Request a Due Date Extension

It may be necessary to request an extension for your cost report due date because of an extraordinary circumstance. An example of an extraordinary circumstance would be a flood or fire that forces a provider to cease operations and transfer [...]

MLN Connects® Newsletter: May 9, 2024

MLN Connects® Newsletter: May 9, 2024 News HHS Releases New Data Showing Over 10 million People with Medicare Received a Free Vaccine Because of the President’s Inflation Reduction Act; Releases Draft Guidance for the Second Cycle of [...]

Submission of a Medicare Cost Report Reopening Request

Submission of a Medicare Cost Report Reopening Request In accordance with CMS policy (42 Code of Federal Regulations 405.1885 and CMS IOM Publication 15-1, The Provider Reimbursement Manual, Section 2931), a provider may request a reopening of [...]

Hospice Certifying Physician Medicare Enrollment Information

Hospice Certifying Physician Medicare Enrollment Information Under CMS' current regulations, the hospice medical director or the physician member of the hospice interdisciplinary group (the “hospice physician”) and the attending physician (if [...]

Request an Accelerated Payment

Medicare Part A guidelines provide for accelerated payments under highly exceptional circumstances. Accelerated payment criteria and eligibility requirements are outlined in the CMS Paper-Based Manuals Publication 15-1, Medicare Provider [...]

Request an Interim Rate Adjustment

When requesting an interim rate adjustment, it's important to submit your interim financial data to National Government Services using the appropriate Interim Rate Review Documentation Request Form. These forms are designed to capture important [...]

Request an Interim Rate Adjustment

When requesting an interim rate adjustment, it's important to submit your interim financial data to National Government Services using the appropriate Interim Rate Review Documentation Request Form. These forms are designed to capture important [...]

CMS Medicare Administrative Contractor Information

CMS Medicare Administrative Contractor Information Note: Please do not include PHI such as Medicare numbers within emails. Navigation [Part A] [Part B] [DME MAC] [Federally Qualified Health Center] [Home [...]

Physicians: Are You Ordering Knee Orthosis for Your Patients?

Physicians: Are You Ordering Knee Orthosis for Your Patients? This is your opportunity to hear directly from the Medicare contractors regarding documentation required for the coverage criteria to be met. You’ll also learn how to help your [...]

Staying Up To Date on Vaccines

Staying Up To Date on Vaccines It's important to stay up to date on vaccines. Vaccines protect your patients from serious illness and can keep them out of the hospital. Talk with your patients about which vaccines may be right for them, many [...]

File an Amended Cost Report

Table of Contents File an Amended Cost Report Timeframe to Amend the Medicare Cost Report [Return to Top] File an Amended Cost Report A provider may elect to submit an amended cost report subsequent to the initial filing. The Centers [...]

File an Amended Cost Report

A provider may elect to submit an amended cost report subsequent to the initial filing. The CMS Medicare Paper-Based Manuals Publication 15-1, Provider Reimbursement Manual—Part I, Chapter 29 Section 2931.2A, allows the Medicare Administrative [...]

Prepare and Submit a Cost Report

Table of Contents Prepare and Submit a Cost Report Submit Cost Report Documentation MCReF Other Electronic Media Formats Electronic Filing Requirements and List of Vendors Approved XML IRIS Vendors Home [...]

Contacting Medicare

Contacting Medicare Medicare constituents (or People with Medicare) can have their Medicare questions answered by calling 1-800-MEDICARE (1-800-633-4227) 24-hours a day; 7-days a week. 1-800-MEDICARE users can speak to a live person either by [...]

Medicare’s Annual Wellness Visit in Minnesota: Understanding the Benefit and Preventing Denials

Medicare’s Annual Wellness Visit in Minnesota: Understanding the Benefit and Preventing Denials National Government Services Jurisdiction 6 MAC by Michael J. Dorris; Carolyn S. Henson, CPC , CAC, CACO, CPC-I, AAPC I-10 Instructor; and Nathan [...]

Billing & Claim Forms

Billing & Claim Forms Medicare Authorization to Disclose Medicare Information Use this form to advise Medicare of the person or persons you have chosen to have access to your personal health information. Patient's Request for Medical [...]

Claim Data Entry

Chapter V: Claims/Attachments Submenu (02) Claim Data Entry Purpose The Claims Entry options allows the provider to enter claims and roster bills electronically into the FISS DDE Provider Online System. To initiate claim data entry [...]

FQHC and Group Therapy Services Job Aid

FQHC and Group Therapy Services Job Aid Historically, federally qualified health center’s (FQHC’s) billing instructions have been the same. However, effective 1/1/2011, the billing requirements changed for this facility type. Beginning with [...]

Revenue Codes (13)

Chapter IV: Inquiries Submenu (01) Revenue Codes (13) Purpose The purpose of the REVENUE CODES option is to provide access to details related to the revenue codes available to be reported on a claim. A revenue code is a four-digit number [...]

