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 [...]

Sign and Submit the Application(s)

Credit Balance Reminder: Submissions For Quarter Ending 6/30/2024 Start Soon!

Credit Balance Reminder: Submissions For Quarter Ending 6/30/2024 Start Soon! CBR submissions can be submitted starting on 7/1/2024 and are due within 30 days to be considered timely. Remember, even if no monies are owed to Medicare for this [...]

For First Time Users: Request a User ID and Connection

For First Time Users: Request a User ID and Connection Instructions for accessing PECOS: If you are unsure if you have a user ID, select “Forgot User ID?” from PECOS. Connect to the Identity & Access (I&A) Management System, [...]

New Provider Corporation or Group (Multiple Owners)

New Provider Corporation or Group (Multiple Owners) Download CMS-855B: Complete sections 1, 2, 3, 4, 5, 6, 8, 12, 13, 15B and 15D (if applicable).   Attachment 1 for Ambulance Suppliers Attachment 2 for IDTFs Attachment 3 [...]

Accelerated Payment Program Available for Providers Impacted by the Ascension Health Cyber Related Incident (CRI)

Accelerated Payment Program Available for Providers Impacted by the Ascension Health Cyber Related Incident Part A Providers experiencing cash flow problems related to Ascension Health CRI, which began on 5/8/2024, may be eligible for [...]

PECOS Enrollment Process and Advantages

Navigating Medicare: Part A Insights for Providers Podcast

Navigating Medicare: Home Health & Hospice Insights for Providers Podcast

National Government Services is on LinkedIn

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 25th Sessions!

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 25th Sessions! We’re wrapping up our Medicare Part B 2024 Spring/Summer Virtual Conference with education [...]

Targeted Probe and Educate Educational Videos

Targeted Probe and Educate Educational Videos Video Description MAC Medical Review Best Practices: Updating Your Contact Information Did you know providers can now designate a separate [...]

Best Practices for a Successful Targeted Probe and Educate Review

Best Practices for a Successful Targeted Probe and Educate Review Table of Contents Getting Started With TPE Notification Letter During the Review Process Post-Probe/Review Results Letter Prepare for Post-Probe Education [Return to [...]

Botulinum Toxin Best Practices

Botulinum Toxin Best Practices Botulinum toxins are potent neuromuscular blocking agents that are useful in treating various focal muscle spastic disorders and excessive muscle contractions, such as dystonias, spasms and twitches. They produce [...]

Provider Enrollment

Provider Enrollment The National Government Services Provider Customer Care Department has direct telephone lines available for provider enrollment inquiries. Who should I call for technical issues regarding PECOS, EUS Helpdesk or MAC? CMS [...]

Provider Enrollment

Provider Enrollment The National Government Services Provider Customer Care Department has direct telephone lines available for provider enrollment inquiries. Who should I call for technical issues regarding PECOS, EUS Helpdesk or MAC? CMS [...]

Opt Out and Private Contracting

Opt Out and Private Contracting Opt out does not require a physician or practitioner to initially enroll with Medicare or complete a CMS-855I application. Opting out of Medicare allows a physician or practitioner to render services to [...]

Renewal to the Medicare Opt-Out Law for Physicians and Practitioners

Renewal to the Medicare Opt-Out Law for Physicians and Practitioners Prior to enactment of the MARCA of 2015, physician or practitioner opt-out affidavits were only effective for two years. As a result of changes made by MACRA, valid opt-out [...]

Opt-Out Physician or Practitioner Providing Emergency or Urgent Care

Opt-Out Physician or Practitioner Providing Emergency or Urgent Care In an emergency or urgent situation, a physician or practitioner who opts out may treat a Medicare beneficiary with whom they do not have a private contract. In this [...]

Providers Not Eligible to Opt Out and Enter Into Private Contracts

Providers Not Eligible to Opt Out and Enter Into Private Contracts Providers Who May Not Opt Out of the Medicare Program Chiropractors Opt-out law does not define ‘physician’ to include chiropractors; therefore, they may not opt out of [...]

