Denials for Medically Unnecessary Ambulance Transports: Avoiding Reason Code 55B10

Claim Denials for Medically Unnecessary Ambulance Transports Table of Contents Claim Denials for Medically Unnecessary Ambulance Transports Medical Necessity and Coverage Guidelines for Ambulance Transport Avoiding Reason Code 55B10 [...]

Inpatient Psychiatric Facilities Billing When Benefits Exhaust Job Aid

Inpatient Psychiatric Facilities Billing When Benefits Exhaust Job Aid Table of Contents Inpatient Psychiatric Facilities Billing When Benefits Exhaust Job Aid Benefits Exhaust Date Submitting Claims Through the Benefits Exhaust Date [...]

November 2023

In This Issue National Government Services Articles for Part A and Part B Providers Collaborative A/B/DME Therapeutic Shoes for Persons with Diabetes Webinar Decrease Burden and Combine Multiple PDFs in one Document Before Responding to [...]

MLN Connects® Newsletter: Take Our Provider Survey Today - November 1, 2023

MLN Connects® Newsletter: Take Our Provider Survey Today - November 1, 2023 News Take Our Provider Survey Today Posted 11/1/2023