Determine if Medicare Will Make Payment on an MSP Claim

Table of Contents Determine if Medicare Will Make Payment on an MSP Claim Step 1: Determine if Medicare will Make an MSP Payment Step 2: Determine the Amount of Secondary Benefits Billing Reminders Which Can Affect your Medicare [...]

Helpful Resources Change of Address Find & Compare Doctors, Plans, Hospitals, Suppliers, & Other Providers Beneficiary Fact Sheets for Medicare Coverage and Cost Medicare.gov Sign into Medicare.gov

Provider Based Determinations

Table of Contents Provider Based Determinations Processing of Provider-Based Determinations MAC Provider-Based Designation Checklist Related Content [Return to Top] Provider Based Determinations On 4/18/2003, CMS issued a Program [...]

FY 2025 Occ Mix Hospital Letter Final

FY 2025 Occ Mix Hospital Letter Final CY 2022 Medicare Occupational Mix Survey Submission Section 1886(d) (3) (E) of the Social Security Act requires CMS to collect data every three years on the occupational mix of employees for each [...]

Self-Administered Drug Exclusion

Self-Administered Drug Exclusion Medications that are self-administered more than 50% of the time for all Medicare beneficiaries are excluded from Medicare Part B coverage.  At the direction of CMS, each MAC shall create an article that [...]

Provider Enrollment: NGSMedicare.com Website Resources to Help Reduce Development on CMS-855A Application

Provider Enrollment: NGSMedicare.com Website Resources to Help Reduce Development on CMS-855A Application To reduce requests for additional information, National Government Services offers several provider enrollment topics, helpful tips and [...]

A/B DME MAC Collaborative Webinar: Nebulizers and Nebulizer Drugs

A/B DME MAC Collaborative Webinar: Nebulizers and Nebulizer Drugs Physicians/Practitioners! Are you Ordering Nebulizers and Nebulizer Drugs for your Patients? This is your opportunity to hear directly from the Medicare contractors regarding [...]

Helpful Resources Change of Address Find & Compare Doctors, Plans, Hospitals, Suppliers, & Other Providers Beneficiary Fact Sheets for Medicare Coverage and Cost Medicare & You Handbook Medicare.gov Sign into Medicare.gov

Helpful Resources Change of Address Find & Compare Doctors, Plans, Hospitals, Suppliers, & Other Providers Beneficiary Fact Sheets for Medicare Coverage and Cost Medicare & You Handbook Medicare.gov Sign into Medicare.gov

Helpful Resources Change of Address Find & Compare Doctors, Plans, Hospitals, Suppliers, & Other Providers Beneficiary Fact Sheets for Medicare Coverage and Cost Medicare & You Handbook Medicare.gov Sign into Medicare.gov

Helpful Resources Change of Address Find & Compare Doctors, Plans, Hospitals, Suppliers, & Other Providers Beneficiary Fact Sheets for Medicare Coverage and Cost Medicare & You Handbook Medicare.gov Sign into Medicare.gov

Medicare’s Annual Wellness Visit in Illinois: Understanding the Benefit and Preventing Denials

Medicare’s Annual Wellness Visit in Illinois: Understanding the Benefit and Preventing Denials National Government Services Jurisdiction 6 MAC by Michael J. Dorris; Carolyn S. Henson, CPC , CAC, CACO, CPC-I, AAPC I-10 Instructor; and Nathan [...]

Medicare’s Annual Wellness Visit in Wisconsin: Understanding the Benefit and Preventing Denials

Medicare’s Annual Wellness Visit in Wisconsin: Understanding the Benefit and Preventing Denials National Government Services Jurisdiction 6 MAC by Michael J. Dorris; Carolyn S. Henson, CPC , CAC, CACO, CPC-I, AAPC I-10 Instructor; and Nathan [...]

Billing Fascia Iliaca Blocks with 64999

Billing Fascia Iliaca Blocks with 64999 National Government Services is receiving information that does not provide the documentation necessary to process claims for Fascia Iliaca Blocks when billed with CPT 64999. Since this is an unlisted [...]

Registration Is Open for the Medicare Part B 2024 Spring/Summer Virtual Conference! Mastering Medicare: Tuesday Tutorials for Part B Providers

Registration is Open for the Medicare Part B 2024 Spring/Summer Virtual Conference! Mastering Medicare: Tuesday Tutorials for Part B Providers We’ve devoted Tuesdays in June to host a series of educational webinars focused on evaluation and [...]

MLN Connects® Newsletter: May 16, 2024

MLN Connects® Newsletter: May 16, 2024 News Administration Acts to Improve Access to Kidney Transplants DMEPOS: Updated List of Items Potentially Subject to Conditions of Payment Lymphedema Compression Treatment Items: New [...]

Provider Enrollment: NGSMedicare.com Website Resources to Help Reduce Development on CMS Enrollment Forms

Provider Enrollment: NGSMedicare.com Website Resources to Help Reduce Development on CMS Enrollment Forms To reduce requests for additional information, National Government Services offers several provider enrollment topics, helpful tips and [...]

