52NCD

Avoiding/Correcting This Error Ensure all Medicare coverage and medical necessity requirements are met prior to billing. If the provider determines that Medicare will not cover the services, consider submitting the charges as noncovered. [...]

54NCD

Avoiding/Correcting This Error Review coverage guidelines for the service being denied to ensure medical necessity of the services being provided to the beneficiary. Ensure all Medicare coverage and medical necessity requirements are met [...]

55B31

Avoiding/Correcting This Error Review coverage guidelines and patient records to determine if all appropriate documentation was sent for review that may have supported medical necessity. When you receive an ADR from National Government [...]

55B31

Avoiding/Correcting This Error Review coverage guidelines and patient records to determine if all appropriate documentation was sent for review that may have supported medical necessity.  When you receive an ADR from National Government [...]

55S05

Avoiding/Correcting this Error The SNF should ensure that SNF services that are not covered are identified. After discussion with the beneficiary and/or representative you should properly issue an ABN and bill for the noncovered services [...]

55S29

Avoiding/Correcting This Error Respond promptly to a MAC, CERT, RAC, SMRC, or UPIC request for additional documentation.  Documentation is necessary to verify compliance with a benefit category requirement. Ensure that all records, [...]

59118

Avoiding/Correcting This Error Review reason code 59118 in the Direct Data Entry system for applicable codes. Alternatively, review the latest Change Requests/MLN® Matters articles for relevant ICD-10 updates. The most current MLN Matters [...]

59118

Avoiding/Correcting This Error Review reason code 59118 in the Direct Data Entry system for applicable codes. Alternatively, review the latest Change Requests/MLN® Matters articles for relevant ICD-10 updates. The most current MLN Matters [...]

Frequently Asked Questions Have Been Reviewed and Updated

Frequently Asked Questions Have Been Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Topics available are: ASCA Appeals CAR T-cell [...]

Overpayment: How Should I Respond?

Table of Contents Overpayment: How Should I Respond? What Action Should I Take? Complete a Voluntary Refund Where Should I Send my Forms and Payments? [Return to Top] Overpayment: How Should I Respond? An overpayment may be [...]

Request an Immediate Recoupment

National Government Services has implemented a standardized “immediate recoupment” process that gives you the option to avoid interest from accruing on claims overpayments when the debt is recouped in full prior to or by the 30th day from the [...]

Complete a Voluntary Refund

A voluntary refund is when you have self-identified you have been overpaid and you need to refund the excess funds to Medicare. All checks are made payable to National Government Services. Whenever possible, the refund to Medicare should be [...]

Set Up an Extended Repayment Schedule

If repaying an overpayment would constitute a “hardship” on the provider, a request for an ERS should be submitted immediately. While you may request an ERS at any time during the debt-collection process, timely submission of a valid request [...]

Payment Withholding Information

Payment Withholding Information What Is a Payment Withholding? Why Are Payments Withheld? Who Can I Contact for Further Assistance? What About Cost Report Interim and Final Settlement Withholdings? What Is a Payment Withholding? An [...]

MSP Post-Pay Adjustments

If you have received an overpayment because Medicare paid as the primary insurer and another insurance carrier should be the primary payer, follow the instructions on the Part A voluntary refund form. A separate refund form is needed for [...]

Refunds Due to Beneficiaries by Providers

Refunds Due to Beneficiaries by Providers In some situations, providers are responsible for refunding monies to beneficiaries that have paid for services providers have determined to be noncovered and nonpayable by Medicare. When an ABN has [...]

Credit Balance Reporting

Table of Contents What is a Credit Balance? What Should I Do When I Have a Credit Balance? Additional Tips for a Successful Credit Balance Report Submission [Return to Top] What is a Credit Balance? Generally, when a provider [...]

Part A Fundamentals of Medicare Online Guide

Part A Fundamentals of Medicare Online Guide Attention Part A Providers and Support Staff:  National Government Services produces the Fundamentals of Medicare online guide to help build understanding of the Original Medicare [...]

Medicare Participating Physicians Directory

Medicare Participating Physicians Directory The 2025 MEDPARD is now available. It includes all Part B providers in Jurisdiction 6 and Jurisdiction K who have agreed to accept assignment on all Medicare-covered services. The updated list [...]

Using the Medicare Coverage Database: How to Find Important Medicare Coverage Information

Are you responsible for looking up whether a service is covered in the Medicare program at your facility but you're not sure where to look for the most relevant information? Have you received national coverage determination (NCD) or local [...]

