Electronic Funds Transfer Form and Instructions

Table of Contents Electronic Funds Transfer Form and Instructions Submitting the EFT Form CMS-588 EFT Completion Tips for Sole Proprietors, Sole Owners, Clinic/Groups, Organizations, Providers and Suppliers [Return to Top] Electronic [...]

Frequently Asked Questions Have Been Reviewed and Updated

Frequently Asked Questions Have Been Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Topics available are: ASCA Appeals CAR T-cell [...]

9/18/2024 Part B POE Advisory Group Meeting

9/18/2024 Part B POE Advisory Group Meeting Meeting Minutes Meeting Time: 10:00 a.m.‒12:00 p.m. ET Member Attendees: Elizabeth Aldrich, Dawson Ballard, Doris Barnes, Aurelia Barraco, Sheila Bembeneck, Madelon Berger, Todd Bergstrom, Louise [...]

Notification of the 2025 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review

Notification of the 2025 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review The amount that must remain in controversy for ALJ hearing requests filed on or [...]

MLN Connects® Newsletter: October 24, 2024

MLN Connects® Newsletter: October 24, 2024 News CMS Roundup (October 18, 2024) Rural Health Clinic & Federally Qualified Health Center: Final CY 2024 Payment Policies Claims, Pricers, & Codes Home Health Consolidated [...]

PECOS Correct and Resubmit Application Instructions

PECOS Correct and Resubmit Application Instructions Login to PECOS and select the following: My Associates View Enrollment for applicable enrollment under Existing Associates Correct and Resubmit for applicable [...]

Supporting Documentation Information

Supporting documentation with the submission of an application is very important. The paper CMS-855A identifies applicable information under section 17. Here’s a list when applicable for initial enrollment, change of information or [...]

Anesthesia Billing Modifiers

Anesthesia Billing Modifiers Table of Contents Physician Anesthesia Modifiers Qualified Nonphysician Anesthetist Modifiers Monitored Anesthesia Care (MAC) MAC Deep Complex Complicated Teaching Physicians Anesthesia Furnished in [...]

Anesthesia

Anesthesia General Anesthesia Information Anesthesia is the administration of a drug or gas to induce partial or complete loss of consciousness. Services involving administration of anesthesia should be reported by the use of the CPT [...]

Concurrent, Medical Direction and Supervision

Concurrent, Medical Direction and Supervision Table of Contents Concurrent Medically Directed Procedures Medical Direction and Temporary Relief Medical Directed Rate Medically Supervised Related Content [Return to Top] [...]

Group/Member Practice Responsibilities

Group/Member Practice Responsibilities Table of Contents Members of a Group More than One Teaching Physician Related Content [Return to Top] Members of a Group If anesthesiologists are in a group practice, one physician member may [...]

Local Coverage Determinations

Local Coverage Determinations General An LCD is a decision by Medicare, whether to cover, and under what circumstances to cover, a particular item or service in our jurisdiction in accordance with Section 1862(a) (1) (A) of the Social [...]

Moderate (Conscious) Sedation

Moderate (Conscious) Sedation Moderate sedation codes 99143‒99150 were deleted and replaced with codes 99151‒99157 in 2017. 99151‒99157: Are not used to report administration of medications for pain control, minimal sedation, deep sedation, [...]

National Coverage Determinations

National Coverage Determinations General Medicare coverage is limited to items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category). NCDs [...]

Teaching Anesthesiology Services

Teaching Anesthesiology Services Table of Contents Teaching Anesthesiology Services Anesthesia Services and Teaching CRNA Physician Personally Performed and Personally Performed with CRNA and AA Related Content [Return to Top] [...]

Resources and References

Resources and References Anesthesia Guidelines and Regulations CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 12 Section 50 CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 10 CMS [...]

Anesthesia Billing Codes

Anesthesia Billing Codes Table of Contents Anesthesia Not Otherwise Classified Codes Add-On Codes for Anesthesia Related Content [Return to Top] Anesthesia Body Area CPT Codes Head 00100‒00222 [...]

Daily Management and Pain Management

Daily Management and Pain Management Table of Contents Daily Management of Continuous Pain Control Techniques Pain Management Consultations Postoperative Pain Control Procedures [Return to Top] Daily Management of Continuous [...]

Monitoring Anesthesia Services

Monitoring Anesthesia Services Monitored Anesthesia Monitored anesthesia care involves intraoperative monitoring by a physician or qualified individual under the medical direction of a physician or of the patient’s vital physiological signs [...]

