MPFS Resources

Note: Codes that have a $0 (zero) fee schedule amount will not display a search result. You must select Details to view policy indicator information. Full descriptions for policy indicators and values displayed can be found on the Fee [...]

Overpayment Recovery Tool Page Top

Overpayment Recovery Tool The Overpayment Recovery Tool will allow you to quickly access information regarding overpayments identified by the DME MAC. Once you receive your overpayment demand letter, this tool will allow you [...]

Top Customer Care Telephone Inquiries

Top Customer Care Telephone Inquiries The following chart provides a listing of the top provider customer care telephone inquiries and suggestions for locating this information.   Type of Inquiry How to [...]

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.       [...]

DME National Supplier Clearinghouse

DME National Supplier Clearinghouse The primary role of the National Supplier Clearinghouse is to process the Medicare enrollment application from a DME supplier in order to be eligible to receive Medicare payment for covered services [...]

Railroad Retirees Part B Questions

Railroad Retirees Part B Questions Palmetto GBA processes all Railroad Retirement Part B (medical) coverage claims and handles all inquiries for Railroad Retirees on a national basis. Railroad Retirees can call 877-772-5772 for their Part [...]

About Medicare

About Medicare Part A Hospital Services Part A (hospital insurance) provides coverage of inpatient hospital, limited skilled nursing facility, home health & hospice care, and health care center services. National Government Services [...]

CMS National Training Program

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

Membership Rosters

Membership Rosters Jurisdiction K Connecticut Maine, Massachusetts, New Hampshire, Rhode Island, Vermont New York Jurisdiction 6 Illinois, Minnesota, Wisconsin

Temporary Holding for Some Part B Claims

An issue has been identified resulting in the need to hold a segment of claims until the appropriate system fix can be installed.

06/21 B MMR: Evaluation and Management Coding: Medical Decision Making Moderate Point Scoring for Data Elements

Evaluation and Management Coding: Medical Decision Making Moderate Point Scoring for Data Elements On 1/1/2021, CMS approved and issued modifications to E/M coding guidelines that were originally developed and adopted by the AMA. This change [...]

Review for codes 0207T and 0563T

Review for codes 0207T and 0563T Services for CPT 0207T (Evacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral), and CPT 0563T (Evacuation of meibomian glands, automated, using heat delivered through [...]

Medicare Learning Network Articles, Medicare Monthly Review

Sample Results Letter

Sample Results Letter MAIL DATE PROVIDER NAME PROVIDER ADDRESS CITY, STATE, ZIP Provider PTAN/NPI Number: XXXXXXXX RE:Notice of Review - Targeted Probe and Education Results (Round X) Case Number: XXXXXX Dear Medicare Provider, Supplier [...]

Botox Chemodenervation Administration Codes

The above-described administration codes are billed on the Part B claim without the corresponding drug J0585, J0586, J0587 or J0588 and the claim rejects with messages CO16 N56 MA130. The article A52848 indicates the drug should be billed on [...]

End-Stage Renal Disease

NGSMedicare Videos

Nephrology

Eligibility

ClaimTimelyFilingCalc-footer

Claims for services furnished to Medicare beneficiaries must be filed to the appropriate MAC no later than one calendar year after the date the services were rendered. Revised 10/20/2021

Care Management

American Medical Association’s Behavioral Health Integration Webinar Series

American Medical Association’s Behavioral Health Integration Webinar Series National Government Services is excited to provide some additional resources on BHI from the AMA. This webinar series, titled “BHI Overcoming Obstacles”, will prepare [...]

Additional Development Requests

Three Ways to Protect Your Medicare Enrollment Information

Protect Your Identity and Privacy

Protect Your Identity and Privacy

Help Prevent Bank Account Fraud

Common Claim Status/Locations

Resources Common Claim Status/Locations Status/Location Claim Disposition P B9996 Claim waiting the payment floor hold P B9997 Processed claim – finalized location P O9998 Processed claim [...]

FISS Reason Code Overview

Resources FISS Reason Code Overview FISS reason codes are five-digit codes that direct the outcome of a claim edit or process; they are the “traffic cops” of the system. The following chart outlines the various positions of the FISS reason [...]

Program Function/Escape Key Crosswalk

Resources  Program Function/Escape Key Crosswalk Program Function Key FISS/DDE <Esc> X-Walk Function F1/PF1 Esc 1 Serves as a “Help” key. Allows you to access information contained on the [...]

Ambulance Attachment (43)

Chapter VI: Claims Correction Submenu (03) Ambulance Attachment (43) Purpose Not applicable This option is currently not utilized by National Government Services. Revised 9/18/2018

Pacemaker Attachment (42)

Chapter VI: Claims Correction Submenu (03) Pacemaker Attachment (42) Purpose Not applicable This Fiscal Intermediary Standard System (FISS)/Direct Data Entry (DDE) Provider Online System option is not utilized as Medicare no longer [...]

Home Health Attachment (45)

Chapter VI: Claims Correction Submenu (03) Home Health Attachment (45) Purpose Not applicable This Fiscal Intermediary Standard System (FISS)/Direct Data Entry (DDE) Provider Online System option is not utilized. Revised 9/9/2016

ESRD CMS-382 Form Attachment (57)

Chapter V: Claims/Attachments Submenu (02) ESRD CMS-382 Form Attachment (57) Purpose This feature allows the user the capability to enter either a new CMS-382 form or a new method selection. Note: Per CR 7064, ESRD PPS was implemented [...]

