CO-119

Avoiding/Correcting This Error The beneficiary has reached their therapy cap limit for the year. The Bipartisan Budget Act of 2018 repealed application of the Medicare outpatient therapy caps but retains the former cap amounts as a threshold [...]

Federally Qualified Health Center

Federally Qualified Health Center Table of Contents Counseling to Prevent Tobacco Use Diagnosis Coding Billing FQHC for Smoking and Tobacco Cessation Services Related Content [Return to Top] Counseling to Prevent Tobacco [...]

What is the requirements for diagnostic injections? Are two required?

What is the time period between a therapeutic injection and repeat diagnostic, if the therapeutic injection has not been performed for an extended period? At this point, does diagnostic need to be repeated?

What is the time period between a therapeutic injection and repeat diagnostic? If the therapeutic injection has not been performed for an extended period of time does diagnostic need to be repeated?

What should be done if patient does not want to continue conservative treatment?

When does a pain scale or functional assessment need to be done?

When will this go into effect?

Will RFA be an acceptable treatment?

Will prior authorization be required?

Will there be a minimal amount of time between SI joint steroid injections?

Can a mass immunizer combine pneumococcal with other vaccines on one roster bill?

Does Medicare pay for counseling and education of the pneumococcal vaccine?

If I administer two different vaccinations during the same visit, e.g., influenza and pneumococcal, can I bill for two separate administrations?

Is an order required to administer the pneumococcal vaccine?

Is the pneumococcal vaccine subject to coinsurance and deductible?

What are the allowance limits for the cost of the pneumococcal vaccine?

What is the administration code for the pneumococcal vaccine?

What is the frequency requirement for the pneumococcal vaccine?

CMS-855I: How do I complete a reassignment?

CMS-855I: Who needs to sign the CMS-855I for a reassignment?

APPLICATION STATUS: Where can I find the status of a submitted application?

APPLICATION FEE: Who needs to pay an application fee?

APPLICATION FEE: What is the amount of the application fee?

PECOS: I received an email to sign an application; how do I do this?

PECOS: In PECOS, how do I know if the authorized/delegated official or individual provider signed the application?

PECOS: In PECOS, how do I know what enrollment information Medicare currently has on file for a provider or supplier?

PECOS: In PECOS, how do I submit an application?

PECOS: In PECOS, how do you find an enrollment to submit an application?

PECOS: In PECOS, please advise how to respond when the MAC needs additional information or supporting documentation for submitted application.

REVALIDATION: Do I need to revalidate if it has not been five years since my last revalidation?

REVALIDATION: How do I know I need to revalidate?

REVALIDATION: Where is the revalidation notification letter sent?

SIGNATURES: Who signs the CMS applications and forms for an entity? (ex. 855A, 855B, 20134, 460, 588)

SIGNATURES: Who signs the CMS-855I application?

APPROVAL RECOMMENDATION STATUS: The status of my application is approval recommendation, how can I verify if the state agency or CMS has completed their process?

APPROVAL RECOMMENDATION STATUS: Whom can I contact for questions about an application in approval recommendation status?

Local Coverage Determination Retirement

Local Coverage Determination Retirement An LCD is a policy decision made by a MAC concerning whether to allow coverage of a particular item or service. The Centers for Medicare & Medicaid Services, Internet-Only Manual Publication 100-08, [...]

10/14/2024

table, td, th table { border-collapse: collapse; width: 50%; } Self-Service Pulse: What You Need To Know This Week As your MAC, National Government Services wants to provide you with a comprehensive source containing the most [...]

Utilizing Modifiers for Medicare Part B Dental Services

The purpose of this webinar is to discuss the modifiers that are currently allowed to be appended to inextricably linked dental services. We’ll also review the correct placement and billing guidelines for these modifiers when submitting [...]

DETERMINATION LETTER: Where are the determination (approval/denial) letters sent?

DETERMINATION LETTER: Where are the determination (approval/denial) letters sent?