Payment and Reimbursement

Payment and Reimbursement Table of Contents Anesthesia Claim Billing Instructions Multiple Anesthesia Procedures Multiple CRNAs Same Procedure Payment at Personally Performed Rate Payment at Medically Directed Rate Payment at [...]

Provider Qualifications

Provider Qualifications Table of Contents General State Licensing Physician – Anesthesiologist (Specialty 05) Medical and Surgical Services Performed with Anesthesia by an Anesthesiologist Qualified Nonphysician Anesthetists [...]

National Government Services Guide for New Providers

National Government Services Guide for New Providers

National Government Services Guide for New Providers

National Government Services Guide for New Providers

A/B DME MAC Collaborative Lower Limb Orthoses Webinar

A/B DME MAC Collaborative Lower Limb Orthoses Webinar This is your opportunity to hear directly from the Medicare contractors regarding Medicare’s criteria necessary for the coverage of lower limb orthoses. Representatives from all four DME [...]

Cervical Fusion with Disc Removal Best Practices

Cervical Fusion with Disc Removal Best Practices Table of Contents Introduction Coverage General Documentation Requirements Medical Necessity Criteria for Each Indication Limitations and Exceptions to Conservative Therapy [Return to [...]

Home Health Billing

Avoiding Reason Code 38200

CR 9189 Transmittal 602: Medical Review of Home Health Services

Contractor Advisory Committee

Assist National Government Services in the Development of Local Coverage Determinations Background CMS released Change Request 10901 and the companion MLN® Matters MM10901: Local Coverage Determinations (LCDs) article to expand the parameters [...]

Appeals/Reopenings

Medicare Part B 101 Manual Appeals/Reopenings Table of contents Reopenings for Minor Errors and Omissions Telephone Reopening Unit Appeals Time Limit for Filing Appointment of Representative Redeterminations Acceptable Signature [...]

CMS-1500 Claim Form

Medicare Part B 101 Manual CMS-1500 Claim Form Table of Contents General Information Claim Filing Instructions for Paper and Electronic Submission Regulations on Charging for Claim Form Completion OCR System Missing, Incomplete, [...]

Comprehensive Error Rate Testing

Medicare Part B 101 Manual Comprehensive Error Rate Testing Table of Contents Comprehensive Error Rate Testing What Is CERT? How Long Do Providers Have to Respond to a Request From the CERT Contractor? What Happens if the Provider [...]

Fraud and Abuse

Medicare Part B 101 Manual Fraud and Abuse Fraud and Abuse Unified Program Integrity Contractors Defining Fraud and Abuse Fraud Abuse Bribes, Kickbacks and Rebates Penalties Waiving Deductible and Coinsurance What You Can Do As a [...]

Medical Policy Development

Medicare Part B 101 Manual Medical Policy Development Table of Contents Medical Policy Development National Policies National Coverage Determinations National Coverage Provisions in Interpretive Manuals Local Policies [...]

Help with Medicare Costs

Help with Medicare Costs Medicare Savings Programs Learn about your options for help with Part B premiums Costs for Medicare Drug Coverage Learn how to get extra help with Part D Revised 11/1/2024

Don’t Wait Until 11/18/2024 To Use NGSConnex for Beneficiary Eligibility Information

Don’t Wait Until 11/18/2024 To Use NGSConnex for Beneficiary Eligibility Information  As we’ve communicated, beginning 11/18/2024, Beneficiary Eligibility information will not be offered on the IVR. This includes all beneficiary [...]

Report a Change of Tax ID (Other than Change of Ownership)

Step 1: Determine You are in the Right Place If you are currently an enrolled health care organization that is changing your Tax ID and the change does not involve a change of ownership, it is essential that you report changes of Tax ID within [...]

Report a Change of Tax ID (Other than Change of Ownership)

Step 1: Determine You are in the Right Place If you are currently an enrolled health care organization that is changing your Tax ID and the change does not involve a change of ownership, it is essential that you report changes of Tax ID within [...]

Report a Change of Tax ID (Other than Change of Ownership)

Table of Contents Step 1: Determine You are in the Right Place Step 2: Complete the Medicare Application Step 3: Submit Required Documentation Related Content [Return to Top] Step 1: Determine You are in the Right Place If you are [...]

Mission and Charter

​​National Government Services Provider Outreach and Education Advisory Group Charter National Government Services serves as the MAC for J6 and JK Part A, Part B and Home Health and Hospice. We maintain four POE AGs: Part A POE [...]

