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Posting Date: 04/29/2022
Proper Claim Submission for Repetitive, Scheduled, Non-Emergent Ambulance Transports
Proper Claim Submission for Repetitive, Scheduled, Non-Emergent Ambulance Transports The CMS implemented the prior authorization of RSNAT. NGS J6 states Illinois, Minnesota, and Wisconsin were added to the RSNAT Model effective with dates [...]
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Posting Date: 12/20/2016
Membership Rosters
Membership Rosters Member Lists JK Part A J6 Part A Federally Qualified Health Center (All States) Revised 11/4/2024
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Posting Date: 10/14/2024
B_Podcast Web Banner
Listen to Our New Podcast! https://www.ngsmedicare.com/web/ngs/podcasts?selectedArticleId=11841955&lob=96664&state=97057&rgion=93623
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Posting Date: 01/27/2021
Billing Medicare Part A When Veteran’s Administration Eligible Medicare Beneficiaries Receive Services in Non-VA Facilities
Billing Medicare Part A When Veteran’s Administration Eligible Medicare Beneficiaries Receive Services in Non-VA Facilities Table of Contents Background Beneficiary Chooses to Use Medicare Beneficiary Chooses to Use VA Benefits VA [...]
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Posting Date: 04/27/2022
New Provider Center
New Provider Center National Government Services: A Medicare Administrative Contractor – Who Are We? A MAC is a private health care insurer to whom the CMS has awarded geographic jurisdiction to process FFS Medicare claims for beneficiaries [...]
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Posting Date: 09/01/2021
New Provider Center
New Provider Center National Government Services: A Medicare Administrative Contractor Who Are We? A MAC is a private health care insurer to whom the CMS has awarded geographic jurisdiction to process FFS Medicare claims for beneficiaries [...]
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Posting Date: 04/04/2024
New Provider Center
New Provider Center National Government Services: A Medicare Administrative Contractor – Who Are We? A MAC is a private health care insurer to whom the CMS has awarded geographic jurisdiction to process FFS Medicare claims for beneficiaries [...]
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Posting Date: 04/04/2024
New Provider Center
New Provider Center National Government Services: A Medicare Administrative Contractor – Who Are We? A MAC is a private health care insurer to whom the CMS has awarded geographic jurisdiction to process FFS Medicare claims for beneficiaries [...]
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Posting Date: 11/07/2024
November is Lung Cancer Awareness Month
November is Lung Cancer Awareness Month Lung cancer is the leading cause of cancer death in the United States and worldwide. Although education, research and treatment options for lung cancer have dramatically improved in recent years, lung [...]
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Posting Date: 11/07/2024
Registration Now Open for the 2024 Preventive Services Virtual Conference!
Registration Now Open for the 2024 Preventive Services Virtual Conference! We are thrilled to announce that registration is now open for the National Government Services Medicare Part B 2024 Preventive Services Virtual Conference, taking place [...]
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Posting Date: 01/05/2024
Intensive Outpatient Program
Intensive Outpatient Program Table of Contents IOP vs. Partial Hospitalization Program Provider Types Eligible to Provide IOP Medicare Beneficiary Eligible for IOP Services Active Treatment and Treatment Plan Covered IOP Services [...]
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Posting Date: 11/03/2020
Introduction
Section 1: Introduction Introduction Disclaimer National Government Services produced this material as an informational reference for providers furnishing services in our contract jurisdiction. NGS employees, agents and staff make no [...]
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Posting Date: 11/03/2020
Federal Government Administration
Section 1: Introduction Table of Contents Federal Government Administration Who Is CMS? CMS' Goals Program Objectives Access to Quality Care Services to Beneficiaries Program Administration CMS Structure CMS [...]
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Posting Date: 04/28/2015
Fundamentals of Medicare: State Responsibilities
Section 1: Introduction State Responsibilities Facilities desiring to participate in either the Medicare or Medicaid programs must meet participation conditions for certification. State agencies certify to the DHHS whether providers satisfy, [...]
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Posting Date: 02/18/2014
Fundamentals of Medicare: Participating Providers
Section 1: Introduction Participating Providers Providers receiving Medicare reimbursement are known as “participating providers.” To become a participating provider, a provider must be in compliance with applicable provisions of Title VI of [...]
