Education Partnership Request Form

Education Partnership Request Form

Education Partnership Request Form

MLN Connects® Newsletter: August 8, 2024

MLN Connects® Newsletter: August 8, 2024 Final Payment Rule Hospital Inpatient Prospective Payment System & Long-Term Care Hospital Prospective Payment System FY 2025 Final Rule News Transitional Coverage for Emerging Technologies [...]

Removal of Facet HCPCS Codes

Removal of Facet HCPCS Codes Prior Authorization Outpatient Department Update  Effective 8/16/2024, the CMS is removing two current procedural terminology codes from the OPD Facet Joint Injection list of codes: 64492 – Facet joint [...]

Prior Authorization OPD Alerts

Prior Authorization OPD Alerts Month/Year Topic August 2024  Removal of Facet HCPCS Codes July 2023 Prior Authorization Outpatient Department Rejections Alert July 2023 Prior [...]

Medical Policy Contact Information

Medical Policy Contact Information Please Note: General inquiries related to Medicare coverage policies, including clinical issues, drugs, radiopharmaceuticals, local and national coverage determinations, billing and reimbursement must be [...]

Medical Policy Contact Information

Medical Policy Contact Information Please Note: General inquiries related to Medicare coverage policies, including clinical issues, drugs, radiopharmaceuticals, local and national coverage determinations, billing and reimbursement must be [...]

Medical Policy Contact Information

Medical Policy Contact Information Please Note: General inquiries related to Medicare coverage policies, drugs, radiopharmaceuticals, local and national coverage determinations, billing and reimbursement must be directed to the Provider [...]

Medical Policy Contact Information

Medical Policy Contact Information Please Note: General inquiries related to Medicare coverage policies, including clinical issues, drugs, radiopharmaceuticals, local and national coverage determinations, billing and reimbursement must be [...]

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations) If you disagree with Medicare’s claim determination, you may Appeal. However, please follow these important tips before you submit a first level of appeal [...]

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations) If you disagree with Medicare’s claim determination, you may Appeal. However, please follow these important tips before you submit a first level of appeal [...]

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations) If you disagree with Medicare’s claim determination, you may Appeal. However, please follow these important tips before you submit a first level of appeal [...]

Medicare Bad Debts

Table of Contents Review Medicare Bad Debt Listing Identifying Non-Allowable Fee Schedule Services Fee Schedules Included in Bad Debt Policy Medicare Bad Debts Related Content [Return to Top] Review Medicare Bad Debt Listing [...]

Monoclonal Antibodies in Treatment of Alzheimer’s Disease - Medicare Advantage Plan Responsibility

Monoclonal Antibodies in Treatment of Alzheimer’s Disease - Medicare Advantage Plan Responsibility NCD 200.3 was issued by CMS in April,2022 and outlines Medicare coverage policy for monoclonal antibodies that target amyloid (or plaque) for [...]

HETS EDI Enrollment Form User Guide

The HETS ​​​​​​EDI Enrollment Form allows providers to attest their relationship with a 3rd party entity to exchange the ANSI X12 270/271 Beneficiary Eligibility transaction on their behalf. Table of Contents Step 1 – Authorization [...]

HETS EDI Enrollment Form

HETS EDI Enrollment Form

HIPAA Eligibility Transaction System (HETS) allows users to exchange HIPAA compliant ANSI ASC X12 270/271 transactions for the purpose of checking Medicare eligibility.  The HETS EDI Enrollment Form allows providers to attest their [...]

Telehealth Place of Service 02 and 10 Clarification

Telehealth Place of Service 02 and 10 Clarification National Government Services has been receiving inquiries from providers in regard to POS 02 and POS 10 for telehealth service reporting. We’ve created this article to provide clarification. [...]

CLIA Number Processing Issue

CLIA Number Processing Issue National Government Services has been made aware of an issue with CLIA lab claims processing. CLIA numbers were not loaded through CWF, resulting in claim denials as CLIA did not match any file. We were informed [...]

