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Posting Date: 11/05/2020
MLN Connects® for Thursday, November 5, 2020
MLN Connects® for Thursday, November 5, 2020 COVID-19 Vaccine: Find Out How to Prepare MLN Connects® for Thursday, November 5, 2020 View this edition as a: Webpage | PDF News COVID-19 Vaccine: Find Out How to Prepare Hospital [...]
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Posting Date: 11/19/2020
MLN Connects® for Thursday, November 19, 2020
MLN Connects® for Thursday, November 19, 2020 Nursing Homes: Take COVID-19 Training MLN Connects® for Thursday, November 19, 2020 View this edition as a: Webpage | PDF News CMS Releases Nursing Home COVID-19 Training Data with [...]
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Posting Date: 11/12/2020
MLN Connects® for Thursday, November 12, 2020
MLN Connects® for Thursday, November 12, 2020 COVID-19: Non-Physician Practitioner Billing for Audio Services MLN Connects® for Thursday, November 12, 2020 View this edition as a: Webpage | PDF News Critical Care: Comparative [...]
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Posting Date: 10/06/2020
Notification of the 2020 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review
Notification of the 2020 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review The amount that must remain in controversy for ALJ hearing requests filed on or [...]
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Posting Date: 03/26/2020
New Version of PC-ACE: April 2020
New Version of PC-ACE: April 2020 PC-ACE Version 4.6 contains several CMS mandates and product enhancements including but not limited to the items listed below. CR 11353 - New Medicare Provider Specialty Code (D5) and Billing Codes [...]
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Posting Date: 01/28/2021
New Uniform Thresholds for Determining Low Medicare Utilization Providers
New Uniform Thresholds for Determining Low Medicare Utilization Providers Effective for all cost reports received on or after 6/19/2020, the MACs are instructed to use the following defined “Low Medicare Utilization Thresholds” compared to [...]
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Posting Date: 04/08/2020
New NGS Part A Redetermination Request Form
New NGS Part A Redetermination Request Form Save time and money by using of the following options instead of mailing a written redetermination request form: Initiate an adjustment in the FISS DDE for fully covered or rejected claims Use [...]
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Posting Date: 09/16/2020
National Government Services and the Public Health Emergency
National Government Services and the Public Health Emergency The health and well-being of our beneficiaries, providers, associates and communities is our top priority. We understand the uncertainty and concerns you may be experiencing during [...]
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Posting Date: 09/01/2020
National Government Services Provider Enrollment Appeals Mailbox Reminder
National Government Services Provider Enrollment Appeals Mailbox Reminder National Government Services, Inc. has seen an increase in submissions to the PE appeals mailbox (NGS-PE-Appeals@Anthem.com) that are not appropriate. The NGS PE appeals [...]
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Posting Date: 03/27/2020
National Government Services Accepting and Processing Claims for Expanded Coverage of Telehealth Services as of 3/6/2020
National Government Services Accepting and Processing Claims for Expanded Coverage of Telehealth Services as of 3/6/2020 On 3/17/2020, CMS issued MLN Connects® Special Edition for Tuesday, March 17, 2020, President Trump Expands Telehealth [...]
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Posting Date: 10/30/2020
Medicare Usage of CPT 99072
Medicare Usage of CPT 99072 National Government Services has received many questions regarding CPT 99072 for Medicare usage since the AMA announced the code on 9/8/2020. Many providers have been asking if CMS will cover this code for Medicare [...]
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Posting Date: 02/24/2020
Chiropractors Billing Medicare for Therapy Services
Chiropractors Billing Medicare for Therapy Services Chiropractors in the Medicare fee-for-service realm are only allowed to be considered for spinal manipulation via submission of CPT codes 98940‒98942. Medicare pays for these services when [...]
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Posting Date: 01/08/2020
Top Reasons for Unprocessable Claims
Top Reasons for Unprocessable Claims National Government Services has composed a list of the top reasons for returning claims as unprocessable; due to missing, incomplete, insufficient or invalid claim information. An unprocessable claim is [...]
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Posting Date: 06/22/2020
What Part B Providers Need to Know About the Prior Authorization Program for Certain Medicare Services Performed in the Hospital Outpatient Department
What Part B Providers Need to Know About the Prior Authorization Program for Certain Medicare Services Performed in the Hospital Outpatient Department Hospitals submitting claims for certain outpatient department services will be required to [...]
