Reminder: Medicare Part B Providers Receiving Hardcopy Standard Paper Remittances – Moving to Biweekly Mailing Schedule

Reminder: Medicare Part B Providers Receiving Hardcopy Standard Paper Remittances – Moving to Biweekly Mailing Schedule Beginning 8/9/2019, we will change from a weekly to biweekly mailing schedule for Part B hard copy SPR. The only exception [...]

MLN Connects® Special Edition - Friday, August 2, 2019

MLN Connects® Special Edition - Friday, August 2, 2019 IPPS/LTCH: FY 2020 PPS Final Rule IRF: FY 2020 Payment and Policy Changes Hospice: FY 2020 Hospice Payment Rate Final Rule IPPS/LTCH: FY 2020 PPS Final Rule On August 2, CMS [...]

August is National Immunization Awareness Month

August is National Immunization Awareness Month This annual health observance is a great opportunity to educate seniors and other Medicare beneficiaries about the importance of disease control and prevention through immunization. [...]

MLN Connects® for Thursday, August 1, 2019

MLN Connects® for Thursday, August 1, 2019 Protect Your Patients’ Identities: Use the MBI Now MLN Connects® for Thursday, August 1, 2019 View this edition as a PDF News SNF: FY 2020 Payment and Policy Changes IPF: FY 2020 [...]

MLN Connects® Special Edition - Monday, July 29, 2019

MLN Connects® Special Edition - Monday, July 29, 2019 Medicare and ASC Payment System CY 2020 Proposed Rule ESRD and DMEPOS CY 2020 Proposed Rule PFS: Proposed Policy, Payment, and Quality Provisions Changes for CY 2020 On July 29, [...]

MLN Connects® for Thursday, July 25, 2019

MLN Connects® for Thursday, July 25, 2019 Questions about Using the MBI? MLN Connects® for Thursday, July 25, 2019 View this edition as a PDF News New Medicare Card: Questions about Using the MBI? 2020 QRDA III Implementation Guide, [...]

Targeted Probe and Educate Letters – An Informational Overview

Targeted Probe and Educate Letters – An Informational Overview As part of our contractual obligation with the CMS, NGS, your Jurisdiction 6 or K MAC performs TPE to analyze provider compliance with CMS regulatory requirements. The TPE review [...]

Health and Human Services Office of Inspector General Telehealth and Potential Fraud

Health and Human Services Office of Inspector General Telehealth and Potential Fraud The DHHS, of whom the CMS reports to, published a brief last week from the OIG regarding telehealth and the PHE expansion of services. The article addresses [...]

Understanding your Remittance Advice for Merit-Based Incentive Payment System Adjustments

Understanding your Remittance Advice for Merit-Based Incentive Payment System Adjustments National Government Services has seen an increase in invalid overpayment requests related to the MIPS program. MIPS is part of the QPP that determines [...]

MLN Connects® Special Edition for Thursday, February 3, 2022

MLN Connects® Special Edition for Thursday, February 3, 2022 Biden-Harris Administration Will Cover Free Over-the-Counter COVID-19 Tests Through Medicare CMS Developing Initiative to Enable Access to Eight Free Over-the-Counter COVID-19 Tests [...]

Provider Enrollment Authorization and Accreditation

​​​​​​​Provider Enrollment Authorization and Accreditation Provider Enrollment added articles State License and Registrations for Certified Providers and Suppliers and Certified Provider and State Survey Agency for reminders, clarification and [...]

Top Claim Errors

Top Claim Errors Did you know we publish the top claim errors on our website? This information provides you with: the error reason code; a description of the error; the error type; details that include steps you can take to [...]

Jurisdiction 6 State Licensing and Certification Websites

Jurisdiction K State Licensing and Certification Websites

Jurisdiction 6 State Licensing and Certification Websites

Jurisdiction K State Licensing and Certification Websites

Provider Enrollment: Obtaining and Verifying State License

Provider Enrollment: Obtaining and Verifying State License Providers must contact their State agency when initially enrolling or making a change to a current Medicare enrollment for certification materials for their provider/supplier type. For [...]

Certified Provider and State Survey Agency

Certified Provider and State Survey Agency

MLN Connects® Newsletter for Thursday, August 4, 2022

MLN Connects® Newsletter for Thursday, August 4, 2022 ICD-10-CM Code Files: Fiscal Year 2023 News Hospices: Volunteer to Test Hospice Outcomes & Patient Evaluation Instrument Immunization: Protect Your Patients Claims, Pricers, [...]

Modifier 52 Claim Submission Billing Reminder

Modifier 52 Claim Submission Billing Reminder National Government Services found that on many occasions, providers are billing for reduced services with modifier 52 appended to the CPT code; however, they are billing the regular charged amount [...]

Comprehensive Error Rate Testing Redetermination Deadline 9/27/2022

Comprehensive Error Rate Testing Redetermination Deadline 9/27/2022 The CERT RY 2022 is quickly coming to an end. The deadline for redetermination completion is 9/27/2022 to be considered for the CERT RY. National Government Services requests [...]