Home Health Documentation Checklist

Home Health Documentation

How to Obtain a Refund

A refund will only be granted in the following instances: The application fee was not required for the application submitted A hardship request was subsequently approved and a fee was paid An application was rejected prior to the screening [...]

How to Submit a Hardship Request

To request a hardship consideration, submit with a letter and any supporting documentation describing the hardship and why it justifies the exception for your application. Your hardship request will not be considered if it is received [...]

State License and Registrations for Certified Providers and Suppliers

State License and Registrations for Certified Providers and Suppliers Prior to submitting a provider enrollment application to Medicare, ensure that all applicable state requirements are met for your provider type. Each state has unique [...]

Eligible Method II Providers

Eligible Method II Providers If a CAH wants to become a Method II biller, email the request to A&R at ngsreimbursement@anthem.com.  Suppliers who can enroll as a Method II Biller Reassignment. Doctor of Medicine (MD) Doctor of [...]

Description of NPI and a Link to NPPES Registry

Description of NPI and a Link to NPPES Registry   As mandated by HIPAA, you should maintain (verify and update) your NPI data via NPPES on a regular basis. The NPI: is a ten-digit number and must be submitted on the enrollment form, [...]

Eligible Institutional Providers

Eligible Institutional Providers Certified Providers and Certified Suppliers that Enroll via the Form CMS-855A. Unique statutory and regulatory requirements for these types of providers/suppliers are addressed in the CMS IOM Publication [...]

MLN Connects® Newsletter: August 15, 2024

MLN Connects® Newsletter: August 15, 2024 News Negotiating for Lower Drug Prices Works, Saves Billions Resources & Flexibilities to Assist with the Public Health Emergency in Florida, Georgia, and South Carolina Hospitals: New EMTALA [...]

Additional Development Requests for Part A Claims for CPT J9299

Additional Development Requests for Part A Claims for CPT J9299 A system error on 7/25/2024 caused ADR letters to be issued in error on Part A claims for CPT J9299 with DOS on or after 3/1/2024. The issue has been resolved and all impacted [...]

End-Stage Renal Disease: Medicare Part A Quick Reference Manual

End-Stage Renal Disease: Medicare Part A Quick Reference Manual Table of Contents ESRD Provider PTAN Number Range: Third through sixth digit FL 04 Type of Bill FL 6 Statement Covers Period FL 18-28 Condition Codes FL 18-28 Condition [...]

Claim Submission Guidelines

Claim Submission Guidelines CMS developed and transmitted HCPCS and PFS payment and coding files to include revisions to add other CDT codes and indicated parameters for payment to implement the finalized Medicare Parts A and B payment for [...]

Disproportionate Share Hospital

The Medicare DSH adjustment provision under Section 1886(d) (5) (F) of the Act was enacted by section 9105 of the COBRA of 1985 and became effective for discharges occurring on or after 5/1/1986. According to section 1886(d) (5) (F) of the Act, [...]

Electronically Submitted Claims that Exceed $99,999.99 Reminder

Electronically Submitted Claims that Exceed $99,999.99 Reminder Electronically submitted claims containing a dollar amount in excess of 99,999.99 will be rejected as a front-end EDI edit. The Standard Companion Guide for Health Care Claim: [...]

MLN Connects® Newsletter: August 22, 2024

MLN Connects® Newsletter: August 22, 2024 News Commemorating the 2nd Anniversary of the Lower Cost Prescription Drug Law MolDx Local Coverage Determination Statement Hospital Price Transparency: Get Resources to Help You Comply New [...]

Facet Joint Interventions

Facet Joint Interventions National Government Services will begin accepting PARs for Facet Joint Intervention codes on 6/15/2023 for services provided beginning on or after 7/1/2023.   To meet coverage criteria, the patient’s medical [...]

Part B

Part B  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us EDI Enrollment EDI Solutions Forms [...]

FQHC

FQHC and RHC  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us Cost Reports EDI Enrollment EDI [...]

Part A

Part A  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us Cost Reports EDI Enrollment EDI [...]