MLN Connects® for Thursday, April 29, 2021

MLN Connects® for Thursday, April 29, 2021 NPI: What You Need to Know View this edition as a: Webpage | PDF News Clinical Diagnostic Laboratories: Resources about the Private Payor Rate-Based CLFS Compliance Cardiac Device [...]

MLN Connects® Special Edition for Tuesday, April 27, 2021

MLN Connects® Special Edition for Tuesday, April 27, 2021 CMS Proposes to Enhance the Medical Workforce in Rural and Underserved Communities to Support COVID-19 Recovery and Beyond Proposed rule would require hospitals to report vaccination [...]

MLN Connects® for Friday, April 16, 2021

MLN Connects® for Friday, April 16, 2021 2% Payment Adjustment (Sequestration) Suspended Through December View this edition as a: Webpage | PDF News Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Suspended Through December [...]

MLN Connects® for Thursday, April 8, 2021

MLN Connects® for Thursday, April 8, 2021 More FY20 PEPPERs Available View this edition as a: Webpage | PDF News PEPPERs for LTCHs, CAHs, IRFs, IPFs, Hospices, & SNFs Preparedness Resources: Cybersecurity & Post-Acute [...]

MLN Connects® Special Edition for Tuesday, March 30, 2021

MLN Connects® Special Edition for Tuesday, March 30, 2021 Temporary Claims Hold Pending Congressional Action to Extend 2% Sequester Reduction Suspension In anticipation of possible Congressional action to extend the 2% sequester reduction [...]

NPPES

Modifiers

Home Health Core-Based Statistical Area Payment issue (Code 50007)

CBSA Code 50007 was loaded into the CY 2021 wage index table of the home health (HH) Pricer with an incorrect effective date. This error is causing incorrect payment on claims with CBSA 50007 in the Value Code 61 amount field by using the wrong [...]

Part A 11X Claims Returned to Provider

11X claims with DOS prior to 10/1/2021 with ICD-10 diagnosis code Z515 and POA indicator of Y have RTP with edit message 34931.

Enrollment

Enrollment

Service Specific Post Payment Review of Darbepoetin Alfa Injection, 1 microgram (Non-ESRD Use)

National Government Services Part B MR Department analyzes national and local data to identify possible improper payment for Medicare services. In an effort to reduce the Part B CERT error rate, the MR Department will be conducting a service [...]

Announcing Service Specific Post-Payment Audits of Hyperbaric Oxygen (HBO) Services for J6 A Regions: IL, WI, and MN

Edit Reason Code: 5FPJP Bill Type = 13X CPT/HCPCS/Modifiers: G0277 Overview The Medical Review Department of National Government Services will be performing service specific post-payment reviews for claims submitted to Medicare Part A. When a [...]

Hospice Beneficiary Election Statement Addendum Frequently Asked Questions

Hospice Beneficiary Election Statement Addendum Frequently Asked Questions National Government Services, in collaboration with Palmetto GBA, CGS and CMS, developed these FAQs to assist providers in a better understand of the federal [...]

Multi-Jurisdictional Contractor Advisory Committee (CAC)/Subject Matter Expert Meeting

Multi-Jurisdictional Contractor Advisory Committee (CAC)/Subject Matter Expert Meeting March 10, 2022 Topic: SIJ Interventions and Procedures Questions for SIJ Interventions For all questions, answers must be based on clinical literature [...]

MLN Connects® Special Edition for Thursday, January 7, 2021

MLN Connects® Special Edition for Thursday, January 7, 2021 Physician Fee Schedule Update On December 27, the Consolidated Appropriations Act, 2021 modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS): Provided a [...]

MLN Connects® for Thursday, January 7, 2021

MLN Connects® for Thursday, January 7, 2021 COVID-19 Vaccines: CDC Long-Term Care Facility Toolkit View this edition as a: Webpage | PDF News COVID-19 Vaccines: CDC Long-Term Care Facility Toolkit MLN Web-Based Training: Complete [...]

Home Health Aide Services and the Intermittent or Part-Time Rule

Home Health Aide Services and the Intermittent or  Part-Time Rule Job Aid The CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 7, Section 50.2 states: The reason for the visits by the home health aide must [...]

PDGM Resources

PDGM Resources MLN Matters Article MM11081 – "Home Health Patient-Driven Groupings Model (PDGM) - Split Implementation" MLN Matters Article MM11395 – "Home Health Patient-Driven Groupings Model - Revised and Additional Manual Instructions" [...]

Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment

Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment This edit is applied to claims when a RAP and final episode claim are submitted at the same time or when a RAP is submitted when there is one for the same [...]

ESRD PC Pricer

Long-Term Care Hospital PPS PC Pricer

Inpatient Psychiatric Facility PPS PC Pricer

Inpatient Rehabilitation Facility PPS PC Pricer

How to Become a Medicare Enrolled OTP Supplier

How to Become a Medicare Enrolled OTP Supplier OTPs with current, valid, and full certification by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accredited by a SAMHSA-approved accrediting body; including DEA and [...]

Prior Authorization Request for Outpatient Services: Botulinum Toxin

Prior Authorization Request for Outpatient Services: Blepharoplasty, Blepharoptosis Repair and Brow Ptosis Repair

Prior Authorization Request for Outpatient Services: Vein Ablation

Prior Authorization Request for Outpatient Services: Rhinoplasty

Prior Authorization Request for Outpatient Services: Panniculectomy

Prior Authorization Requests Submitted by Exempt Providers Alert The National Government Services PA Department has observed an increase in submission of PAR for exempt providers. These submissions are from the HOPD and/or physician offices on [...]

Hospice Cap

Medicare Number

Chapter I: Online System Terminology Medicare Number Purpose The FISS DDE Provider Online System utilizes the terminology MBI to identify the beneficiary’s Medicare number. For the purpose of this manual, “Medicare [...]

Program Function Keys

Chapter III: Navigating the Online System Program Function Keys Purpose The following chart outlines the screen movement associated with each of the keyboard program function <F/PF> keys. Note: From a functional standpoint, [...]

Appeals Calculator Levels of Appeal Table

Five Levels of Appeals: Overview Levels Level One Level Two Level Three Level Four Level Five Type of Appeal Redetermination Reconsideration (QIC) Administrative Law Judge (ALJ) Medicare Appeals [...]

About the 201 Pend Report

Chapter VII: Online Reports View Submenu (04) About the 201 Pend Report Purpose The 201 Pend Report is designed to assist providers in accessing information regarding the status of their submitted claims. This report is available to view [...]

About the 702 ACS Appeals Received Report

Chapter VII: Online Reports View Submenu (04) About the 702 ACS Appeals Received Report Description: The Automated Correspondence System (ACS) master record inputs into the system so that this daily report can be created to allow providers [...]

Request a Redetermination

Request a Redetermination The first level of appeal is the redetermination and is carried out by the MAC. Time limit to initiate = 120 days from date of receipt of the initial determination notice Time limit to complete the [...]

About NGSConnex

This user guide is specific to your line of business and state. To ensure you are viewing the correct user guide, check your information in the top right corner. If your line of business and state is not correct, please select your applicable [...]