Comprehensive Error Rate Testing Documentation Deadline 8/22/2022

Comprehensive Error Rate Testing Documentation Deadline 8/22/2022 The CERT RY 2022 is quickly coming to an end. In order to give sufficient time for the CERT RC to complete the review of your claims, all documentation and additional [...]

October 2022 Release "Dark Days" for the Common Working File Hosts

October 2022 Release "Dark Days" for the Common Working File Hosts For the upcoming October 2022 Release: For Production, CWF will be observing the Gray Day on Thursday, September 29th and Dark Days starting Friday, September 30th through [...]

MLN Connects® Newsletter for Thursday, August 11, 2022

MLN Connects® Newsletter for Thursday, August 11, 2022 Monkeypox & Smallpox Vaccines: New Product Codes News Monkeypox & Smallpox Vaccines: New Product Codes Payment Allowance Update for COVID-19 Monoclonal Antibody Therapy [...]

Outpatient Department Prior Authorization UTN Alert

Each UTN is Valid for One-Time Use The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient department procedures: Panniculectomy, Rhinoplasty, Vein Ablation, Blepharoplasty [...]

Outpatient Department Prior Authorization Type of Bill Alert

Providers Who Submit a Type of Bill 13X Are Required to Submit a Prior Authorization Request for the OPD PA Services The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient [...]

UTN Alert: Implanted Spinal Neurostimulator Trial and Permanent UTN

UTN Alert: Implanted Spinal Neurostimulator Trial and Permanent UTN The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient department procedures: Panniculectomy, [...]

Type of Bill Code is a Requirement for All Prior Authorization Requests

Type of Bill Code is a Requirement for All Prior Authorization Requests The National Government Services PA Department has seen an increase in cases that are submitted without a TOB code. PA staff conducts outreach to obtain this code; [...]

Outpatient Department Prior Authorization Implanted Spinal Neurostimulators Alert

Outpatient Department Prior Authorization Implanted Spinal Neurostimulators Alert Implanted Spinal Neurostimulator Prior Authorization National Government Services Medical Review initiated a prior authorization review outpatient department [...]

MLN Connects® Newsletter: September 14, 2023

MLN Connects® Newsletter: September 14, 2023     News Inflation Reduction Act Continues to Lower Out-of-Pocket Prescription Drug Costs for Drugs with Price Increases Above Inflation CMS Roundup (Sept 8, 2023) New Provider [...]

Billing for Originating Site

Billing for Originating Site Originating Site An originating site is the location of an eligible Medicare beneficiary at the time the telehealth services is being furnished via a telecommunications system. Medicare beneficiaries are eligible [...]

Distant Site

Distant Site The term “distant site” means the site where the physician or practitioner providing the professional service is located at the time the service is provided via a telecommunications system. Medicare distant site practitioners who [...]

General Information

General InformationTelehealth services require use of an interactive audio and video telecommunications system that permits real-time communication between the provider at the distant site and the Medicare beneficiary at the originating [...]

Originating Site

Originating Site An originating site is the location of an eligible Medicare beneficiary at the time the telehealth services is being furnished via a telecommunications system. Medicare beneficiaries are eligible for telehealth services only [...]

Facility Fee for Originating Site

Facility Fee for Originating Site The originating site facility fee is a separately billable Part B payment. The payment amount to the originating site is the lesser of 80 percent of the actual charge or 80 percent of the originating site [...]

Billing and Payment for Distant Site Professional Fee

Billing and Payment for Distant Site Professional Fee Claims for distant site telehealth services are submitted to the Part B MAC that processes claims for the performing physician/practitioner’s service area. Physicians/practitioners submit [...]

List of Covered Medicare Telehealth Services

List of Covered Medicare Telehealth Services Several conditions must be met for Medicare to make payments for telehealth services under the Physician Fee Schedule. The service must be on the list of Medicare telehealth services and meet [...]

G0 Modifier Required for Telehealth for Individuals with Acute Stroke

G0 Modifier Required for Telehealth for Individuals with Acute Stroke Effective for claims with dates of service on and after 1/1/2019, Medicare will accept HCPCS modifier G0 to identify telehealth services furnished for purposes of diagnosis, [...]

GT Modifier

GT Modifier Effective 10/01/2018, the GT modifier (via interactive audio and video telecommunications systems) is only required on institutional claims for distant site services billed under CAH Method II (claim type 085X). The GT modifier is [...]

Clarification of Telehealth for DSMT

Clarification of Telehealth for DSMT Individual and group DSMT services may be paid as a Medicare telehealth service. Effective for claims with dates of service on and after 1/1/2019, Medicare allows all ten hours of the initial DSMT training [...]

ESRD-Related Services as a Telehealth Service

ESRD-Related Services as a Telehealth Service Effective for DOS on/after 1/1/2019, renal dialysis facilities and the homes of ESRD beneficiaries receiving home dialysis may be originating sites and will not apply originating site geographic [...]

