Attention All OPPS Providers with Provider-Based Department(s): Permanent Edit Implementation Begins on/after 8/1/2023

Attention All OPPS Providers: Provider-Based Department Edits Being Implemented on/after 8/1/2023 Certain edits are being implemented on/after 8/1/2023 to ensure you are billing your provider-based locations correctly. The edits are FISS [...]

Attestation

Attestation At the start of an EDI Guided Enrollment submission, you will need to read and accept the attestation in order to proceed.

I Am a Billing Service and “I Want to Use a Provider's PIN From their Letter of Authorization (LOA)”

I Am a Billing Service and “I Want to Use a Provider's PIN From their Letter of Authorization (LOA)” This selection will prompt you to complete the Logon Request with PIN Form. This objective is for a third party who wishes to request, [...]

MLN Connects® Newsletter: July 27, 2023

MLN Connects® Newsletter: July 27, 2023 News CMS Continues Work on Behavioral Health Discarded Drugs and Biologicals: Updated FAQs on JW & JZ Modifiers Expanded Home Health Value-Based Purchasing Model: July 2023 Interim Performance [...]

Reason Codes

Chapter I: Online System Terminology Reason Codes Purpose Reason codes direct the outcome of an edit or process within FISS—they are the traffic cops of the system. Each reason code, when assigned, sends the claim to a specific [...]

View a Report (R2)

Chapter VII: Online Reports View Submenu (04) View a Report (R2) Purpose This option allows the provider to go directly to MAP1661 for report viewing. Task To access the View a Report option from the Fiscal Intermediary (FISS)/Direct [...]

FISS UB-04 Data Entry Payer Codes

Resources FISS UB-04 Data Entry Payer Codes The following payer codes may be reported in the CD field on CLAIM PAGE 03 of the online UB-04 claim entry record. Payer Code Description 1 Medicaid 2 Blue [...]

How to Adjust a Claim

Resources How to Adjust a Claim To adjust a claim using the FISS/DDE Provider Online System, follow these steps: Step Action 1 Select the CLAIMS CORRECTION (03) submenu from the MAIN MENU 2 Key the [...]

FISS Claim Change/Condition Reason Codes

Resources FISS Claim Change/Condition Reason Codes The following adjustment/cancel claim change reason codes may be reported in the COND CODE field on CLAIM PAGE 01 of the adjustment/cancel claim record. For Adjustment Claims Only (TOB [...]

How to Cancel a Claim

Resources How to Cancel a Claim To cancel a claim on the FISS/DDE Provider Online System, follow these steps: Step Action 1 Select the CLAIMS CORRECTION (03) submenu from the MAIN MENU 2 Key the [...]

Online System Menu Quick-Reference

Resources Online System Menu Quick-Reference Main Menu Inquires Submenu (01) Claims/Attachments Submenu (02) 01 – Inquires 02 – Claims/Attachments 03 – Claims Correction 04 – Online Reports View 10 [...]

Document Control Number

Chapter I: Online System Terminology Document Control Number Purpose The FISS DDE Provider Online System refers to the claim control number as a DCN. The DCN provides a reference number for the control and monitoring of each claim. To [...]

LCD, Billing and Coding Article Updates for August 2023

LCD, Billing and Coding Article Updates for August 2023 New LCDs and Articles (Effective 8/1/2023) Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin [...]

January 2024 Release "Dark Days" for the Common Working File Hosts

January 2024 Release "Dark Days" for the Common Working File Hosts For the upcoming January 2024 Release: For Production, CWF will be observing the Gray Day on Thursday, 12/28/2023 and Dark Days starting Friday, 12/29/2023 through Sunday, [...]

MLN Connects® Newsletter: November 22, 2023

MLN Connects® Newsletter: November 22, 2023 News CMS Roundup (Nov 17, 2023) Provider Enrollment Application Fee: CY 2024 Clinical Laboratory Fee Schedule: CY 2024 Final Payment Determinations & Reporting Delay Medicare Ground [...]

WellSky Home Health Claim Primary Diagnosis Coding Issue

WellSky Home Health Claim Primary Diagnosis Coding Issue WellSky has identified a software error for their HHA customers that potentially impacted claims submitted between 9/29/2021 and 10/27/2022. The error resulted in the software using [...]

The CY 2024 Medicare Physician Fee Schedule Is Now Available

The CY 2024 Medicare Physician Fee Schedule Is Now Available The CY 2024 MPFS is now available. You can view the new fees using the Fee Schedule Lookup tool located on NGSMedicare.com. Posted 11/29/2023

The Comprehensive Error Rate Testing Contractor

The Comprehensive Error Rate Testing Contractor The CERT contractor randomly selects claims providers submit to Medicare to determine if the claim was paid properly under Medicare coverage, coding and billing rules by requesting medical [...]

Critical Access Hospitals: Bill Correctly

Critical Access Hospitals: Bill Correctly   The CERT contractor randomly selects claims providers submit to Medicare to determine if the claim was paid properly under Medicare coverage, coding and billing rules by requesting medical [...]

December 2023

In This Issue National Government Services Articles for Part A and Part B Providers Tobacco Cessation Counseling Doesn’t Have To Be Lengthy or Intimidating January 2024 Release "Dark Days" for the Common Working File Hosts The Great [...]