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Posting Date: 11/03/2020
Voluntary and Involuntary Termination of Provider Agreement
Section 1: Introduction Voluntary and Involuntary Termination of Provider Agreement Table of Contents Voluntary and Involuntary Termination of Provider Agreement Voluntary (Provider-Requested) Termination of Agreement Involuntary [...]
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Posting Date: 04/28/2015
Disclosure of Health Insurance Information
Section 1: Introduction Disclosure of Health Insurance Information Providers have restrictions on the information that they may disclose. The CMS IOM, Publication 100, Medicare General Information, Eligibility and Entitlement Manual, Chapter [...]
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Posting Date: 04/24/2015
Privacy Act
Section 1: Introduction Privacy Act The purpose of the Privacy Act of 1974 (Act), Title 5, United States Code, Section 552a, is to balance the government’s need to maintain information about individuals with the rights of individuals to be [...]
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Posting Date: 02/14/2014
National Provider Identifier
Section 1: Introduction National Provider Identifier The NPI is a HIPAA Administrative Simplification standard. The NPI is a unique identification number for covered health care providers that have replaced the legacy provider number. [...]
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Posting Date: 11/03/2020
Legacy Provider Numbers/Provider Transaction Access Numbers (PTANs)
Section 1: Introduction Legacy Provider Numbers/Provider Transaction Access Numbers Table of Contents Legacy Provider Numbers/Provider Transaction Access Numbers State Code Facility Type Third-Digit Specialty Unit Designations [...]
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Posting Date: 05/31/2024
Medicare Administrative Contractors
Section 1: Introduction Medicare Administrative Contractors What's A MAC Who are the MACs Table of Contents Medicare Administrative Contractors Who Is National Government Services? The Focus of the Provider Outreach & Education [...]
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Posting Date: 04/24/2015
Fundamentals of Medicare: Information References
Section 1: Introduction Information References Table of Contents Information References Telephone Inquiries Interactive Voice Response Eligibility Information Claim Status Information Check and Remittance Information General [...]
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Posting Date: 04/24/2015
Fundamentals of Medicare: Glossary of Terms
Section 1: Introduction Glossary of Terms Beneficiary: An individual who is eligible for Medicare. Benefit Period: The way that Medicare measures the use of hospital and SNF inpatient days. Claim: A bill for services rendered by a provider [...]
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Posting Date: 04/24/2015
The History of Medicare
Section 2: Medicare Basics The History of Medicare During the 30 years following the passage of the SSA in 1935, many attempts were made to include health insurance as part of the Social Security system. It was not until the bill H.R. 6675 [...]
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Posting Date: 04/24/2015
What Is the Medicare Program and How Is It Funded?
Section 2: Medicare Basics What Is the Medicare Program and How Is it Funded? Medicare is a federally funded health insurance program for: People age 65 or older Certain individuals under age 65 who qualify due to disability People with [...]
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Posting Date: 04/24/2015
Medicare Eligibility and Premiums
Section 2: Medicare Basics Medicare Eligibility and Premiums The following groups of people are eligible for Medicare: Individuals aged 65 or older (or their spouse) who have worked at least 40 quarters, or ten years, in Medicare-covered [...]
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Posting Date: 04/24/2015
The Social Security Administration and Medicare Enrollment
Section 2: Medicare Basics The Social Security Administration and Medicare Enrollment The SSA office has the responsibility for handling Medicare enrollment and managing premium billing and payment. Premiums may be deducted from a [...]
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Posting Date: 04/24/2015
The Medicare Card
Section 2: Medicare Basics The Medicare Card Once a person is enrolled in Medicare, they are issued a card that indicates they are covered by Medicare. The Medicare card is red, white and blue in color. It is issued (and can be reissued) [...]
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Posting Date: 05/31/2024
Inpatient Hospital Care
Section 2: Medicare Basics Inpatient Hospital Care Table of Contents Inpatient Hospital Care Inpatient Benefit Days and Cost-Sharing Full Days—Renewable Coinsurance Days—Renewable Lifetime Reserve Days—Nonrenewing Inpatient [...]
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Posting Date: 04/24/2015
Skilled Nursing Facility Inpatient Care
Section 2: Medicare Basics Skilled Nursing Facility Inpatient Care Table of Contents Skilled Nursing Facility Inpatient Care Requirements for Coverage Technical Requirements Medical Requirements Inpatient SNF/Swing Bed Benefit [...]
