Hospice

Medicare Part B 101 Manual Hospice Table of Contents General Requirements Coinsurance Coinsurance on Outpatient Drugs and Biologicals Respite Care Coinsurance Physicians’ Services Attending Physician Services Care Plan Oversight [...]

Participation Program

Medicare Part B 101 Manual Participation Program Table of Contents Eligibility Participation Enrollment Period/Participating Status Changes Participation Program Participating Provider Nonparticipating Provider When [...]

Ordering and Referring Claims Information

Medicare Part B 101 Manual Ordering and Referring Claims Information Table of Contents Ordering and Referring Claims Information How to Identify the Ordering or Referring Provider on a Claim Ordering and Referring Eligible Provider [...]

Refunds and Overpayments

Medicare Part B 101 Manual Refunds and Overpayments Table of Contents Medicare Contractor Initiated Demand Letters Providers Not on Automatic Recoupments Jurisdiction K (CT, MA, ME, NH, NY, RI , VT) Jurisdiction 6 (IL, MN, WI) [...]

Return/Reject

Medicare Part B 101 Manual Return/Reject While it's easy to group processed claims as either approved or denied, there are differences in the way claims are returned unpaid by Medicare. Only claims that are filed with complete and correct [...]

Health Professional Shortage Area

Medicare Part B 101 Manual Health Professional Shortage Area What is a HPSA? What is the HPSA Incentive Bonus? Who is Eligible for the Incentive Bonus? How is the Bonus Billed? What Else You Should Know To Learn More [Return to [...]

Assignment of Benefits

Medicare Part B 101 Manual Assignment of Benefits Table of Contents Assignment of Benefits Mandatory Assignment Collecting from Medicare Patients on Assigned Claims Related Content [Return to Top] Assignment of Benefits An [...]

Advance Beneficiary Notice of Noncoverage for Not Reasonable and Necessary Denials

Medicare Part B 101 Manual Advance Beneficiary Notice of Noncoverage for Not Reasonable and Necessary Denials Table of Contents Limited Coverage Medical Necessity Expectations ICD-10-CM Coding Reasons for Noncoverage Beneficiary [...]

Set Up a Beneficiary's Medicare Secondary Payer Record

Table of Contents Background: Set Up a Beneficiary’s Medicare Secondary Payer Record Step 1: Provider Receives New MSP Information for a Beneficiary Step 2: Check for a Matching Medicare Secondary Payer Record for the Beneficiary in the [...]

Modifier 90 Reference to Outside Laboratory

Modifier 90: Reference to Outside Laboratory Modifier 90 is to be used when the billing laboratory refers a specimen to another laboratory for testing. In these cases, the billing laboratory is titled the “referring laboratory” while the [...]

Initiate Patient Status Lookup

Initiate Patient Status Lookup Click the Eligibility Lookup button from the NGSConnex homepage. In the Select a Provider panel, click the Select button next to the applicable provider account. In the Select a Beneficiary panel, [...]

Hospice Payment Rates

MSP Post-Pay Overpayments

Forms You’ll Need Jurisdiction K CT-MA-ME-NH-NY-RI-VT Medicare Part B MSP Overpayment Request Form Jurisdiction 6 IL-MN-WI Medicare Part B MSP Overpayment Request Form JK or J6 Medicare Secondary Payer Part B Voluntary [...]

Cognitive Assessment and Care Plan Information

Cognitive Assessment and Care Plan Information Select Cognitive Assessment & Care Plan Information from the left-side navigation. The Cognitive Assessment & Care Plan information panel provides information for the following HCPCS [...]

Part B Deductible

Part B Deductible Select Part B Deductible from the left-side navigation. The information displayed in this section will provide the current year’s Part B deductible amount and if available up to four years of additional historical deductible [...]

Beneficiary Eligibility Information Panel

Beneficiary Eligibility Information Panel Table of Contents Beneficiary Eligibility Information Panel Printable View Initiate a New Search [Return to Top] Beneficiary Eligibility Information Panel The Beneficiary Eligibility [...]

Flu Vaccine

Flu Vaccine Select Flu Vaccine from the left-side navigation. You will find the patient's flu vaccination history in this section. The Medicare beneficiary must have active Part B coverage and must not have a date of death on file at the [...]

Hepatitis Screening

Hepatitis Screening Select Hepatitis Screening from the left-side navigation. The Hepatitis Screening panel provides information for the following HCPCS codes. 86704 ‒ Hepatitis B core antibody (HBcAb); total 86706 ‒ Hepatitis B surface [...]

Hospice Payment Rates

Hospice Payment Rates National Government Services publishes hospice rate sheets you can use to validate hospice payments based on your service location. Although FISS is the official payment made by the Medicare Program, you can use the rates [...]