Medicare Part B Electronic Claims that Exceed the Threshold for Charges and Units of Service

Medicare Part B Electronic Claims that Exceed the Threshold for Charges and Units of Service  Medicare Part B electronic claims (ANSI X12 837P) with total charges exceeding $99,999.99 cannot be processed in the MCS. If a single claim [...]

MLN Connects® Newsletter: October 31, 2024

MLN Connects® Newsletter: October 31, 2024 News Medicare Shared Savings Program Continues to Deliver Meaningful Savings and High-Quality Health Care Compliance Major Hip & Knee Replacement or Reattachment of Lower Extremity: [...]

11/4/2024

This is Our Last Self-Service Pulse We sincerely thank you for being a loyal reader of our Self-Service Pulse each week. To continue receiving updates on our latest self-service tools and services, please subscribe to our general Email [...]

Report a Change of Ownership, Acquisition/Merger or Consolidation

Table of Contents Step 1: Determine You Are in the Right Place Step 2: Understand Type of CHOW Change of Ownership Acquisition/Merger Consolidation CHOW Reminders Step 3: Make Changes via Enrollment Application Change of [...]

Two Weeks to Prepare to use NGSConnex for Beneficiary Eligibility Information

Two Weeks to Prepare to use NGSConnex for Beneficiary Eligibility Information As we’ve communicated, beginning 11/18/2024, Beneficiary Eligibility information will not be offered on the IVR. This includes all beneficiary eligibility [...]

Instructions for Unfinished PECOS Enrollment Application(s)

Table of Contents Instructions for Unfinished PECOS Enrollment Application(s) Instructions for Unfinished PECOS Application(s) Instructions for Application Status “Pending E-Signature” Submitted Enrollment Application(s) on Behalf of an [...]

Report a Change of Information

Report change of enrollment information timely. Changes can be either submitted electronically via PECOS or by mail with the paper CMS-855A and/or CMS-588 EFT agreement. A change in the Tax ID with no ownership change will need to submit [...]

Report a Change of Information

Report change of enrollment information timely. Changes can be either submitted electronically via PECOS or by mail with the paper CMS-855A and/or CMS-588 EFT agreement. A change in the Tax ID with no ownership change will need to submit [...]

Report a Change of Information

Table of Contents Report a Change of Information PECOS Submission Related Content Paper Submission Related Content [Return to Top] Report a Change of Information Report change of enrollment information [...]

Coming Soon ‒ The CY 2025 Medicare Physician Fee Schedule

Coming Soon ‒ The CY 2025 Medicare Physician Fee Schedule The CY 2025 MPFS will soon be available on the Fee Schedule Lookup tool located on NGSMedicare.com, after the CY 2025 physician fee schedule regulation is put on display. Once the Fee [...]

Ambulance Transports Excluded from SNF Consolidated Billing

Ambulance Transports Excluded from SNF Consolidated Billing When a Medicare beneficiary is a resident in a SNF under a Part A stay, not all ambulance transports are included in the PPS (prospective payment system) payment for a SNF. SNF [...]

Ambulance Medical Necessity Reminder for ESRD Patients

Ambulance Medical Necessity Reminder for ESRD Patients National Government Services receives a significant amount of dialysis facility ambulance transports that do not meet medical necessity criteria. Documentation must explicitly describe the [...]

Related Content

Related Content Ambulance Services Center MLN® Booklet: Medicare Ambulance Transports Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, [...]

Billing for A0426 or A0428

Billing for A0426 or A0428 National Government Services has been receiving electronic claims with the 2300 REF segment (G1 qualifier) for prior authorization, however, the value entered in REF02 is a ZIP code. This segment is intended for the [...]

Medical Necessity of Ambulance Services

Medical Necessity of Ambulance Services Table of Contents Medical Necessity of Ambulance Services What You Can Do Nearest Appropriate Facility: GY Modifier What You Can Do Related Content [Return to Top] Medical [...]

Prior Authorization of Repetitive Scheduled Non-Emergent Ambulance Transport

Ambulance Medical Necessity

Ambulance Medical Necessity According to the Centers for Medicare & Medicaid Services’ (CMS) Internet Only Manual (IOM) 100-02, Medicare Benefit Policy Manual, Chapter 10, Ambulance Services; (400 KB) 10.2 - Necessity and Reasonableness [...]

Responsibility of Providing a Properly Executed Physician Certification Statement/Certificate of Medically Necessity

Responsibility of Providing a Properly Executed Physician Certification Statement/Certificate of Medically Necessity Recent National Government Services educational efforts have highlighted an issue between facilities and the ambulance [...]