[REVISED] 2024 Gapfill Request

[REVISED] 2024 Gapfill Request National Government Services, the MAC for JK and J6 is in receipt of the new laboratory test codes identified by the CMS to be gap-fill priced for 2024. The PAMA regulations instruct the MACs to establish local [...]

Change Healthcare Security Incident

Change Healthcare Security Incident The CMS and National Government Services are aware that Change Healthcare recently suffered a cyber-attack. Change Healthcare is a clearinghouse vendor that connects providers with insurance payers and has [...]

MLN Connects® Newsletter: February 29, 2024

MLN Connects® Newsletter: February 29, 2024 Events ICD-10 Coordination & Maintenance Committee Meeting — March 19–20 MLN Matters® Articles Appropriate Use Criteria for Advanced Diagnostic Imaging: CY 2024 Update Clinical [...]

Tobacco Counseling via Telehealth

Tobacco Counseling via Telehealth Tobacco use is the leading cause of preventable disease, disability and death in the United States. Each year, nearly half a million Americans die prematurely of smoking or exposure to secondhand smoke. [...]

You Asked, We Listened: Redesigned Events Page Coming Soon

You Asked, We Listened: Redesigned Events Page Coming Soon We’re always looking for and appreciate feedback from our providers. Your ideas and recommendations help drive improvements to our website. Providers suggested that we display the [...]

March 2024

In This Issue National Government Services Articles for Part A and Part B Providers Common Working File (CWF) Host Dark Days for April 2024 Release Health Benefits of Quitting Smoking 2024 Gapfill Request Correct Coding of Molecular [...]

CMS Rural Health Resources

CMS Rural Health Clinics Center

Prior Authorization Process for Repetitive Scheduled Nonemergent Ambulance Transport

Prior Authorization Process for Repetitive Scheduled Nonemergent Ambulance Transport CMS implemented the prior authorization program for RSNAT to reduce expenditures while maintaining and/or improving quality of care. This program applies to [...]

Appeals

Appeals State MAC Appeals Address Qualified Independent Contractor Address CT, MA, ME, NH, NY, RI, VT National Government Services, Inc. Appeals Department P.O. Box 7111 Indianapolis, IN 46207-7111 [...]

Claim Status <2>

table, td, th table { border-collapse: collapse; width: 50%; } Claim Status <2> If you are part of a group, remember to use the group NPI, PTAN and TIN for authentication purposes. When Claim Status is selected, the IVR will [...]

Investigational Device Exemption Requests ‒ Renewals and Modifications

Investigational Device Exemption Requests ‒ Renewals and Modifications Effective for Category A and B IDE studies approved by the FDA on or after 1/1/2015, interested parties (i.e. study sponsors) seeking Medicare coverage must submit a [...]

NGSMedicare.com Scheduled Maintenance: 3/9/2024-3/10/2024

NGSMedicare.com Scheduled Maintenance Due to scheduled maintenance, NGSMedicare.com will be inaccessible beginning Saturday, 3/9/2024 through Sunday, 3/10/2024. We apologize for any inconvenience this may cause. Posted 3/7/2024

MLN Connects® Newsletter: March 7, 2024

MLN Connects® Newsletter: March 7, 2024 News HHS Statement Regarding the Cyberattack on Change Healthcare Final Guidance to Help People with Medicare Prescription Drug Coverage Manage Prescription Drug Costs Current Status of Blood [...]

You Asked, We Listened, We Delivered: Redesigned Events Page Live

You Asked, We Listened, We Delivered: Redesigned Events Page Live We’re always looking for and appreciate feedback from our providers. Your ideas and recommendations help drive improvements to our website. Providers suggested that we display [...]

Advance and Accelerated Payment Program Available for Providers Impacted by the Change Healthcare/Optum Payment Disruption

Advance and Accelerated Payment Program Available for Providers Impacted by the Change Healthcare/Optum Payment Disruption Part A and Part B Providers experiencing cash flow problems related to Change Healthcare/Optum Payment Disruption [...]

The Change Healthcare/Optum Payment Disruption (CHOPD) CMS Fact Sheet Now Available

The Change Healthcare/Optum Payment Disruption (CHOPD) CMS Fact Sheet Now Available CMS issued the Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated Payments to Part A Providers and Advance Payments to Part B Suppliers Fact Sheet [...]

Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated and Advance Payments for Part A Providers and Part B Suppliers

Proper Medicare Part B Claim Submissions – Completion and Regulation for the CMS-1500 Paper Claim Form Due to the Change Healthcare Security Incident

Proper Medicare Part B Claim Submissions – Completion and Regulation for the CMS-1500 Paper Claim Form Due to the Change Healthcare Security Incident Health care professionals and suppliers play a vital role in protecting the integrity of the [...]

Privacy Notice

Privacy Notice National Government Services, Inc. (NGS) contracts with the Centers for Medicare & Medicaid Services (CMS) and is a CMS contractor under the authority granted in Sections 1842, 1862(b) and 1874 of Title XVIII of the Social [...]

Reminder: Medicare Part A Claim Submissions Due to the Change Healthcare Security Incident

Reminder: Medicare Part A Claim Submissions Due to the Change Healthcare Security Incident Medicare Part A providers can use the FISS DDE for Part A claim entry. This option is free, and the provider may already use FISS DDE. Note: FISS DDE [...]

MLN Connects® Newsletter: March 14, 2024

MLN Connects® Newsletter: March 14, 2024 News CMS Roundup (Mar 8, 2024) Marriage and Family Therapists & Mental Health Counselors: Updated Enrollment FAQs Skilled Nursing Facilities: Billing Medicare for Respiratory Vaccines [...]

Publications for People with Medicare

Publications for People with Medicare Medicare & You Handbook Medicare News Medicare Publications

G0179FrequencyCalculatorBottom

  The home health agency (HHA) certification code can be billed only when the patient has not received Medicare-covered home health services for at least 60 days. The HHA recertification code is used after a patient has received services for [...]

G0179FrequencyCalculatorTop

G0179 Frequency Calculator Use this calculator to determine the date the next recertification code G0179 may be billed. Enter the date of the last recertification or certification service that met the billing requirements for code G0179 or [...]

Laboratory Tests Billing Alert: Lipid Panel Test (80061) Completed on the Same Date of Service as an LDL Test (83721)

Laboratory Tests Billing Alert: Lipid Panel Test (80061) Completed on the Same Date of Service as an LDL Test (83721) National Government Services, Inc. Medical Review initiated a review of claims containing both a lipid panel test and [...]

What is Medicare Secondary Payer?

Medicare Secondary Payer is the term used for when a Medicare beneficiary has other insurance or coverage that is the primary payer, based on a federal MSP provision, for the beneficiary’s healthcare services. As a result, Medicare is the [...]

Provider Enrollment: Verify Bank Account Information to Prevent Interruption in Medicare Payment

Provider Enrollment: Verify Bank Account Information to Prevent Interruption in Medicare Payment National Government Services receives numerous electronic funds transfer banking rejections each year due to frozen or closed bank accounts. [...]

Provider Enrollment: Verify Bank Account Information to Prevent Interruption in Medicare Payment

Provider Enrollment: Verify Bank Account Information to Prevent Interruption in Medicare Payment National Government Services receives numerous electronic funds transfer banking rejections each year due to frozen or closed bank accounts. [...]

Prevent an MSP Rejection on a Medicare Primary Claim

Table of Contents Prevent an MSP Rejection on a Medicare Primary Claim Step 1 Step 2 Step 3 Related Content [Return to Top] Prevent an MSP Rejection on a Medicare Primary Claim If you submit a Medicare primary claim when there is [...]

Populating MSP Insurance Type Code on Electronic Claims

Table of Contents Populating MSP Insurance Type Code on Electronic Claims GHP NGHP Related Content [Return to Top] Populating MSP Insurance Type Code on Electronic Claims When you identify beneficiaries that have Medicare as the [...]

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Please refer to the Physician Fee Schedule Look up on the CMS Web site to determine whether the procedure in question has a 90 day global period.

Hospital-Issued Notices of Noncoverage

Inhalation Treatment CPT 94640 – Billing Errors

Inhalation Treatment CPT 94640 – Billing Errors The National Government Services Appeals Department has identified billing errors relevant to CPT code 94640 for inhalation treatment. When you bill more than one unit per episode of care, the [...]

DME CERT Physician's Corner

DME CERT Physician’s Corner In an effort to reduce the CERT claims error rate, CGS Jurisdiction B DME MAC, has created a Physician’s Corner page which is specifically designed for physicians and practitioners to provide detailed information [...]