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Posting Date: 04/24/2015
Home Health Care Benefit
Section 2: Medicare Basics Home Health Care Benefit Table of contents Home Health Care Benefit Responsibilities of Hospitals Discharging Medicare Beneficiaries Home Health Prospective Payment System Responsibilities of Providers [...]
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Posting Date: 01/19/2021
The Hospice Benefit
Section 2: Medicare Basics The Hospice Benefit Table of Contents The Hospice Benefit Requirements for Coverage Hospice Benefit Days and Costs Hospice Services Noncovered Hospice Services [Return to Top] The Hospice Benefit [...]
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Posting Date: 05/31/2024
Medicare Part B Medical Insurance
Section 2: Medicare Basics Medicare Part B—Medical Insurance Table of Contents Medicare Part B—Medical Insurance Part B Costs Medicare Deductible, Coinsurance and Premium Rates Covered Part B Services Covered Physicians’ Services [...]
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Posting Date: 01/19/2021
Fundamentals of Medicare - Medicare Program Exclusions
Section 2: Medicare Basics Medicare Program Exclusions No payment can be made under Medicare Part A or Medicare Part B for certain items and services. The list below includes the general Medicare program exclusions. For details regarding [...]
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Posting Date: 01/19/2021
Medicare Advantage Organizations
Section 2: Medicare Basics Medicare Advantage Organizations Table of Contents What are Medicare Health Plans? Medicare Managed Care Plans [Return to Top] What are Medicare Health Plans? Medicare health plans provide different ways [...]
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Posting Date: 01/19/2021
Medicare Secondary Payer
Section 2: Medicare Basics Medicare Secondary Payer Table of Contents Medicare Secondary Payer MSP Provisions MSP Billing - General Benefits Coordination & Recovery Center Contacting the BCRC [Return to Top] Medicare [...]
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Posting Date: 01/19/2021
Coordination of Benefits Trading Partners
Section 2: Medicare Basics Coordination of Benefits Trading Partners COBC exclusively crosses over all claims to trading partners. “Trading partner” is defined as an issuer of an insurance policy that supplements Medicare or a state agency [...]
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Posting Date: 04/27/2015
Fraud and Abuse
Section 3: Fraud and Abuse Fraud and Abuse Table of Contents Fraud and Abuse Examples of Fraud Examples of Abuse [Return to Top] Fraud and Abuse Fraud occurs when there is an intentional deception or misrepresentation that an [...]
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Posting Date: 02/27/2014
Benefit Integrity
Section 3: Fraud and Abuse Benefit Integrity Providers have an obligation, under law, to conform to the requirements of Medicare. A key to avoiding fraud and abuse is the integrity of the provider as an entity and of each individual that is [...]
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Posting Date: 04/27/2015
Fundamentals of Medicare: Program Safeguard Contractor/Zone Program Integrity Contractor
Section 3: Fraud and Abuse Program Safeguard Contractor/Zone Program Integrity Contractor The primary goal of the PSC/ZPIC is to: identify cases of suspected fraud; develop them thoroughly and in a timely manner; and take immediate [...]
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Posting Date: 04/28/2015
Office of Inspector General
Section 3: Fraud and Abuse Office of Inspector General Table of Contents Office of Inspector General Compliance Programs Benefits of a Compliance Program Elements of A Compliance Program OIG Compliance Guidance Self-Discovery [...]
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Posting Date: 11/18/2020
Fraud and Abuse/Compliance Resources
Section 3: Fraud and Abuse Fraud and Abuse/Compliance Resources CMS Resources CMS IOM Publication 100-08, Program Integrity Manual OIG website OIG Fraud Prevention and Detection NGS Fraud and Abuse Resources Reviewed 6/4/2024
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Posting Date: 01/18/2022
Appeals Process
Section 3: Fraud and Abuse Appeals Process Table of Contents Appeals Process The Five Levels of Appeal Appeals Request Process First Level—Redetermination Second Level—Reconsideration Third Level—Administrative Law Judge [...]
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Posting Date: 04/28/2015
Comprehensive Error Rate Testing Process
Section 3: Fraud and Abuse Comprehensive Error Rate Testing Process Table of Contents Comprehensive Error Rate Testing Process What is CERT? Who Performs CERT? How Does It Work? CERT Information Available from CMS [Return to Top] [...]
