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 [...]

Check Provider Enrollment Application Status

Check Provider Enrollment Application Status You may run simple search queries to retrieve and view the status of your CMS-855 application via two options. Case number/web tracker id NPI and TIN combination Related Content Check [...]

Interactive Voice Response System

Interactive Voice Response System You may check the status of your provider enrollment application (PECOS or paper) submissions via the IVR by: Case number/web tracker id or NPI and TIN combination Related Content Part B Provider [...]

Approval or Denial

Approval or Denial Approval Once your application is approved, you will receive an email containing a Medicare Letter with PTAN. Review this letter to ensure that everything is accurate and if you have any questions, please contact the [...]

Acknowledgement Email

Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: CustomerService-DoNotReply@cms.hhs.gov containing the PECOS web tracking number. [...]

Physicians and Nonphysician Practitioners that Reassign All Benefits

Physicians and Nonphysician Practitioners that Reassign All Benefits Download CMS-855I. Complete Sections: 1, 2, 3, 4, 4F, 12, 13 and 15B Note: Submit national board certification and diploma for nonphysician practitioners. If adding [...]

Unnecessary Adjustments for Part B Claims

Unnecessary Adjustments for Part B Claims A recent transition process at the Medicare Part B system maintainer has resulted in unnecessary and inappropriate Part B claim adjustments, impacting all MACs nationwide. This issue started to occur [...]

Incident to Quick Reference Chart

Incident to Quick Reference Chart Location PT Status Scenario Who Bills Comments Office New patient NPP sees patient - MD not present in office suite NPP bills for the service under the NPP NPI NPP [...]

ASCA Requirements for Paper Claim Submissions

Table of Contents ASCA Requirements for Paper Claim Submissions Submitting Electronic Claims Submitting Paper Claims ASCA Exception Criteria Related Content [Return to Top] ASCA Requirements for Paper Claim Submissions [...]

“Incident to” Services

“Incident to” Services This article has been specially designed for our providers who perform services “Incident to” the services of a physician/NPP. Table of Contents The “Incident to” Provision of Medicare Your Office Hospital or [...]

Home Health Referrals

Home Health Referrals Table of Contents Home Health Referrals Order for Home Health Services Documentation to Support Homebound Status Documentation to Support the Need for Skilled Services Documentation Regarding the Face-to-Face [...]

Supplemental Security Income Ratio Realignment for Cost Reporting Periods Starting Before 10/1/2013

Supplemental Security Income Ratio Realignment for Cost Reporting Periods Starting Before 10/1/2013 On 6/9/2023, in response to the Supreme Court’s ruling in Azar v. Allina Health Services, 139 S. Ct. 1804 (2019), the CMS issued a final rule [...]

About Appeals

About Appeals Table of Contents About Appeals Reopening vs. Redetermination Reopening Redetermination [Return to Top] About Appeals Providers and beneficiaries have the right to appeal claim determinations made by National [...]

Home Health Forms – Which is Required?

Home Health Forms – Which is Required? The Advance Beneficiary Notice/Home Health Change of Care Notice/Notice of Medicare Noncoverage Scenario ABN HHHCN NOMNC Patient met goals under the POC and is being [...]

Homebound Status

Homebound Status A Medicare beneficiary must be confined to the home in order to use their Medicare home health benefit. CMS defines homebound status in the CMS IOM Publication 100-02, Medicare Benefit Policy [...]

Home Health Certification Statement

Home Health Certification Statement What is a home health certification statement? It is an attestation that the Medicare beneficiary is eligible for home health services. It is a CMS requirement and condition of payment for a home health [...]

Wound Care Under the Medicare Home Health Benefit

Wound Care Under the Medicare Home Health Benefit Wound care treatment typically involves three skilled nursing interventions, which may be performed at the same time or separately from each other. The three services are: Performing the [...]

Medical Unlikely Edits Implemented for Some HCPCS and CPT Codes

Medical Unlikely Edits Implemented for Some HCPCS and CPT Codes Table of Contents Medical Unlikely Edits Implemented for Some HCPCS and CPT Codes Looking Up MUEs Accessing MUE Tables Common Questions [Return to Top] Medical Unlikely [...]

Education Partnership Request Form

Education Partnership Request Form

Education Partnership Request Form

Education Partnership Request Form

MLN Connects® Newsletter: August 8, 2024

MLN Connects® Newsletter: August 8, 2024 Final Payment Rule Hospital Inpatient Prospective Payment System & Long-Term Care Hospital Prospective Payment System FY 2025 Final Rule News Transitional Coverage for Emerging Technologies [...]

Maine, Massachusetts, New Hampshire, Rhode Island and Vermont

Maine, Massachusetts, New Hampshire, Rhode Island, Vermont Member Name Professional Title Association Business Name/Address Email Bedard, Brenda Insurance Compliance & Training Supervisor Maine [...]

Removal of Facet HCPCS Codes

Removal of Facet HCPCS Codes Prior Authorization Outpatient Department Update  Effective 8/16/2024, the CMS is removing two current procedural terminology codes from the OPD Facet Joint Injection list of codes: 64492 – Facet joint [...]

Prior Authorization OPD Alerts

Prior Authorization OPD Alerts Month/Year Topic August 2024  Removal of Facet HCPCS Codes July 2023 Prior Authorization Outpatient Department Rejections Alert July 2023 Prior [...]

Medical Policy Contact Information

Medical Policy Contact Information Please Note: General inquiries related to Medicare coverage policies, including clinical issues, drugs, radiopharmaceuticals, local and national coverage determinations, billing and reimbursement must be [...]

Medical Policy Contact Information

Medical Policy Contact Information Please Note: General inquiries related to Medicare coverage policies, including clinical issues, drugs, radiopharmaceuticals, local and national coverage determinations, billing and reimbursement must be [...]