New Medicare Part B Redetermination Notice Initiative

New Medicare Part B Redetermination Notice Initiative  National Government Services is excited to announce a new initiative for providers who submit Medicare Part B appeals using our portal, NGSConnex.  Starting 3/3/2025, NGS [...]

Billing Telehealth Services for Part B Providers

During this webinar, we’ll provide you with insight into covered Medicare telehealth services and coverage requirements. We’ll discuss originating sites, distant sites and billing and payment guidelines. Note: registration has reached maximum [...]

Take Advantage of Tobacco Counseling When Performing Medicare Wellness Visits 

Take Advantage of Tobacco Counseling When Performing Medicare Wellness Visits Medicare providers have a valuable opportunity to optimize revenue and improve patient outcomes through Medicare's Annual Wellness Visits. These visits help identify [...]

NGSConnex: Part B Redetermination Notifications

Beginning in March 2025, National Government Services will discontinue mailing paper Medicare Redetermination Notices (MRNs) when Part B redetermination requests are submitted through NGSConnex. During this webinar, we’ll share information and [...]

NGSConnex: Part B Redetermination Notifications

Beginning in March 2025, National Government Services will discontinue mailing paper Medicare Redetermination Notices (MRNs) when Part B redetermination requests are submitted through NGSConnex. During this webinar, we’ll share information and [...]

NGSConnex: Part B Redetermination Notifications

Beginning in March 2025, National Government Services will discontinue mailing paper Medicare Redetermination Notices (MRNs) when Part B redetermination requests are submitted through NGSConnex. During this webinar, we’ll share information and [...]

NGSConnex: Part B Redetermination Notifications

Beginning in March 2025, National Government Services will discontinue mailing paper Medicare Redetermination Notices (MRNs) when Part B redetermination requests are submitted through NGSConnex. During this webinar, we’ll share information and [...]

EDI Gateway Outage

The National Government Services EDI gateway was unavailable for all submitters. 

Set Up an Extended Repayment Schedule

Forms you’ll need J6 Applying for an Extended Repayment Schedule JK Applying for an Extended Repayment Schedule If repaying an overpayment would constitute a “hardship” on the provider, a request for an ERS should be submitted [...]

J6 Part B Applying for an Extended Repayment Schedule

Medicare Part B Ambulance Coverage, Basics and Billing

During this webinar, we'll educate new staff or those needing a refresher on basic Medicare Part B ambulance billing guidelines.

Diabetes Screening

Preventive Services Guide Diabetes Screening Table of Contents Diabetes Screening Coverage Criteria and Frequency Limits HCPCS/CPT Coding Diagnosis Coding Cost Sharing Reimbursement Nonparticipating Providers Common Claim [...]

KX Modifier Threshold

KX Modifier Threshold The Bipartisan Budget Act of 2018 repealed application of the Medicare outpatient therapy caps but retains the former cap amounts as a threshold above which claims must include the KX modifier as a confirmation that [...]

Discarded Drugs/Wastage and JW, JZ Modifier

Discarded Drugs/Wastage and JW, JZ Modifier Medicare may pay for discarded drugs or wasted drugs and biologicals when: The provider/supplier must discard the remainder of a single-dose container after administering a dose or quantity to a [...]

Preventive Services: Screening for Cardiovascular Disease and Abdominal Aortic Aneurysm

During this webinar, we'll review the coverage, coding and billing guidelines for cardiovascular disease (CVD) screening blood tests, intensive behavioral therapy for CVD and ultrasound screening for abdominal aortic aneurysm preventive services.

Meeting Schedule for Home Health and Hospice

Meeting Schedule for Home Health and Hospice Jurisdiction 6 (Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Jersey, New York, Northern Mariana Island, Oregon, Puerto Rico, U.S. Virgin [...]

Long-Term Care Hospitals: Interruptions

To prevent return to provider (RTP) claims, join us for this webinar in which we will review “three-day or less interruptions” as well as “greater than three-day interruptions” in a beneficiary’s long term care hospital (LTCH) stay, how to [...]

Billing Telehealth Services for Part B Providers

During this webinar, we’ll provide you with insight into covered Medicare telehealth services and coverage requirements. We’ll discuss originating sites, distant sites and billing and payment guidelines.

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 Logon ID Recertification

All users who access the FISS DDE system are required by the CMS to recertify their access annually. National Government Services will designate one state at a time to complete the annual logon recertification. To complete the recertification [...]