Standard Companion Guide Health Care Claim: Dental (837D)

NGS Medical Review Process

NGS Medical Review Process Medicare contractors, like National Government Services, operate the medical review program to prevent improper payments and protect the Medicare Trust Fund. Medical reviews involve the collection and clinical review [...]

How to Prevent Common Skilled Nursing Facility Denials

How to Prevent Common Skilled Nursing Facility Denials This article was developed to increase awareness and educate SNFs on the top errors found by our Medical Review team. The information below includes suggestions to ensure documentation [...]

ADR Documentation List by Reason Code

The Exemption Process: Additional Documentation Request Suggested list of documentation for all services to submit to National Government Services Note: Please remember, this is not an all-inclusive list Blepharoplasty, Eyelid Surgery, Brow [...]

Exemption Process

Exemption Table of Contents Exemption Exemption Database Updates to the Exemption Process Annual Cycle Starting January 1 Quick Overview Detailed Overview Ten Claim Sample ADRs Prior Authorization Reminder Related Content [...]

People with Medicare

Welcome! Please note that the Medicare website at https://www.medicare.gov is the official U.S. government site for the Medicare Program and your primary source for Medicare information. However, National Government Services also includes links [...]

Medicare Plan Choices

Medicare Plan Choices Your Medicare Health Plan Options Medicare Part D (Prescription Drug Coverage) Medigap Rates and Insurers Find your states’ Department of Insurance What's Medicare Supplement (Medigap) Insurance?

Reporting Home Health Periods with No Skilled Visits

Reporting Home Health Periods with No Skilled Visits Eligibility for the Medicare HH benefit requires that the beneficiary have a need for intermittent skilled nursing care, PT, SLP, or a continuing need for OT. The need for skilled care makes [...]

Common Working File (CWF) Host Dark Days for July 2024 Release

Common Working File (CWF) Host Dark Days for July 2024 Release For the upcoming July 2024 Release: For Production, CWF will be observing the Gray Day on Thursday, 6/27/2024 and Dark Days starting Friday, 6/28/2024 through Sunday, 6/30/2024 to [...]

Enrolling in Medicare

Enrolling in Medicare To be eligible to bill and receive direct payment for professional services under Medicare Part B, the medical professional and dentist must be enrolled in Medicare and meet all other requirements for billing under the [...]

Dental Services

Dental Services If you're a new or seasoned provider billing dental services to Fee-for-Service Medicare or Original Medicare, this article guides you through recently clarified payment provisions for dental services in 2023, the provider [...]

New Medicare Provider

New Medicare Provider To assist you in understanding the Medicare Program, visit our New Provider Center and review our Medicare Part B 101 Manual; which will provide you with an overview and additional resources. The Part B Provider Outreach [...]

Inpatient Services in Connection With Dental Procedures

Inpatient Services in Connection With Dental Procedures When a patient is an inpatient of a hospital for a dental procedure and the dentist's service is covered under Part B, the inpatient hospital services furnished are covered under Part [...]

Modifier GY

Modifier GY Providers should be aware of the guidelines for submitting the noncovered outpatient dental service for a denial when the patient has supplemental insurance or if a denial is needed for any other reason. Modifier GY is reported [...]

Attention Clearinghouses and Vendors!

Attention Clearinghouses and Vendors! National Government Services is ready to accept Medicare Part B dental claims from your dental providers using the 837D dental claim transaction. Dental providers have the following options for submission [...]

Opt Out Search

Opt Out Search Doctors/practitioners included in the opt out database are those who have elected to “opt out” of the Medicare Program and enter into private contracts with Medicare beneficiaries if specific requirements are met. By “opting [...]

Physicians or Practitioners Eligible to Enter Into Private Contracts

Physicians or Practitioners Eligible to Enter into Private Contracts Eligible physicians and practitioners Physicians Physician assistants Nurse practitioners Clinical nurse specialists Certified registered nurse anesthetists Certified [...]

Skilled Nursing Facility Town Hall Question and Answers

Skilled Nursing Facility Town Hall Questions and Answers Are daily notes required for skilled rehabilitation? Answer: Daily notes for rehabilitation are not required, however, they do support that therapy performed was skilled and [...]

Skilled Nursing Facility Educational Center

Skilled Nursing Facility Educational Center As part of the effort to lower the SNF improper payment rate, CMS has initiated a five claim Skilled Nursing Facility Probe & Educate allowing for outreach to all Medicare billing SNFs in the [...]