Medical Policy Contact Information

Medical Policy Contact Information Please Note: General inquiries related to Medicare coverage policies, drugs, radiopharmaceuticals, local and national coverage determinations, billing and reimbursement must be directed to the Provider [...]

Medical Policy Contact Information

Medical Policy Contact Information Please Note: General inquiries related to Medicare coverage policies, including clinical issues, drugs, radiopharmaceuticals, local and national coverage determinations, billing and reimbursement must be [...]

Steps to Claim Corrections

This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

Submitting Revalidation via PECOS

During this webinar, we’ll provide an understanding of how to utilize the CMS Internet-based Provider Enrollment Chain & Ownership System (PECOS) to be comfortable in navigating the system to submit a provider enrollment electronic application.

Provider Enrollment: Completing the CMS-855A Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855A provider enrollment paper application.

Provider Enrollment: Completing the CMS-855B Paper Application

During this webinar, we'll provide an understanding of how to complete the CMS-855B provider enrollment paper application for a clinic, group, or supplier.

Provider Enrollment: Completing the CMS-855I Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855I provider enrollment paper application for a group member, sole proprietor, or sole owner and we’ll also focus on reassigning Medicare benefits.

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations) If you disagree with Medicare’s claim determination, you may Appeal. However, please follow these important tips before you submit a first level of appeal [...]

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations) If you disagree with Medicare’s claim determination, you may Appeal. However, please follow these important tips before you submit a first level of appeal [...]

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations) If you disagree with Medicare’s claim determination, you may Appeal. However, please follow these important tips before you submit a first level of appeal [...]

Medicare Bad Debts

Table of Contents Review Medicare Bad Debt Listing Identifying Non-Allowable Fee Schedule Services Fee Schedules Included in Bad Debt Policy Medicare Bad Debts Related Content [Return to Top] Review Medicare Bad Debt Listing [...]

Monoclonal Antibodies in Treatment of Alzheimer’s Disease - Medicare Advantage Plan Responsibility

Monoclonal Antibodies in Treatment of Alzheimer’s Disease - Medicare Advantage Plan Responsibility NCD 200.3 was issued by CMS in April,2022 and outlines Medicare coverage policy for monoclonal antibodies that target amyloid (or plaque) for [...]

HETS EDI Enrollment Form User Guide

The HETS ​​​​​​EDI Enrollment Form allows providers to attest their relationship with a 3rd party entity to exchange the ANSI X12 270/271 Beneficiary Eligibility transaction on their behalf. Table of Contents Step 1 – Authorization [...]

HETS EDI Enrollment Form

HETS EDI Enrollment Form

HIPAA Eligibility Transaction System (HETS) allows users to exchange HIPAA compliant ANSI ASC X12 270/271 transactions for the purpose of checking Medicare eligibility.  The HETS EDI Enrollment Form allows providers to attest their [...]

Telehealth Place of Service 02 and 10 Clarification

Telehealth Place of Service 02 and 10 Clarification National Government Services has been receiving inquiries from providers in regard to POS 02 and POS 10 for telehealth service reporting. We’ve created this article to provide clarification. [...]

CLIA Number Processing Issue

CLIA Number Processing Issue National Government Services has been made aware of an issue with CLIA lab claims processing. CLIA numbers were not loaded through CWF, resulting in claim denials as CLIA did not match any file. We were informed [...]

Home Health Documentation Checklist

Home Health Documentation

Verify Bank Account Information

Verify Bank Account Information

Verify Bank Account Information

The CY 2023 Medicare Physician Fee Schedule Is Now Available

The CY 2023 Medicare Physician Fee Schedule Is Now Available The CY 2023 MPFS is now available. You can view the new fees using the Fee Schedule Lookup tool page on NGSMedicare.com. Posted 11/14/2022

Proper Steps for Notice of Admission Cancel/Resubmission

Proper Steps for Notice of Admission Cancel/Resubmission The purpose of the NOA is to open a new admission period for a home health beneficiary. There are few circumstances when the home health NOA must be canceled and resubmitted to correct [...]

Sequestration Questions and Answers

Sequestration Questions and Answers If a durable medical equipment capped rental period started before 4/1/2013, are the rental payments for months after 4/1/2013, subject to the 2 percent reduction? Answer: Any claims for rental [...]

Billing for Tape Codes (A4450 and A4452) and Modifiers (AU, AV and AW)

Billing for Tape Codes (A4450 and A4452) and Modifiers (AU, AV and AW) Policy specific informational modifiers can be located in the local medical policies. When submitting claims that require policy specific informational modifiers, [...]

Claim Completion Requirements for Facility Location (Item 32)

Claim Completion Requirements for Facility Location (Item 32) When a supplier submits a claim for DMEPOS provided in a location other than the beneficiary’s home (POS 12), the supplier must enter in Item 32, Facility Location, the name and [...]

Coverage and Correct Coding of Blincyto

Coverage and Correct Coding of BlincytoTM Joint DME MAC Publication On 12/3/2014, the FDA gave accelerated approval for Blinatumomab (BlincytoTM) for the treatment of Philadelphia negative relapsed/refractory acute lymphoblastic leukemia. [...]

2015 HCPCS Code Update

2015 HCPCS Code Update The following list identifies changes to level II HCPCS codes for 2015. Added Codes/Added Modifiers: New codes and modifiers are effective for dates of service on or after 1/1/2015. Discontinued Codes/Deleted [...]

Medical Policies/LCDs

What's New in Home Health Education?

What's New in Home Health Education? Updates are currently being made to home health YouTube tutorials and job aids to ensure that all federal regulation changes are captured. Most recently, we have updated the following educational materials [...]