Medicare Quality Improvement Organization

Medicare Quality Improvement Organization Questions or complaints regarding quality of care and patient rights for a Medicare-covered service, please contact 1-800-MEDICARE (1-800-633-4227) to locate each state’s QIO.       [...]

CMS National Training Program

CMS National Training Program Access to the Centers for Medicare & Medicaid Services National Training Program Resources  

NGSMedicare Crosswalk Reference

Prolonged Services: Comparative Differences of Face-to-Face/Non Face-to-Face CPT Codes

Prolonged Services: Comparative Differences Face-to-Face vs. Non Face-to-Face CPT Codes Face-to-Face ( CPT Codes 99354-99355, 99356-99357) Non Face-to-Face (CPT Codes 99358-99359) Have been [...]

Prolonged Services: Face-to-Face

Prolonged Services: Face-to-Face Coding Guidelines Counseling and Coordination of Care Office versus Hospital Setting Excluded Time Examples NGS JK MAC has noted an increase in claims representing face-to-face prolonged [...]

Tips to Ensure an Optimal NGSMedicare.com Experience

Tips to Ensure an Optimal NGSMedicare.com Experience Most of you are probably aware, but if not, on Friday, 5/14/2021, we launched our new combined homepage. These changes were a result of your feedback. You now only need to go to [...]

Skilled Nursing Facility Patient Driven Payment Model Billing For Noncovered Days With An Occurrence Span Code 76

Skilled Nursing Facility Patient Driven Payment Model Billing For Noncovered Days With An Occurrence Span Code 76 The CR 11992 updated the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 6, Sections 40.3.2 and 40.6 to [...]

ESRD PC Pricer

Long-Term Care Hospital PPS PC Pricer

Inpatient Psychiatric Facility PPS PC Pricer

Inpatient Rehabilitation Facility PPS PC Pricer

How to Become a Medicare Enrolled OTP Supplier

How to Become a Medicare Enrolled OTP Supplier OTPs with current, valid, and full certification by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accredited by a SAMHSA-approved accrediting body; including DEA and [...]

Prior Authorization Request for Outpatient Services: Botulinum Toxin

Prior Authorization Request for Outpatient Services: Blepharoplasty, Blepharoptosis Repair and Brow Ptosis Repair

Prior Authorization Request for Outpatient Services: Vein Ablation

Prior Authorization Request for Outpatient Services: Rhinoplasty

Prior Authorization Request for Outpatient Services: Panniculectomy

Prior Authorization Requests Submitted by Exempt Providers Alert The National Government Services PA Department has observed an increase in submission of PAR for exempt providers. These submissions are from the HOPD and/or physician offices on [...]

Hospice Cap

Medicare Number

Chapter I: Online System Terminology Medicare Number Purpose The FISS DDE Provider Online System utilizes the terminology MBI to identify the beneficiary’s Medicare number. For the purpose of this manual, “Medicare [...]

Program Function Keys

Chapter III: Navigating the Online System Program Function Keys Purpose The following chart outlines the screen movement associated with each of the keyboard program function <F/PF> keys. Note: From a functional standpoint, [...]

Appeals Calculator Levels of Appeal Table

Five Levels of Appeals: Overview Levels Level One Level Two Level Three Level Four Level Five Type of Appeal Redetermination Reconsideration (QIC) Administrative Law Judge (ALJ) Medicare Appeals [...]

About the 201 Pend Report

Chapter VII: Online Reports View Submenu (04) About the 201 Pend Report Purpose The 201 Pend Report is designed to assist providers in accessing information regarding the status of their submitted claims. This report is available to view [...]

About the 702 ACS Appeals Received Report

Chapter VII: Online Reports View Submenu (04) About the 702 ACS Appeals Received Report Description: The Automated Correspondence System (ACS) master record inputs into the system so that this daily report can be created to allow providers [...]

Request a Redetermination

Request a Redetermination The first level of appeal is the redetermination and is carried out by the MAC. Time limit to initiate = 120 days from date of receipt of the initial determination notice Time limit to complete the [...]

About NGSConnex

This user guide is specific to your line of business and state. To ensure you are viewing the correct user guide, check your information in the top right corner. If your line of business and state is not correct, please select your applicable [...]

Email Verification

Email Verification The Email Verification screen will display the first time you log in to NGSConnex. All NGSConnex users are required to complete a one-time verification to validate the email associated with their NGSConnex user profile. The [...]

Printing in NGSConnex

Printing in NGSConnex You have the ability to print in several areas of NGSConnex. The printable information will display in a separate window. Select the Printable View icon or link. Right-click your mouse to view and print or save [...]

View Remittance

View Remittance If you receive SPR you will not be able to view remittance statements in NGSConnex. If you are signed up to receive an 835 ERA or have elected to view remittance statements through NGSConnex, you may view and print remittance [...]

Annual Security Training

Annual Security Training Every 365 days, NGSConnex LSOs and users are required to review the annual Security Awareness Training, including the rules of behavior and acknowledge access still is required, NGSConnex will display the Security [...]

Forgot User ID or Password

Account Suspension

Ophthalmology/ Optometry

Laboratory/ Pathology

About the 050 Claims Returned to Provider

Chapter VII: Online Reports View Submenu (04) About the 050 Claims Returned to Provider Description This is a listing by provider of claims in RTP status. The claims on the report are in status/location TB9997. The daily report will be [...]