Coverage Requirements

Coverage Requirements Eligibility, preadmission, and 30-day transfer are components of coverage requirements for Skilled Nursing Facilities. There are several components to each of the coverage requirements; please utilize the links below to [...]

Required Documentation

Required Documentation Table of Contents Required Documentation The medical record should contain patient specific information detailing Certification and Recertification Requirements Signature Requirement for Certifications and [...]

How to Prevent Common Skilled Nursing Facility Denials

How to Prevent Common Skilled Nursing Facility Denials This resource was developed to increase awareness and educate SNFs on the top errors found by our Medical Review team. The information includes suggestions to ensure documentation [...]

How to Find and Respond to Post Payment Review ADR

How to Find and Respond to Post Payment Review ADR Table of Contents How to Find and Respond to Post Payment Review ADR Responding to Post Payment Review ADR Steps to View and Print ADRs from FISS/DDE Provider Online System Related [...]

Patient Driven Payment Model

Patient Driven Payment Model Table of Contents Assessment Schedule Administrative Presumption Lookback Period (Observation Period) Examples General PDPM Resources [Return to Top] Assessment Schedule Learn more about the [...]

NGS Medical Review Process

NGS Medical Review Process Medicare contractors, like NGS, operate the medical review program to prevent improper payments and protect the Medicare Trust Fund. Medical reviews involve the collection and clinical review of medical records and [...]

LCD and Article Updates for June/July 2024

LCD and Article Updates for June/July 2024 Articles Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms A56867  Due to the quarterly CPT/HCPCS code update, PLA code 0204U was deleted from CPT/HCPCS Codes [...]

MLN Connects® Newsletter: June 27, 2024

MLN Connects Newsletter: June 27, 2024 News CY 2025 Home Health Prospective Payment System Proposed Rule PrEP Using Antiretroviral Therapy to Prevent HIV Infection: Technical FAQs for Pharmacies Claims, Pricers, & Codes Medicare [...]

July 2024

In This Issue National Government Services Articles for Part A and Part B Providers National Government Services Proposed LCDs for Comment - July 18, 2024 Improving Customer Experience New Version of PC-ACE: July 2024 Common Working File [...]

Medical Documentation Requirements

Medical Documentation Requirements When filing a claim to Medicare for payment, please include all applicable diagnosis codes to the highest level of specificity to establish the medical necessity of the services provided. National Government [...]

Daily Treatment Notes Requirement for Inpatient SNF Services

Therapy Treatment Note Requirement for Inpatient SNF Services The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-2, Medicare Benefit Policy Manual, Chapter 15 is the primary source for therapy [...]

National Government Services Proposed LCDs for Comment - July 18, 2024

National Government Services Proposed LCDs for Comment - July 18, 2024 The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 6/27/2024 through [...]

Additional Development Request Letters Guide

Outpatient Institutional Providers Reimbursed Under MPFS: When to Split Claims for Updated Rates

Outpatient Institutional Providers Reimbursed Under MPFS: When to Split Claims for Updated Rates If you have monthly outpatient and/or inpatient ancillary claims with DOS 3/1/2024 – 3/31/2024, you may take the following steps to ensure correct [...]

2024 CMS Health Equity Services

2024 CMS Health Equity Services The 2024 Physician Fee Schedule Final Rule expanded Medicare coverage by adding four services to the Medicare program for coverage. These services are to help further address the priorities of reducing [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Please note the following county assignments for downstate and upstate New York. Downstate: Bronx, Columbia, Delaware, Dutchess, Greene, Kings, Nassau, New York, Orange, Putnam, Queens County, Richmond, Rockland, [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Business Function State Mailing Address Administration Simplification Compliance Act Waiver Request Forms All states National Government Services, Inc. Attn: ASCA P.O. Box 7022 [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Business Function State Mailing Address Additional Documentation Requests CT, MA, ME, NH, NY, RI, VT National Government Services, Inc. P.O. Box 7108 Indianapolis, IN [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Business Function Mailing Address Additional Development Requests National Government Services, Inc. Attn: Medical Review P.O. Box 6474 Indianapolis, IN 46206-6474 ASCA [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Business Function Mailing Address Additional Development Requests National Government Services, Inc. Attn: Medical Review P.O. Box 6474 Indianapolis, IN 46206-6474 ASCA [...]