Ambulatory Surgical Center Pass-Through Devices

Ambulatory Surgical Center Pass-Through Devices What is a Pass-Through Device? Pass-through status is determined for newly FDA-approved drug and device products on an individual basis. Drugs and devices qualifying for pass-through status [...]

MLN Connects® Newsletter: COVID-19: Updated mRNA Vaccines for Patients 6 Months & Older – September 14, 2023

MLN Connects® Newsletter: COVID-19: Updated mRNA Vaccines for Patients 6 Months & Older – September 14, 2023     News COVID-19: Updated mRNA Vaccines for Patients 6 Months & Older Posted 9/14/2023

New YouTube Video: Surgical Dressings and Supplies: Part A/B and DME Collaborative Presentation

New YouTube Video: Surgical Dressings and Supplies: Part A/B and DME Collaborative Presentation The Part A/B and DME MACs are offering a YouTube video on Surgical Dressings and Supplies. This video offers information on the coverage criteria [...]

Interested in Becoming a Home Health or Hospice Provider Outreach and Education Advisory Group Member?

Interested in Becoming a Home Health or Hospice Provider Outreach and Education Advisory Group Member? Are you someone who would be interested in helping shape the education provided by your MAC? We want to hear from you! Join us to [...]

Don’t Let Your Flu Vaccination Claims Deny!

Don’t Let Your Flu Vaccination Claims Deny! The 2023-2024 flu vaccine season has begun. At the beginning of each flu season, National Government Services sees an increase in claim denial volume for flu vaccinations. This notice is being [...]

Save the Dates! National Government Services Fall 2023 Virtual Conference for Part B Providers

Save the Dates! National Government Services Fall 2023 Virtual Conference for Part B Providers Understanding Medicare Compliance 11/6/2023-11/8/2023 We’re excited to announce our Medicare Part B 2023 Fall Virtual Conference! This three-day [...]

Attention all OPPS Providers: Provider-Based Department Edits Being Implemented on/after 8/1/2023

Attention All OPPS Providers: Provider-Based Department Table of Contents Edits Being Implemented on/after 8/1/2023 Reason Code 34977: Practice address issue Reason Code 34978: PO and/or PN modifier missing Reason Code 34984: ER [...]

URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations

URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations Table of Contents Urgent: Provider Compliance Required Effective 8/1/2023 Requirements Claim Filing Requirements Final Reminders Related Content [Return to [...]

ESRD Facilities: Clarification for Providing Dialysis Services to Patients Acute Kidney Injury

ESRD Facilities: Clarifications for Providing Dialysis Services to Patients Acute Kidney Injury Effective 1/1/2017. ESRD facilities (hospital-based and freestanding) may furnish renal dialysis services to beneficiaries with AKI (both adult and [...]

JK: Medicare Paid Hospital Providers Twice for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient IPPS Hospital Stays

Medicare Paid Hospital Providers Twice for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient IPPS Hospital Stays Table of Contents Provider Action Payment Window Policy and Under Arrangement Policy [...]

Professional Services During a Patient Hospice Election

Professional Services during a Patient Hospice Election Table of Contents Article Overview Hospice Election Medicare Payment During Hospice Election Determining the Correct Entity to Bill Separately Payable Part B Services Hospice and [...]

Direct Data Entry Users May Need to Adjust Screen Size

Direct Data Entry Users May Need to Adjust Screen Size CMS recently issued Change Request 13138 “Implementation to Expand Monetary Amount Fields Related to Billing and Payment to Accommodate 10-Digits in Length ($99,999,999.99) - Phase 1”. [...]

Drugs and Biologicals - Coverage and Billing

Drugs and Biologicals – Coverage and Billing Medicare Part B will provide coverage for drugs that are furnished “incident to” a physician’s service. Coverage applies to drugs are not usually self-administered by the patients who take them. In [...]

Outpatient Therapy Functional Reporting

Outpatient Therapy Functional Reporting Table of Contents Outpatient Therapy Functional Reporting Reporting Episode - similar to the therapy episode of care Required Functional Reporting Discharge Reporting Unique Functional Reporting [...]

Home Health Referrals

Home Health Referrals The certifying physician or allowed nonphysician practitioner, and/or the acute/post-acute care facility referring the patient for home care must ensure that the medical record justifies the referral for Medicare home [...]

Modifier CS and COVID-19 Billing

Modifier CS and COVID-19 Billing How should the CS modifier, which removes application of beneficiary cost-sharing (deductible and co-payment), be applied to telehealth services and/or E/M visits? The CS modifier should be applied for certain [...]

MLN Connects® Newsletter: September 21, 2023

MLN Connects® Newsletter: September 21, 2023     News CMS Announces Resources and Flexibilities to Assist with the Public Health Emergency in the State of Georgia Organ Transplantation Affinity Group: Strengthening [...]

Telehealth Services