Printing FISS Screens

Chapter III: Navigating the Online System Printing FISS Screens There are two print options available in FISS that will allow you to print any screen or multiple screens. From the File menu, select Print Screen to send a single screen to [...]

Online Reports View Submenu

Chapter II: Online Menu Functions Overview Online Reports View Submenu Purpose      In the ONLINE REPORTS VIEW submenu, providers can view a variety of reports, as well as submit their quarterly Credit Balance [...]

Claims Correction Submenu

Chapter II: Online Menu Functions Overview Claims Correction Submenu Purpose The CLAIMS CORRECTION submenu is where providers correct RTP claims, adjust processed or rejected claims and cancel processed claims. This submenu also contains [...]

Accessing the Common Working File

Introduction Accessing the Common Working File Beneficiary eligibility records, which are maintained for CMS by the SSA, are stored electronically in the CWF system. You can access CWF records to view beneficiary eligibility information in [...]

Electronic Submissions

Introduction Electronic Submissions The FISS/DDE system is available through either a leased line connection or dial-up connection using a personal computer and modem. You should have knowledge of your setup since there are a [...]

Electronic Data Interchange (EDI)

Appeals

LCDs & NCDs

EDI E-mail Inquiry Form Bottom

Once you submit your completed form, you should receive an automated acknowledgement stating your email inquiry has been received by EDI. Response time for email inquiries is within ten business days of receipt. Please make sure you [...]

Part B Remittance Statements Missing Financial Control Numbers

Due to an issue associated with the 10/1/2021 release, Part B remittances classified as withholding (WO) are being generated without FCN information. Without the necessary control number, providers cannot cross-reference the reason for [...]

Check Provider Enrollment Application Status

This inquiry tool can be used to check on the status of your application. How to Search To perform a search please enter into a field below either a valid Case Number/Web Tracking ID (Option 1) or a valid National Provider [...]

Technical Guides and Information

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

Accessing the Inquiries Submenu

Chapter IV: Inquiries Submenu (01) Accessing the Inquiries Submenu Purpose This section explains how to access the Inquiries submenu from the Main Menu. Task To access the Inquiries submenu from the FISS/DDE Provider Online System Main [...]

MLN Connects® Special Edition for Wednesday, April 14, 2021

MLN Connects® Special Edition for Wednesday, April 14, 2021 J&J COVID-19 Vaccine: Health Alert The CDC issued a Health Alert, about the CDC and FDA’s recommended pause in the use of the J&J COVID-19 vaccine, in part, to ensure that [...]

MLN Connects® Special Edition for Tuesday, April 20, 2021

MLN Connects® Special Edition for Tuesday, April 20, 2021 COVID-19 Update: FDA Revoked the EUA for Bamlanivimab When Administered Alone On April 16, the FDA revoked the Emergency Use Authorization (EUA) for bamlanivimab, when administered [...]

MLN Connects® for Thursday, May 20, 2021

MLN Connects® for Thursday, May 20, 2021 Mental Health: Medicare Covers Preventive Services View this edition as a: Webpage | PDF News Hospice Outcomes & Patient Evaluation: Submit Beta Test Application by June 14 Mental [...]

MLN Connects® for Thursday, June 3, 2021

MLN Connects® for Thursday, June 3, 2021 MACs Resume Medical Review View this edition as a: Webpage | PDF News Medicare Shared Savings Program: Submit Notice of Intent to Apply by June 7 Clinical Diagnostic Laboratories: Key Dates [...]

MLN Connects® Newsletter for Thursday, July 8, 2021

MLN Connects® Newsletter for Thursday, July 8, 2021 COVID-19 Accelerated and Advance Payments: Updated FAQs View this edition as a: Webpage | PDF News COVID-19 Accelerated and Advance Payments: Updated FAQs COVID-19 Snapshot: [...]

MLN Connects® Newsletter for Thursday, July 22, 2021

MLN Connects® Newsletter for Thursday, July 22, 2021 COVID-19: EUA for Tocilizumab Monoclonal Antibody Product View this edition as a: Webpage | PDF News COVID-19: EUA for Tocilizumab Monoclonal Antibody Product Medicare Ground [...]

Evaluation and Management

Reopening versus Redetermination

MLN Connects® for Thursday, January 14, 2021

MLN Connects® for Thursday, January 14, 2021 Ensuring our Nation’s Seniors Have Access to Latest Advancements View this edition as a: Webpage | PDF News Ensuring our Nation’s Seniors Have Access to Latest Advancements Opioid [...]

MLN Connects® for Thursday, March 18, 2021

MLN Connects® for Thursday, March 18, 2021 Open Payments & You – Register for March 25 Call View this edition as a: Webpage | PDF News Clinical Laboratory Data Reporting Delayed Until 2022: Reminder Comprehensive Eye [...]

MLN Connects® Newsletter for Thursday, August 12, 2021

MLN Connects® Newsletter for Thursday, August 12, 2021 COVID-19: Vaccinate Your Patients View this edition as a: Webpage | PDF News COVID-19: Vaccinate Your Patients CMS Resumes Targeted Probe & Educate Program Compliance [...]

NGSConnex: Initiate and View Confirmation of Part A Quarterly Credit Balance Reports

NGSConnex: Initiate and View Confirmation of Part A Quarterly Credit Balance Reports Did you know as a Part A, HH+H and FQHC provider, you are able to use our secure self-service portal, NGSConnex, to submit your quarterly credit balance [...]