MLN Connects® Newsletter: November 30, 2023

MLN Connects® Newsletter: November 30, 2023 News Quality Payment Program: Preview Your Performance Information by December 12 HIV: Screening is Knowledge Claims, Pricers, & Codes Resubmit Telehealth Claims with Modifier CS [...]

National Government Services Medicare Administrative Contractor Provider Intervention Program

National Government Services Medicare Administrative Contractor Provider Intervention Program Are you aware that National Government Services has a MAC MPIP? The goal of this program is to notify you of potential billing aberrancies found as a [...]

The Comprehensive Error Rate Testing Contractor Process

The Comprehensive Error Rate Testing Contractor Process The CERT contractor randomly selects claims providers submit to Medicare to determine if the claim was paid properly under Medicare coverage, coding and billing rules by requesting [...]

Institutional Providers: Revised CMS-855A Medicare Enrollment Paper Application Required 12/17/2023

Institutional Providers: Revised CMS-855A Medicare Enrollment Paper Application Required 12/17/2023 If you don’t use PECOS, use the revised CMS-855A (Medicare Enrollment Application -Institutional Providers) to enroll or update your [...]

MLN Connects® Newsletter: December 7, 2023

MLN Connects® Newsletter: December 7, 2023 News Citrix Bleed Vulnerability: Act Now Marriage and Family Therapists & Mental Health Counselors: Enroll in Medicare Now Health Professional Shortage Area: CY 2024 Bonus Payments [...]

Reminder: OPPS Provider-Based Edits

Reminder: OPPS Provider-Based Edits Are you having issues with the recently implemented provider-based billing edits impacting OPPS facilities with multiple service locations? Certain edits were implemented on/after 8/1/2023 to ensure you are [...]

CR13468 - Payment of Codes for Chemotherapy Administration and Nonchemotherapy Injections and Infusions

CR13468 - Payment of Codes for Chemotherapy Administration and Nonchemotherapy Injections and Infusions Posted 12/8/2023

Physicians/Practitioners! Are You Ordering Oxygen for Your Patients?

Physicians/Practitioners! Are You Ordering Oxygen for Your Patients? This is your opportunity to hear directly from the Medicare contractors regarding documentation required for coverage criteria to be met and allow your patients to receive [...]

A/B MACs Team Up with DME MACs for Glucose Monitor and Supplies Webinar on August 25

A/B MACs Team Up with DME MACs for Glucose Monitor and Supplies Webinar on August 25 Local A/B MACs and the DME MACs are excited to announce a collaboration webinar coming Thursday, August 25. This webinar will focus on what providers need to [...]

Remittance Advice Codes: What Are They and Where to Find What They Mean

Remittance Advice Codes: What Are They and Where to Find What They Mean Table of Contents Claim or Service Line Level Adjustments: Using Group Codes, Claim Adjustment Reason Codes and Remittance Advice Remark Codes Group Codes Claim [...]

Related Content

Related Content Centers for Medicare & Medicaid Services (CMS) Telehealth web page CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 CMS IOM Publication 100-04, Medicare Processing Manual, Chapter 12, Section 190 [...]

Molecular Pathology Procedures Reminder

Molecular Pathology Procedures Reminder National Government Services has been receiving many claims submitted for redetermination that were submitted for Group 3 Molecular Pathology Procedures. The Group 3 codes from LCD (L35000/A56199) are [...]

Physical, Occupational and Speech and Language Pathology Therapy Services: Prevent Easily Avoidable Errors

Physical, Occupational and Speech and Language Pathology Therapy Services: Prevent Easily Avoidable Errors Evaluation/Plan of Care Documentation Elements The POC must contain, at a minimum, the following required elements: Diagnoses [...]

National Government Services Proposed LCDs For Comment

National Government Services Proposed LCDs For Comment The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 6/9/2022 through 7/23/2022. These [...]

CMS Medically Unlikely Edits

January 2024

In This Issue National Government Services Articles for Part A and Part B Providers New Version of PC-ACE: January 2024 January 2024 Billing and Coding Articles Updates Micro-invasive Glaucoma Surgery Update Improving Customer [...]

The Importance of Proper Documentation

The Importance of Proper Documentation The CERT contractor randomly selects claims providers submit to Medicare to determine if the claim was paid properly under Medicare coverage, coding and billing rules by requesting medical records. If the [...]

MLN Connects® Newsletter: December 14, 2023

MLN Connects® Newsletter: December 14, 2023 News CMS Releases Revised Guidance for Medicare Prescription Drug Inflation Rebate Program Medicare Part B Inflation Rebate Guidance: Use of the 340B Modifier — Revised Billing for Flu, [...]

Medicare Demand Letter Rebuttals

Medicare Demand Letter Rebuttals National Government Services has seen an influx of overpayment rebuttal inquiries and here’s what you need to know. Rebuttals should be rare and only approved if NGS has processed an account(s) receivable [...]

The New York Regional Office of CMS – Monthly Office Hours/Open Forum

The New York Regional Office of CMS – Monthly Office Hours/Open Forum The New York Regional Office of CMS (Region 2) conducts a monthly Office Hours/Open Forum meeting that allows physicians and their office staff to interact with and ask [...]