Key Features

Key Features PC-ACE is a comprehensive claims management system. Some of the more prominent features include: Combined Medicare Part A, Institutional All-Payer and Professional claims system Electronic submission of claims in ANSI-837 [...]

Minimum System Requirements and Support

Minimum System Requirements and Support Minimum System Requirements SVGA monitor resolution (800 x 600) Windows 10, Windows 8.1, Windows 7 or Vista operating system Adobe Acrobat Reader Version 4.0 or later (for overlaid claim [...]

Minimum System Requirements and Support

Minimum System Requirements and Support In order to use this application you must have NET framework (at least 2.0 service pack 2) installed on each PC utilizing this application. Requires WinZip or compatible decompression application to [...]

Key Features

Key Features MREP software offers the following capabilities: MREP provides for the ability to view and print the following as needed: List of all Claims for a Remittance Details for a single Claim Total Amounts for a Remittance Look up [...]

Technical Guides and Information

Technical Guides and Information 5010 Process Flow Chart X12 Website: Technical Reports/Implementation Guides, Newsletters and X12 Transaction Sets

What is NGSConnex?

What is NGSConnex? NGSConnex  is a free, secure, web-based application developed by National Government Services just for you! NGSConnex provides access to a wide array of self-service functions that save you time and money, such as: [...]

Service Specific Post Payment Review of Darbepoetin Alfa Injection, 1 microgram (Non-ESRD Use)

National Government Services Part B MR Department analyzes national and local data to identify possible improper payment for Medicare services. In an effort to reduce the Part B CERT error rate, the MR Department will be conducting a service [...]

Announcing Service Specific Post-Payment Audits of Hyperbaric Oxygen (HBO) Services for J6 A Regions: IL, WI, and MN

Edit Reason Code: 5FPJP Bill Type = 13X CPT/HCPCS/Modifiers: G0277 Overview The Medical Review Department of National Government Services will be performing service specific post-payment reviews for claims submitted to Medicare Part A. When a [...]

Hospice Beneficiary Election Statement Addendum Frequently Asked Questions

Hospice Beneficiary Election Statement Addendum Frequently Asked Questions National Government Services, in collaboration with Palmetto GBA, CGS and CMS, developed these FAQs to assist providers in a better understand of the federal [...]

Multi-Jurisdictional Contractor Advisory Committee (CAC)/Subject Matter Expert Meeting

Multi-Jurisdictional Contractor Advisory Committee (CAC)/Subject Matter Expert Meeting March 10, 2022 Topic: SIJ Interventions and Procedures Questions for SIJ Interventions For all questions, answers must be based on clinical literature [...]

MLN Connects® Special Edition for Thursday, January 7, 2021

MLN Connects® Special Edition for Thursday, January 7, 2021 Physician Fee Schedule Update On December 27, the Consolidated Appropriations Act, 2021 modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS): Provided a [...]

MLN Connects® for Thursday, January 7, 2021

MLN Connects® for Thursday, January 7, 2021 COVID-19 Vaccines: CDC Long-Term Care Facility Toolkit View this edition as a: Webpage | PDF News COVID-19 Vaccines: CDC Long-Term Care Facility Toolkit MLN Web-Based Training: Complete [...]

Home Health Aide Services and the Intermittent or Part-Time Rule

Home Health Aide Services and the Intermittent or  Part-Time Rule Job Aid The CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 7, Section 50.2 states: The reason for the visits by the home health aide must [...]

PDGM Resources

PDGM Resources MLN Matters Article MM11081 – "Home Health Patient-Driven Groupings Model (PDGM) - Split Implementation" MLN Matters Article MM11395 – "Home Health Patient-Driven Groupings Model - Revised and Additional Manual Instructions" [...]

Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment

Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment This edit is applied to claims when a RAP and final episode claim are submitted at the same time or when a RAP is submitted when there is one for the same [...]

Revised Evaluation and Management Frequently Asked Question for Teaching Environment Services

Revised Evaluation and Management Frequently Asked Question for Teaching Environment Services We’ve revised an FAQ within the Teaching Environment section of our E/M FAQs to further define documentation requirements. Review the information at [...]

How to Get Started

How to Get Started Making the change is easy. If you use a clearinghouse to submit claims, contact your clearinghouse to ask how to enroll for the electronic remittance service. If you currently have a claim submission software program, [...]

Provider Contact Center

MLN Connects® Newsletter for Thursday, May 19, 2022

MLN Connects® Newsletter for Thursday, May 19, 2022 Biosimilars: Safe, Effective, & May Reduce Patient Costs News Biosimilars: Safe, Effective, & May Reduce Patient Costs PECOS Scroll Functionality Clinical Laboratory [...]

PA RSNAT Coversheet

Medicare Provider Enrollment Application Fee Decision Tree Tool

Remote Physiological Monitoring and Cardiovascular Monitoring Service and Billing Information

Billing and Coding and SAD Article Updates for May/June 2022

Billing and Coding and SAD Article Updates for May/June 2022 Billing and Coding: Denosumab (Prolia ™, Xgeva ™) (A52399) The article has been corrected to remove the following statement: (calcium 1000 mg daily and at least 400 IU vitamin D [...]

Modifier Usage