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Posting Date: 02/24/2020
Reminder: 2020 New Codes for Care Management
Reminder: 2020 New Codes for Care Management We are reminding you that the 2020 final rule with regard to the new care management codes is not policy at this time. CMS is considering these changes identified in the final rule. If CMS decides [...]
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Posting Date: 08/25/2020
Proper Billing for Opioid Treatment Program Weekly Bundles for HCPCS Codes G2067-G2075
Proper Billing for Opioid Treatment Program Weekly Bundles for HCPCS Codes G2067-G2075 Medicare introduced the OTP as a covered Part B benefit beginning with dates of service on and after 1/1/2020. Payment is made to Medicare-enrolled OTP [...]
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Posting Date: 10/09/2020
Prior Authorization: Part B Physician Implications
Prior Authorization: Part B Physician Implications For dates of service on and after 7/1/2020, CMS has implemented a prior authorization program for certain hospital OPD services. This has been done to ensure that Medicare beneficiaries [...]
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Posting Date: 08/25/2020
Fee Schedule Adjustments Reminder for 99441-99443
Fee Schedule Adjustments Reminder for 99441-99443 National Government Services has received several inquiries from providers regarding the adjustment of CPT codes 99441-99443. When CMS announced that they were changing the fee schedule [...]
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Posting Date: 03/05/2020
Chiropractors Billing Medicare for Therapy Services
Chiropractors Billing Medicare for Therapy Services Chiropractors in the Medicare fee-for-service realm are only allowed to be considered for spinal manipulation via submission of CPT codes 98940‒98942. Medicare pays for these services when [...]
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Posting Date: 12/11/2020
2021 E/M Prolonged Service Billing Changes for Medicare
2021 E/M Prolonged Service Billing Changes for Medicare National Government Services has received several inquiries regarding changes to office or other outpatient prolonged service coding effective 1/1/2021. When the AMA released the changes [...]
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Posting Date: 11/30/2020
Don’t Forget the CMS-588 Electronic Funds Transfer Authorization Agreement
Don’t Forget the CMS-588 Electronic Funds Transfer Authorization Agreement The CMS-588 Electronic Funds Transfer Authorization Agreement is to be submitted for billing providers upon initial enrollment, change in bank information and [...]
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Posting Date: 03/20/2020
Social Security Income Ratios
Social Security Income Ratios Attention All Part A Inpatient Prospective Payment System Hospitals, Inpatient Rehabilitation Facilities and Long-Term Care Hospitals The federal fiscal year 2018 SSI ratios for IPPS hospitals, IRFs and LTCHs [...]
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Posting Date: 01/08/2020
New EDI Service Offering for the Part A/FQHC/HHH 276/277 Claim Status Inquiry and Response
New EDI Service Offering for the Part A/FQHC/HHH 276/277 Claim Status Inquiry and Response National Government Services is pleased to announce the availability of a ‘near’ real time response to claim status inquiries submitted to EDI with the [...]
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Posting Date: 11/30/2020
Don’t Forget the CMS-588 Electronic Funds Transfer Authorization Agreement
Don’t Forget the CMS-588 Electronic Funds Transfer Authorization Agreement The CMS-588 Electronic Funds Transfer Authorization Agreement is to be submitted for billing providers upon initial enrollment, change in bank information and during [...]
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Posting Date: 08/20/2020
Opioid Treatment Add-on Code G2078 and G2079 MUE Values
Opioid Treatment Add-on Code G2078 and G2079 MUE Values The July 2020 quarterly update for the NCCI added an MUE value of one for OTP HCPCS codes G2067-G2075 and G2078 and G2079. It was later determined by CMS that the incorrect MUE value was [...]
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Posting Date: 09/18/2020
October 2020 Release "Dark Days" for the Common Working File Hosts
October 2020 Release "Dark Days" for the Common Working File Hosts For the upcoming October 2020 Release: For Production, CWF will be observing dark days starting Friday, 10/2/2020 through Sunday, 10/4/2020 to accommodate the anticipated [...]
