Home Health Diagnosis Codes Grouper Update for 4/1/2023

Home Health Diagnosis Codes Grouper Update for 4/1/2023 Effective 4/1/2023, CMS is implementing new HH Grouper edits. The HH Grouper program has various data validity edits that make sure it uses consistent and accurate data when calculating [...]

Clarification on the Proper Use of the CS Modifier

Clarification on the Proper Use of the CS Modifier Per MLN Matters® article SE20011, the CS modifier (cost-sharing waiver for COVID-19 testing) is applicable to certain services furnished beginning on 3/18/2020 through the end of the PHE, [...]

New Fiscal Intermediary Shared System Consistency Edit to Validate Attending Physician National Provider Identifier

New Fiscal Intermediary Shared System Consistency Edit to Validate Attending Physician National Provider Identifier Effective 4/1/2023, CMS implemented a new consistency edit to validate that the attending physician NPI. An Attending Provider [...]

The Advance Beneficiary Notice of Noncoverage

The Advance Beneficiary Notice of Noncoverage We’ve updated our Advance Beneficiary Notice of Noncoverage article to include examples for using an ABN for outpatient therapy and using the KX and GA modifiers appropriately. We encourage you to [...]

MLN Connects® Newsletter: April 13, 2023

MLN Connects® Newsletter:  April 13, 2023 News COVID-19: End of Public Health Emergency CMS Roundup (Apr. 07, 2023) Medicare Shared Savings Program: Application Toolkit Materials Inpatient Rehabilitation Facility [...]

Top Tobacco Counseling Claim Denials and How to Avoid/Correct Them

Top Tobacco Counseling Claim Denials and How to Avoid/Correct Them Providers, are your claims being denied for tobacco counseling services utilizing codes 99406 and 99407? In order to assist our providers in getting claims processed [...]

CR13105 - Technical Revisions Only to the National Coverage Determination (NCD) Manual

CR13105 - Technical Revisions Only to the National Coverage Determination (NCD) Manual

Telehealth Frequently Asked Questions are Updated

Telehealth Frequently Asked Questions are Updated We’ve updated our telehealth frequently asked questions to include changes and flexibilities due to the end of the PHE on 5/11/2023. Please view these FAQs for the answers you need to common [...]

Providers Using NGSConnex to Submit Appeals and Supporting Documentation

Providers Using NGSConnex to Submit Appeals and Supporting Documentation We strongly recommend our providers use NGSConnex to submit your redetermination requests and any supporting documentation. Please be aware that if you do not submit [...]

Medicare University Continuing to Experience Intermittent Issues

Medicare University Continuing to Experience Intermittent Issues We are continuing to experience intermittent outages with Medicare University. You do not need to report these issues with Medicare University to our Provider Contact Center. We [...]

MLN Connects® Newsletter: April 20, 2023

MLN Connects® Newsletter:  April 20, 2023 News Billing Medicare Part B for Insulin with New Limits on Patient Monthly Coinsurance Medical Review & Compliance: Respond to Additional Documentation Requests Hospice: [...]

Hot Topics

Medicare Important Hot Topics Medicare and Coronavirus Medicare and Coronavirus – How to stay up-to-date! Medicare Beneficiary Fact Sheets Beneficiary Fact Sheets for Medicare Cost and Coverage Medicare Coverage Database The MCD [...]

Introduction

Introduction The Congressional Affairs Outreach team at National Government Services, Inc. and our partners are committed to ensuring that congressional offices receive a timely response to all inquiries. For your convenience, National [...]

LCD, Billing and Coding Article Updates for April and May 2023

LCD, Billing and Coding Article Updates for April and May 2023 Billing and Coding Article (A56937): Psychiatry and Psychology Services Removed sentence from article text section - “For psychotherapy sessions lasting 90 minutes or longer, the [...]

Medicare Secondary Payer

Medicare Secondary Payer CMS transitioned COB activities for GHP and non-GHPs from the COBC and Non-GHP recovery functions from the BCRC to the new Medicare Secondary Payer Contractor. There will be no change to any of the COB processes under [...]

Congressional Offices

Congressional Offices Home Communications Hot Topics MAC Directory Contacts Resources

Fraud Awareness Week and National Rural Health Day

Fraud Awareness Week and National Rural Health Day Since this week is Fraud Awareness Week and National Rural Health Day is tomorrow on 11/16/2023, we wanted to share these valuable resources with you. Fraud Awareness Week Traditional [...]

MLN Connects Newsletter: Take Our Provider Survey Today - November 15, 2023

MLN Connects® Newsletter: Take Our Provider Survey Today - November 15, 2023 You helped us before, and we want to learn more about your information needs. CMS is conducting a study to help us improve your experience with the Medicare [...]

Submit a Reconsideration

Submit a Reconsideration The second level of appeal is the reconsideration and is carried out by the QIC. Time limit to initiate = 180 days from date of receipt of redetermination decision Time limit to complete the review = 60 days [...]

MLN Connects® Newsletter: November 16, 2023

MLN Connects® Newsletter: November 16, 2023 News Unprecedented Efforts to Increase Transparency of Nursing Home Ownership Hospital Price Transparency: Use Required CMS Template Layout to Encode Hospital Standard Charge Information [...]

Behavioral Health Integration

Behavioral Health Integration Table of Contents Behavioral Health Integration General Behavioral Health Integration Eligible conditions Service Components Billing Codes Frequently Asked Questions Related Content [Return [...]

Vein Ablation Best Practices

Vein Ablation Best Practices Table of Contents Vein Ablation Best Practices Documentation requirements: Best Practice/Documentation Feedback/Tips and Help Billing/Coding Alerts Related Content [Return to Top] Vein [...]

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 [...]

LCD and Billing and Coding Article Updates for November/December 2023

LCD and Billing and Coding Article Updates for November/December 2023 LCDs Effective 12/24/2023 Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound  (L39139/A58893) This is a [...]

Knowing Where to Look for EDI Enrollment Packet Data

Knowing Where to Look for EDI Enrollment Packet Data Periodically, EDI Enrollment will be publishing articles to help eliminate the number of EDI applications that are denied. Signature is Incorrect: All EDI documents require that the person [...]

Provider Enrollment Application Fee Amount for CY 2024

Provider Enrollment Application Fee Amount for CY 2024 The provider enrollment application fee for calendar year 2024 is $709. For more information, view CMS’ MLN Connects® Newsletter, Wednesday, November 22, 2023. Posted 12/21/2023

New A/B and DME Collaborative YouTube Video

New A/B and DME Collaborative YouTube Video The A/B DME MACs are offering a YouTube video on Therapeutic Shoes for Persons with Diabetes. This video provides guidance on coverage criteria, documentation requirements, certifying physicians and [...]

MLN Connects® Newsletter: December 21, 2023

MLN Connects® Newsletter: December 21, 2023 News CMS Roundup (Dec 15, 2023) Opioid Use Disorder Screenings & Treatment: Medicare Pays for Services Opioid Treatment Programs: New Information for 2024 Skilled Nursing Facility [...]