Instructions to File

Instructions to File The requirements to opting out of Medicare are included on the forms. First, at least one private contracting agreement form must be signed between the physician or practitioner and a beneficiary. Second, the physician [...]

Requirements of Medicare Private Contracting Agreement

Requirements of Medicare Private Contracting Agreement Amendment 4507 of the Balanced Budget Act of 1997 permits a physician or practitioner to “opt out” of Medicare and enter into private contracts with Medicare beneficiaries. Under the [...]

Requirements of Medicare Opt-Out Affidavit Agreement

Requirements of Medicare Opt-Out Affidavit Agreement Amendment 4507 of the Balanced Budget Act of 1997 permits a physician or practitioner to “opt out” of Medicare and enter into private contracts with Medicare beneficiaries if specific [...]

Approval or Denial

Approval or Denial Once your affidavit is approved, you will receive an approval letter of opt-out status along with the opt-out effective date. Review this letter to ensure that everything is accurate and if you have any questions, please [...]

Requests for Additional information

Requests for Additional information While processing the affidavit, 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 from [...]

Organizations That Furnish Physician or Practitioner Services

Organizations That Furnish Physician or Practitioner Services Opt-out regulations apply to all items or services the physician or practitioner furnishes to Medicare beneficiaries, regardless of the location where such services are furnished. [...]

Early Termination for First Time Opt-Out Providers

Early Termination for First Time Opt-Out Providers Opt-out affidavits are effective for two years and cannot be terminated early unless during the first time opt-out period and within 90 days of the effective date of the affidavit. A request [...]

Standard Companion Guides

Standard Companion Guides Standard Companion Guide Trading Partner Information (275) Standard Companion Guide Trading Partner Information (277) Standard Companion Guide Trading Partner Information (278/275) Standard Companion Guide Health [...]

Targeted Probe and Educate Educational Videos

Targeted Probe and Educate Educational Videos   Video Description Targeted Probe and Educate Learn more about the TPE Program.   Additional educational information can be found on our Events page and [...]

Medical Review: Targeted Probe and Educate Review Topics

Medical Review: Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to [...]

Targeted Probe and Educate Review Topics

Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to supply medical [...]

Targeted Probe and Educate Review Topics

Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to supply medical [...]

Targeted Probe and Educate Review Topics

Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to supply medical [...]

Medical Necessity of Vitamin D Assay Testing: Top Denials and How to Prevent Them

Medical Necessity of Vitamin D Assay Testing: Top Denials and How to Prevent Them Learn how to prevent common denials for Vitamin D Assay Testing (CPT Code 82306): 1. Testing may not be used for routine or other screening. There must be [...]

2024 DMEPOS HCPCS Jurisdiction Listing

MLN Connects® Newsletter: June 20, 2024

MLN Connects Newsletter: June 20, 2024 News CMS Preparing to Close Program that Addressed Medicare Funding Issues Resulting from Change Healthcare Cyber-Attack Federal Study Examines Care Following Nonfatal Overdose Among Medicare [...]

Medicare Coverage Exclusion: Dental Services

Medicare Coverage Exclusion: Dental Services It is imperative that our providers are educated regarding the exclusion of dental services from the Medicare Program. Medicare generally does not cover dental services. Since the inception of [...]

Medicare Coverage Exclusion: Dental Services

Medicare Coverage Exclusion: Dental Services Table of Contents Medicare Coverage Exclusion: Dental Services Dental Services Excluded Under Medicare Part B Exceptions to Dental Service Exclusion Inpatient Services in Connection With [...]

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction K Part A Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Debridement, subcutaneous tissue (includes epidermis and dermis, if performed) 11042, 11045 [...]

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction K HHH Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Home Health Medical Necessity N/A 55H3V– The documentation did not support the medical [...]

Best Practices for a Successful Targeted Probe and Educate Review

Best Practices for a Successful Targeted Probe and Educate Review Table of Contents Getting Started With TPE Notification Letter During the Review Process Post-Probe/Review Results Letter Prepare for Post-Probe Education [Return to [...]

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 [...]