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Posting Date: 09/15/2020
October 2020 Fiscal Intermediary Standard System Direct Data Entry Screen Changes
October 2020 Fiscal Intermediary Standard System Direct Data Entry Screen Changes The DDE CWF Inquiry Screen (MAP175M) will display the ABPM and will include the technical and professional dates for HCPCS 93784. The MBI Eligibility FROM and [...]
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Posting Date: 06/24/2020
Registered Dietitians and COVID-19 Allowances for Billing
Registered Dietitians and COVID-19 Allowances for Billing National Government Services has received clarification from CMS in regard to registered dietitians/nutritionists billing. When CPT codes 98966‒98968 were originally opened to coverage [...]
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Posting Date: 05/07/2020
Radiopharmaceuticals Invoice or Acquisition Cost Submission Reminder
Radiopharmaceuticals Invoice or Acquisition Cost Submission Reminder National Government Services has identified situations where claims are being submitted for radiopharmaceuticals without an invoice or acquisition cost provided. For [...]
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Posting Date: 03/02/2020
Quality Innovation Networks - Quality Improvement Organizations Quality Initiatives
Quality Innovation Networks - Quality Improvement Organizations Quality Initiatives CMS leads a national health care quality improvement network of Quality Innovation Networks – Quality Improvement Organizations (QIN-QIOs). Locally, an [...]
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Posting Date: 08/28/2020
Providers' Obligation to Report and Refund Medicare Overpayments with Appropriate Forms
Providers' Obligation to Report and Refund Medicare Overpayments with Appropriate Forms Healthcare providers have an obligation to report and refund federal program overpayments and continue to do so, but National Government Services would [...]
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Posting Date: 10/07/2020
Provider Enrollment Reconsideration Request Reminders
Provider Enrollment Reconsideration Request Reminders National Government Services has been receiving reconsiderations of provider enrollment credentialing requests that do not fall into the appropriate criteria for reconsiderations due to the [...]
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Posting Date: 06/09/2020
Proper Billing for Telehealth Services Claims
Proper Billing for Telehealth Services Claims We have received a high volume of paper CMS-1500 claim forms for telehealth services with dates of service during the PHE that we have to reject because they are improperly coded with two different [...]
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Posting Date: 07/23/2020
Prior Authorization Request Reminders
Prior Authorization Request Reminders Effective for dates of service on or after 7/1/2020, a PAR is required for certain OPD services. For additional information on the Medicare Prior Authorization Program go to our website > log in to any [...]
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Posting Date: 06/04/2020
Prior Authorization Program Becomes Effective for Dates of Service on/after 7/1/2020
Prior Authorization Program Becomes Effective for Dates of Service on/after 7/1/2020 The CMS is implementing a prior authorization program for certain hospital outpatient department services effective for dates of service on or after 7/1/2020. [...]
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Posting Date: 01/16/2020
Reminder: Providers on Automatic Immediate Recoupments
Reminder: Providers on Automatic Immediate Recoupments If you are set up for automatic recoupments, please refrain from submitting checks and overpayment forms. Submitting receipts run the risk of money being offset and your check being [...]
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Posting Date: 12/17/2020
Physicians/Practitioners Medical Records Play a Vital Role in Ordering and Providing DMEPOS to Your Patients
Physicians/Practitioners: Medical Records Play a Vital Role in Ordering and Providing DMEPOS to Your Patients For any DMEPOS item to be covered by Medicare, the patient’s medical record must contain sufficient information about the patient’s [...]
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Posting Date: 06/09/2020
Update on Claims for COVID-19 Testing
Update on Claims for COVID-19 Testing As per CMS PHE guidelines, National Government Services is modifying internal claim editing to permit the following COVID-19-related procedure codes to process as potentially payable without ICD-10 [...]
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Posting Date: 12/14/2020
The CY 2021 MPFS Is Now Available
The CY 2021 MPFS Is Now Available The CY 2021 MPFS is now available. You can view the new fees using the Fee Schedule Lookup tool page on our website. Posted 12/14/2020
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Posting Date: 05/11/2020
Skin Substitutes and Wound Care Products Billing Reminder
Skin Substitutes and Wound Care Products Billing Reminder CMS provides pricing for some wound care products; however, there are many that do not have established pricing. If a skin substitute/wound care product does not have established [...]
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