Reactivation of Billing Privileges

Reactivation of Billing Privileges To reactivate your individual and/or group billing privileges, please follow instructions within the deactivation letter. Assisting with Reactivation Instructions for Accessing PECOS For first-time user, [...]

MLN Connects® Newsletter: July 3, 2024

MLN Connects Newsletter: July 3, 2024 News ESRD Prospective Payment System CY 2025 Proposed Rule — Submit Comments by August 26 CMS Roundup (June 28, 2024) Improve Your Search Results for CMS Content Claims, Pricers, & Codes [...]

PECOS Enrollment Process and Advantages

PECOS Enrollment Process and Advantages The Internet-based PECOS can be used in lieu of the paper enrollment application. Submitting the application via PECOS is the preferred method. Advantages of Online Enrollment: Lets you submit [...]

Enrollment Application Forms

Enrollment Application Forms You have two options for submitting your Part B Enrollment application to Medicare. You can choose to submit: Electronic application through PECOS, or CMS paper application forms Also view Understanding [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Business Function State Mailing Address Additional Documentation Requests CT, MA, ME, NH, NY, RI, VT National Government Services, Inc. P.O. Box 7108 Indianapolis, IN [...]

PECOS Enrollment Process and Advantages

Skilled Services

Skilled Services Table of Contents Skilled Services Skilled Nursing Examples of skilled nursing Skilled Therapy Skilled Respiratory Nonskilled Service Examples Examples of personal care services General Skilled [...]

Dental Services

Dental Services If you're a new or seasoned provider billing dental services to Fee-for-Service Medicare or Original Medicare, this article guides you through recently clarified payment provisions for dental services in 2023, the provider [...]

MLN Connects® Newsletter: July 11, 2024

MLN Connects® Newsletter: July 11, 2024 Proposed Rules Physician Fee Schedule CY 2025 Proposed Rule Hospital Outpatient Prospective Payment System & Ambulatory Surgical Center Payment System CY 2025 Proposed Rule Mitigating the Impact [...]

Hospice Quality Reporting Letters

Hospice Quality Reporting Letters CMS notified MACs of hospice providers that either chose not to participate in the Hospice QRP or failed to meet the Hospice QRP reporting requirements for the data collection period of 1/1/2023 to 12/31/2023 [...]

Home Health Certifying Provider Change

Home Health Certifying Provider Change Home health certifying physician or NPP changes can occur anytime for a variety of reasons. Some examples may include practitioner retirement or vacation and patient choice. Regardless of the [...]

Hospice Transfers

Hospice Transfers The purpose of a hospice transfer is to allow the beneficiary the opportunity to transfer to another agency without affecting the current benefit period and providing continuity of care. Instead of the beneficiary revoking [...]

Billing Hospice Transfers

Billing Hospice Transfers Once a beneficiary elects to receive care under the Medicare hospice benefit, he or she waives rights to Medicare payments for hospice care provided by any other hospice other than the one they have chosen/designated. [...]

MLN Connects® Newsletter: July 18, 2024

MLN Connects® Newsletter: July 18, 2024 News Final Part Two Guidance to Help People with Medicare Prescription Drug Coverage Manage Prescription Drug Costs Medicare Ground Ambulance Data Collection System: Submit Comments by September [...]

A/B DME MAC Collaborative Webinar: Positive Airway Pressure Devices

A/B DME MAC Collaborative Webinar: Positive Airway Pressure Devices Physicians/Practitioners! Are you Ordering PAP Devices for Your Patients? This is your opportunity to hear directly from the Medicare contractors regarding Medicare’s [...]

Requests for Additional Information

Requests for Additional Information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Site Visits

Site Visits Site visits may be required for certain providers and will be unannounced; the contractor representatives must disclose to the provider appropriate identifying credentials and explain the purpose of the visit. CMS has implemented [...]

Requests for Additional Information

Requests for Additional Information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Site Visits

Site Visits Site visits may be required for certain providers and will be unannounced; the contractor representatives must disclose to the provider appropriate identifying credentials and explain the purpose of the visit. CMS has implemented [...]

Requests for Additional Information

Requests for Additional Information While processing the application(s) National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

PECOS Self-Service Application Status

PECOS Self-Service Application Status You may run simple search queries to retrieve and view the status of your PECOS application. Individual View the enrollment application status of an individual provider in an organization or private [...]