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Posting Date: 09/12/2023
Helpful Contacts
Medicare Helpful Contacts and Partner Resources Medicare Helpful Contacts Medicare Partner Resources
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Posting Date: 02/02/2021
Submit an Appeal Electronically via esMD
Submit an Appeal Electronically via esMD CMS developed a mechanism for contractors to receive first level appeals electronically from providers via a secure gateway known as Electronic Submission of Medical Documentation, or esMD. Some [...]
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Posting Date: 02/02/2021
Submit an Appeal Electronically via esMD
Submit an Appeal Electronically via esMD CMS developed a mechanism for contractors to receive first level appeals electronically from providers via a secure gateway known as Electronic Submission of Medical Documentation, or esMD. Some [...]
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Posting Date: 02/02/2021
Submit an Appeal Electronically via esMD
Submit an Appeal Electronically via esMD CMS developed a mechanism for contractors to receive first level appeals electronically from providers via a secure gateway known as Electronic Submission of Medical Documentation, or esMD. Some [...]
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Posting Date: 09/01/2023
September 2023
In This Issue National Government Services Articles for Part A and Part B Providers Introducing PECOS 2.0 Duplicate Claim Editing Information Two Interactive Voice Response System Features Ending 9/30/2023 October 2023 Release "Dark [...]
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Posting Date: 08/01/2023
August 2023
In This Issue National Government Services Articles for Part A and Part B Providers CR13220 - Technical Revisions Only to the National Coverage Determination (NCD) Manual, Publication (Pub) 100-03 Tip Sheet for Medicare Providers on [...]
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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 [...]
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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 [...]
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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, [...]
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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; [...]
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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 [...]
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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 [...]
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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 [...]
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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 [...]
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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 [...]
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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 [...]
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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 [...]
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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 [...]
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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 [...]
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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, [...]
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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 [...]
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Posting Date: 10/31/2019
Clarification of Telehealth for DSMT
Clarification of Telehealth for DSMT Individual and group DSMT services may be paid as a Medicare telehealth service. Effective for claims with dates of service on and after 1/1/2019, Medicare allows all ten hours of the initial DSMT training [...]
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Posting Date: 10/31/2019
ESRD-Related Services as a Telehealth Service
ESRD-Related Services as a Telehealth Service Effective for DOS on/after 1/1/2019, renal dialysis facilities and the homes of ESRD beneficiaries receiving home dialysis may be originating sites and will not apply originating site geographic [...]
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Posting Date: 04/19/2022
Ambulatory Surgical Center Pass-Through Devices
Ambulatory Surgical Center Pass-Through Devices What is a Pass-Through Device? Pass-through status is determined for newly FDA-approved drug and device products on an individual basis. Drugs and devices qualifying for pass-through status [...]
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Posting Date: 09/14/2023
MLN Connects® Newsletter: COVID-19: Updated mRNA Vaccines for Patients 6 Months & Older – September 14, 2023
MLN Connects® Newsletter: COVID-19: Updated mRNA Vaccines for Patients 6 Months & Older – September 14, 2023 News COVID-19: Updated mRNA Vaccines for Patients 6 Months & Older Posted 9/14/2023
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Posting Date: 09/15/2023
New YouTube Video: Surgical Dressings and Supplies: Part A/B and DME Collaborative Presentation
New YouTube Video: Surgical Dressings and Supplies: Part A/B and DME Collaborative Presentation The Part A/B and DME MACs are offering a YouTube video on Surgical Dressings and Supplies. This video offers information on the coverage criteria [...]
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Posting Date: 12/09/2022
Interested in Becoming a Home Health or Hospice Provider Outreach and Education Advisory Group Member?
Interested in Becoming a Home Health or Hospice Provider Outreach and Education Advisory Group Member? Are you someone who would be interested in helping shape the education provided by your MAC? We want to hear from you! Join us to [...]
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Posting Date: 09/08/2023
Don’t Let Your Flu Vaccination Claims Deny!
Don’t Let Your Flu Vaccination Claims Deny! The 2023-2024 flu vaccine season has begun. At the beginning of each flu season, National Government Services sees an increase in claim denial volume for flu vaccinations. This notice is being [...]
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Posting Date: 09/14/2023
Save the Dates! National Government Services Fall 2023 Virtual Conference for Part B Providers
Save the Dates! National Government Services Fall 2023 Virtual Conference for Part B Providers Understanding Medicare Compliance 11/6/2023-11/8/2023 We’re excited to announce our Medicare Part B 2023 Fall Virtual Conference! This three-day [...]
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Posting Date: 07/25/2023
Attention all OPPS Providers: Provider-Based Department Edits Being Implemented on/after 8/1/2023
Attention All OPPS Providers: Provider-Based Department Table of Contents Edits Being Implemented on/after 8/1/2023 Reason Code 34977: Practice address issue Reason Code 34978: PO and/or PN modifier missing Reason Code 34984: ER [...]
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Posting Date: 07/07/2023
URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations
URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations Table of Contents Urgent: Provider Compliance Required Effective 8/1/2023 Requirements Claim Filing Requirements Final Reminders Related Content [Return to [...]
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Posting Date: 12/17/2019
ESRD Facilities: Clarification for Providing Dialysis Services to Patients Acute Kidney Injury
ESRD Facilities: Clarifications for Providing Dialysis Services to Patients Acute Kidney Injury Effective 1/1/2017. ESRD facilities (hospital-based and freestanding) may furnish renal dialysis services to beneficiaries with AKI (both adult and [...]
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Posting Date: 09/12/2017
JK: Medicare Paid Hospital Providers Twice for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient IPPS Hospital Stays
Medicare Paid Hospital Providers Twice for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient IPPS Hospital Stays Table of Contents Provider Action Payment Window Policy and Under Arrangement Policy [...]
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Posting Date: 12/22/2020
Professional Services During a Patient Hospice Election
Professional Services during a Patient Hospice Election Table of Contents Article Overview Hospice Election Medicare Payment During Hospice Election Determining the Correct Entity to Bill Separately Payable Part B Services Hospice and [...]
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Posting Date: 09/18/2023
Direct Data Entry Users May Need to Adjust Screen Size
Direct Data Entry Users May Need to Adjust Screen Size CMS recently issued Change Request 13138 “Implementation to Expand Monetary Amount Fields Related to Billing and Payment to Accommodate 10-Digits in Length ($99,999,999.99) - Phase 1”. [...]
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Posting Date: 10/14/2021
Drugs and Biologicals - Coverage and Billing
Drugs and Biologicals – Coverage and Billing Medicare Part B will provide coverage for drugs that are furnished “incident to” a physician’s service. Coverage applies to drugs are not usually self-administered by the patients who take them. In [...]
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Posting Date: 02/10/2015
Outpatient Therapy Functional Reporting
Outpatient Therapy Functional Reporting Table of Contents Outpatient Therapy Functional Reporting Reporting Episode - similar to the therapy episode of care Required Functional Reporting Discharge Reporting Unique Functional Reporting [...]
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Posting Date: 01/12/2021
Home Health Referrals
Home Health Referrals The certifying physician or allowed nonphysician practitioner, and/or the acute/post-acute care facility referring the patient for home care must ensure that the medical record justifies the referral for Medicare home [...]
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