Cost Report Submission Checklist

Upcoming Annual Logon ID Recertification

Upcoming Annual Logon ID Recertification Upcoming Annual Logon ID Recertification for Maine, Massachusetts, New Hampshire, Vermont, Rhode Island Regions Beginning the week of 5/6/2024, the Maine, Massachusetts, New Hampshire, Vermont, Rhode [...]

Upcoming Annual Logon ID Recertification

Upcoming Annual Logon ID Recertification Upcoming Annual Logon ID Recertification for Maine, Massachusetts, New Hampshire, Vermont, Rhode Island Regions Beginning the week of 05/06/2024, the Maine, Massachusetts, New Hampshire, Vermont, Rhode [...]

CHOPD Accelerated Payments to Providers

CHOPD Advance Payments to Providers

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today!

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today! We’ve dedicated Tuesdays for the month of June to deliver valuable educational topics that will help our provider [...]

CR13566 - Outlier Reconciliation and Cost-to-Charge Ratio (CCR) Updates for the Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS

CR13566 - Outlier Reconciliation and Cost-to-Charge Ratio (CCR) Updates for the Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Posted 5/16/2024

Accelerated Payments to Providers

Advance Payments to Providers

Disposable Negative Pressure Wound Therapy Services Under Home Health

Disposable Negative Pressure Wound Therapy Services Under Home Health Effective for services furnished on or after 1/1/2017, Medicare will make separate payment to HHAs for dNPWT services for patients under the home health benefit. NPWT [...]

Home Health Third Party Liability Demand Billing

Home Health Third Party Liability Demand Billing Table of Contents Background What is a Demand Bill? Requirements for Submission How to Submit a TPL Demand Bill Claim Page 1: Claim Page 2 – Covered and Noncovered Charges Claim [...]

Billing the Home Health Notice of Admission via DDE

Billing the Home Health Notice of Admission via DDE Table of Contents Billing the Home Health Notice of Admission via DDE NOA Claim Page 1 NOA Claim Page 4 Notes Patients Continuing Care in 2022 Related Content [Return to [...]

Home Health Transfers

Home Health Transfers Table of Contents Background What To Do As a Receiving HHA What To Do As the Initial HHA What To Do In Case of a Dispute Related Content [Return to Top] Background A home health transfer occurs when a [...]

Home Health Agency Transfer and Dispute Protocol

Home Health Agency Transfer and Dispute Protocol Specific protocol and steps must be followed prior to opening an admission period for a new patient. Step One: Verify the patient’s eligibility You must ensure the patient is not [...]

Billing Overlap/Dispute Resolution Process

Billing Overlap/Dispute Resolution Process Table of Contents Billing Overlap/Dispute Resolution Process Mailing Addresses and Fax Number JK: J6: General Inquiries JK: J6: [Return to Top] Billing Overlap/Dispute [...]

National Government Services: Raising Awareness About Care Management

National Government Services: Raising Awareness about Care Management According to the Center for Disease Control, six in ten adults in the U.S. have a chronic disease and four in ten adults have two or more. As your MAC for Jurisdiction 6 [...]

Filing an Electronic Notice of Change of Ownership (TOB 8XE)

Filing an Electronic Notice of Change of Ownership (TOB 8XE) The Notice of Change of Ownership (TOB 8XE) is submitted when the hospice has a change of ownership that results in a change of the PTAN. Please refer to the Hospice Change of [...]

Filing an Electronic Notice of Transfer (Type of Bill 8XC)

Filing an Electronic Notice of Transfer (Type of Bill 8XC) Table of Contents Filing an Electronic Notice of Transfer (Type of Bill 8XC) Correcting the Transfer Date on a Previous Submitted Notice of Transfer Related Content [Return to [...]

Hospice Quality Reporting Program

Hospice Quality Reporting Program Along with the other MACs, National Government Services has received several requests from new hospice providers, as well as national and state hospice associations, regarding training and assistance for [...]

Filing an Electronic Notice of Election (Type of Bill 8XA)

Filing an Electronic Notice of Election (Type of Bill 8XA) The NOE, TOB 8XA, is submitted when the hospice receives a signed election statement from the beneficiary acknowledging that he/she wishes to enroll in the Medicare hospice benefit. [...]

Value-Based Insurance Design Model Hospice Benefit Component Overview

Value-Based Insurance Design Model Hospice Benefit Component Overview Beginning on 1/1/2021, CMS is testing the inclusion of the Part A Hospice Benefit within the MA benefits package through the Hospice Benefit Component of the VBID Model. [...]

Avoiding Reason Code 38200

Avoiding Reason Code 38200 Claims are rejected with reason code 38200 when the FISS finds a previously submitted billing transaction that is a duplicate of the recently submitted billing transaction where all of the following fields on the [...]

Billing the Home Health Period of Care Claim - PDGM

Billing the Home Health Period of Care Claim – PDGM Table of Contents Billing the Home Health Period of Care Claim – PDGM Claim Page 1: Claim Page 2: Claim Page 3 Claim Page 4 Claim Page 5 Related Resources [Return to Top] [...]