Accelerated and Advanced Payment Program

COVID-19 Accelerated/Advanced Payment Revised Repayment Terms On 3/28/2020, CMS expanded the existing CAAP to a broader group of Medicare Part B Providers. The CMS CAAP Program was established to increase case flow to Medicare providers and [...]

Bankruptcy Notifications

Notify us if you file bankruptcy. If you have filed a bankruptcy petition or are involved in a bankruptcy proceeding, National Government Services requests that you notify us immediately so that we can properly coordinate with the CMS and the [...]

Complete a Voluntary Refund

Table of Contents Forms Used for Providers NOT on Automatic Immediate Recoupments and Check(s) Are Attached to This Form(s) Option 1: Completing the Voluntary Refund Form High Volume Spreadsheet Instructions Option 2: Large [...]

How Should I Respond?

An overpayment may be identified and self-reported by a provider via clerfical error reopening or an overpayment, may be discovered by Medicare contractors as part of the claim and reimbursement review process. The key to reporting and repaying [...]

Nettings/Offsets Across Organization Affiliations

Effective 1/4/2016, CMS implemented a change to begin netting/offsetting provider money across affiliated providers within the same and also across workloads within a single organization. This CMS change brings consistency to all Part B [...]

Overpayment Rebuttal Process

You’ll need to know what the rebuttal process is before initiating and know that the outcome of the rebuttal may not change the National Government Services recoupment process. The overpayment rebuttal process is a protocol used when an [...]

Overpayment Request

Table of Contents Forms You'll Need Large Scale Overpayments Overpayment Notification Process Timeline for Processing a Demand Letter [Return to Top] Forms You'll Need Forms for non MSP-related are generally done via NGSConnex, but [...]

Respond to a Demand Letter

Table of Contents Form(s) you’ll need Timeline for Processing a Demand Letter [Return to Top] Form(s) you’ll need Providers on Automatic immediate Recoupments Do nothing as this automation process will automatically be done and [...]

Request an Immediate Recoupment

Forms You’ll Need These forms apply to providers that are NOT on Automatic Immediate Recoupments. Electronic Submissions JK or J6 Immediate Recoupment Request Form - Electronic/E-mail Paper Submissions Jurisdiction K [...]

Resources

MLN® Fact Sheet: Medicare Overpayments CMS Internet-Only Manual Publication 100-06, Medicare Financial Management Manual, Chapter 3 - Overpayments Reviewed 10/17/2024

Navigating Medicare Part B Insights for Providers Podcast

Navigating Medicare Part B Insights for Providers Podcast   Listen to our podcast, Navigating Medicare Part B Insights for Providers, on Spotify and Apple Podcasts! We will be posting a new episode on the 2nd and 4th Wednesday of each [...]

Initiate a Prior Authorization Request for OPD Services for Part A Facility

Initiate a Prior Authorization Request for OPD Services for Part A Facility Table of Contents Initiate a Prior Authorization Request Request Details Requestor’s Information Rendering Physician Information Attachments [...]

MLN Connects® Newsletter: October 17, 2024

MLN Connects® Newsletter: October 17, 2024 News Inpatient Psychiatric Facilities: Guidance on All-Inclusive Cost Reporting No-Pay Medicare Summary Notice Mailing Frequency Changed to Every 120 Days Health Literacy: Help Your Patients Get [...]

Interactive Voice Response System

Interactive Voice Response System CMS requires that Medicare contractors offer self-service options to their providers for general inquiries. CMS also requires providers to utilize those self-service options, such as the IVR. National [...]

Skilled Nursing Facility Consolidated Billing

Skilled Nursing Facility Consolidated Billing Back in 1997 as part of the Balanced Budget Act, Congress mandated that payment for the majority of services provided to beneficiaries in a Medicare-covered SNF stay be included in a bundled [...]

Local Coverage Determination

Local Coverage Determination LCDs are developed by the local Medicare contractor in the absence of a national Medicare payment policy. These policies describe specific criteria which determine whether an item or service is covered by Medicare [...]

ABN Modifiers

ABN Modifiers Modifier Description GA Waiver of liability statement issued, as required by payer policy, individual case GX Notice of liability issued, voluntary under payer policy GY Item [...]

American Medical Association and Current Procedural Terminology

American Medical Association and Current Procedural Terminology The AMA is your trusted source for official CPT. The most widely accepted medical nomenclature used to report medical procedures and services under public and private health [...]

CMS Forms and Publications

CMS Forms and Publications CMS publishes and maintains numerous Medicare forms that are used daily by the provider community. Some commonly used forms are: Provider Enrollment CMS-855 forms (CMS-855B, CMS-855I and CMS-855O) Medicare [...]

CMS Regional Offices

CMS Regional Offices CMS has ten RO reorganized in a Consortia structure based on the agency’s key lines of business: Medicare Health Plans Operations Financial Management and Fee-for-Service Operations Medicaid and Children’s Health [...]