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Posting Date: 04/28/2015
Registration of the Medicare Patient
Section 4: Getting Ready to Bill Medicare Registration of the Medicare Patient When a Medicare beneficiary receives hospital or other medical services, he/she is generally registered at the facility. It is possible that the patient may [...]
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Posting Date: 11/07/2024
MLN Connects® Newsletter: November 7, 2024
MLN Connects® Newsletter: November 7, 2024 Final Rules Physician Fee Schedule CY 2025 Final Rule Hospital Outpatient Prospective Payment System & Ambulatory Surgical Center Payment System CY 2025 Final Rule ESRD Prospective Payment [...]
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Posting Date: 04/13/2023
Top Tobacco Counseling Claim Errors
Top Tobacco Counseling Claim Errors Reason Code(s) Description Avoiding/Correcting This Error OA-18 A duplicate claim submission occurs when a provider resubmits a claim either on paper or electronically for a [...]
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Posting Date: 04/25/2024
Skin Substitutes
Skin Substitutes CMS provides pricing for some wound care products; however, there are many that do not have established pricing. When a skin substitute/wound care product does not have established pricing, the pricing for the item will be [...]
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Posting Date: 04/28/2015
Common Working File
Section 4: Getting Ready to Bill Medicare Common Working File The CWF was developed in 1989 as a means to maintain all of the records for each Medicare beneficiary. These records are a detailed account of each Medicare beneficiary’s status [...]
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Posting Date: 04/28/2015
Fiscal Intermediary Standard System
Section 4: Getting Ready to Bill Medicare Fiscal Intermediary Standard System National Government Services utilizes FISS to process claims and maintain Medicare beneficiary information. Providers have access to this information through a [...]
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Posting Date: 04/28/2015
Advance Beneficiary Notice of Noncoverage
Section 4: Getting Ready to Bill Medicare Advance Beneficiary Notice of Noncoverage An ABN is a written notice a provider gives to a Medicare beneficiary before items or services are furnished, when the provider believes that Medicare [...]
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Posting Date: 11/11/2024
Prepare and Submit a Medicare Tertiary Claim
Table of Contents Prepare and Submit a Medicare Tertiary Claim Step 1: Determine When a Claim(s) Must be Submitted to Medicare Step 2: Check for MSP Insurer Information in Medicare’s Records Step 3: Prepare and Submit Medicare Tertiary [...]
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Posting Date: 09/21/2020
Fast Track Access
Fast Track Access You will be prompted for the fast-track access when you use a feature that requires provider authentication (NPI, PTAN, TIN). Features: Claim Status, Checks, Offsets, Pricing, Appeals You can obtain a code after you [...]
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Posting Date: 09/16/2020
Fast Track Access
Fast Track Access You will be prompted for the fast-track access when you use a feature that requires provider authentication (NPI, PTAN, TIN). Features: Claim Status, Checks, Remittance Statements, Patient Status, Appeal Status You [...]
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Posting Date: 09/16/2020
General Information <8>
General Information <8> When General Information is selected, the IVR will present the caller with a submenu. Voice Touch-Tone Entry IVR Supplies Phone Numbers 1 Commonly requested telephone numbers [...]
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Posting Date: 08/30/2022
Use National Government Services Self-Service Tools to Maximize your Workload
Use National Government Services Self-Service Tools to Maximize your Workload Our PCC telephone lines are busiest at the beginning and end of each month, and this creates long wait times for providers trying to resolve claim payments, denials, [...]
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Posting Date: 11/07/2022
Common Denials Guide for Diabetes Self-Management Training and Medical Nutrition Therapy
Common Denials Guide for Diabetes Self-Management Training and Medical Nutrition Therapy National Government Services, MAC for Jurisdiction K and Jurisdiction 6, continues to provide you with resources to help reduce the burden of claim [...]
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Posting Date: 07/21/2022
Non-Appealable Situations with Medicare Advantage Plans - Make Sure Your Staff is Aware
Non-Appealable Situations with Medicare Advantage Plans - Make Sure Your Staff is Aware When a Medicare Beneficiary enrolls in a MA Plan, that MA plan takes the place of Traditional Medicare benefits. National Government Services is [...]
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