Lab National Coverage Determinations (NCDs) Alphabetical Index

PECOS: Manage Signatures and Additional Information Requests

During this webinar, we’ll give direction for the Provider Enrollment, Chain and Ownership System (PECOS) application on understanding how to manage signatures and respond to additional information request from submitted applications.

Medicare Part B Top Claim Denials

During this webinar, we’ll review the current top ten claim denials which are identified by internal claim data and provide guidance for correcting them, and solutions to prevent them from occurring on future claims. There will be time for your [...]

Pneumococcal Vaccine and Administration

Preventive Services Guide Pneumococcal Vaccine and Administration Pneumonia affects approximately 450 million people globally (seven percent of the population) and results in about four million deaths per year. Pneumonia was regarded by [...]

Vaccinations

Vaccinations Part B Medicare provides coverage for specific vaccination types: Seasonal Influenza Virus Pneumococcal Hepatitis B COVID-19 Vaccines and Administration [Return to Top] Seasonal Influenza Virus Annual Influenza Vaccine [...]

Assistants at Surgery at Teaching Hospitals

Assistants at Surgery at Teaching Hospitals CMS instructs providers to use specific modifiers on claims representing assistance during a surgical procedure: Modifier 80 denotes service by an assistant surgeon Modifier 82 denotes service by [...]

Bundled Services Missing Appropriate Modifiers at Time of Initial Claim Submission

Bundled Services Missing Appropriate Modifiers at Time of Initial Claim Submission Accurate coding and reporting of services are critical aspects of proper billing. Services denied based on the NCCI code pair edits or MUEs may not be billed to [...]

Clarification for Billing Services on Fingers and Toes Using Modifiers F1-F9, FA, T1-T9 and TA vs. Modifier 50

Clarification for Billing Services on Fingers and Toes Using Modifiers F1-F9, FA, T1-T9 and TA vs. Modifier 50 National Government Services has identified some providers who have been billing for services on the fingers and/or the toes with [...]

Modifier 25

Modifier 25 National Government Services has identified problems common with claims submitted for evaluation and management (E/M) services where modifier 25 was appended. This article is designed to provide education regarding the correct [...]

Modifier 33

Modifier 33 Table of Contents Preventive Services Anesthesia Services Moderate Sedation Related Content [Return to Top] Preventive Services When the primary purpose of the service is the delivery of an evidence-based service in [...]

COVID-19

COVID-19 The 2019 Novel Coronavirus (COVID-19) was declared a PHE on 3/13/2020 and it was officially expired on 5/11/2023. Please visit CMS' Current emergencies web page for complete details on the PHE. Email Updates To keep you informed [...]

COVID-19 Vaccine and Monoclonal Antibody

COVID-19 Vaccine and Monoclonal Antibody With the end of the PHE, as of 5/11/2023, this information no longer applies. We will keep the information available for PHE-related services that occurred prior to the expiration date that have not yet [...]

Medicare Part A and B Billing for the COVID-19 Vaccine and Monoclonal Antibody

Medicare Part A and B Billing for the COVID-19 Vaccine and Monoclonal Antibody Table of Contents Medicare Part A and B Billing for the COVID-19 Vaccine and Monoclonal Antibody Roster Billing How to Submit a Centralized Bill Medicare [...]

Medicare Coverage of Over-the-Counter COVID-19 Tests

Medicare Coverage of Over-the-Counter COVID-19 Tests The OTC COVID-19 test demonstration ended on 5/11/2023. Starting on 5/12/2023, Medicare no longer covers or pays for OTC COVID-19 tests for those with Medicare Part B benefits. Beginning [...]

Electronic Data Interchange

Medicare Part B 101 Manual Electronic Data Interchange Table of Contents Electronic Data Interchange Transactions Benefits of Submitting Electronically Becoming an Electronic Submitter PC-ACE EDI: Beyond Claims and Extra Features [...]