Download Medicare Remit Easy Print

Download Medicare Remit Easy Print To download MREP, please select the external link below to navigate to the MREP portion of the CMS Website. Download Medicare Remit Easy Print

Prolonged Services Timetable 2024

Prolonged Services Timetable 2024 CPT Code HCPCS Code for Prolonged Service CPT and CMS Base Time CMS-Extra Minutes Needed CMS Time Requirement for Prolonged Services Date Span 99205 G2212 60 15 [...]

Hospice PIP Rate Review Form

Part A Ambulance Claims Not Retaining Fractional Units

Fractional Units are not being retained on ambulance mileage HCPCS entered via DDE. This results in reason code 32226 (Units required but not present).  

ESRD Claims Are Paying Incorrectly

National Government Services has been made aware of ESRD claims with HCPCS code 90999 processing at rates that are cents instead of hundreds of dollars. This is causing the claims to pay incorrectly. This issue appears to have started mid-July, 2023.

Home Health 32G Adjustment Issue for Separation Periods of < 60 Days

A segment of home health claims with 32G type of bills are incorrectly being re-coded to earlier periods during processing, instead of the correct later periods. This error is occurring when the separation between the two periods is 60 days or [...]

Hospice Informational Unsolicited Response Adjustments - Type of Bill 8XG

Due to original informational unsolicited responses (IURs) processing not occurring between the timeframe of 8/1/2017 and 4/1/2021, a significant volume of hospice IUR adjustments have been initiated by the common working file (CWF) to [...]

Optical Character Recognition Misreading Referring Provider Names

OCR software is misreading the referring/ ordering provider name (item 17) on some Part B claims.

Letter of Authorization for EDI

Letter of Authorization for EDI We’ve extended our Letter of Authorization PIN expiration period based on user feedback. Letter of Authorization PINs are now valid for 30 days and there is no limit on the number of times a PIN can be used. [...]

Interim Rate Review Documentation Request Form for Hospitals

Billing Overlap/Dispute Resolution Process Effective 3/1/2023

Billing Overlap/Dispute Resolution Process Effective 3/1/2023 An overlapping situation may occur between hospitals for inpatient stays, home health agencies, outpatient services and hospice agencies. Overlapping situations may also occur due [...]

Hospice Claims Edit Issue RC W7048

National Government Services has noted an increase in hospice claims editing incorrectly for RC W7048 following the July 2023 system release. This is occurring for revenue codes 0250 (non-injectable prescription drugs), 0290 and/or 0294 [...]

Guidelines for Submitting Prior Authorization Certain Hospital Outpatient Department

General PAR Documentation Requesters must include the following data elements in all PARs to avoid potential delays in processing. Your MAC may request additional, optional elements for submission of the PAR. Initial Submission Documentation: [...]

Dispute Request for Assistance (RFA) Form

CMS Links

  Administrative Simplification Overview Ambulatory Surgical Centers (ASC) Center  Clinical Laboratory Improvement Amendments (CLIA)  Beneficiary Notices Initiative (BNI)  CMS.gov Email Updates CMS.gov Open [...]

Proper Medicare Part B Claim Submissions Due to the Change Healthcare Security Incident

Proper Medicare Part B Claim Submissions Due to the Change Healthcare Security Incident With many providers submitting paper claims due to the Change Healthcare security incident, it is important to submit your claims correctly. Failure to do [...]

MLN Connects® Newsletter: April 11, 2024

MLN Connects® Newsletter: April 11, 2024 Proposed Payment Rules CMS Proposes New Policies to Support Underserved Communities, Ease Drug Shortages, and Promote Patient Safety News CMS Roundup (Apr. 5, 2024) Medicare Shared Savings [...]

NGSConnex Medicare Part B Remittances

NGSConnex Medicare Part B Remittances We’ve added an enhancement that offers providers the option to view/print remittance advices in NGSConnex for up to 24 months from the date of search. You are required to complete the EDI enrollment to [...]

Social Security Income Ratios

Social Security Income Ratios The federal fiscal year 2022 SSI ratios for IPPS hospitals, IRFs and LTCHs were posted on the CMS website. IPPS IRF LTCH We will update the latest published 2022 SSI ratios in the Provider Specific File of [...]

Reimbursing Place of Service 10 at the Nonfacility Rate for Medicare Telehealth Services

In CY 2024, CMS issued a change to processing for telehealth services billed with POS 10. As of 1/1/2024, these claims are to be paid at the nonfacility PFS rate. A system processing issue resulted in incorrect payments at the facility rate and [...]

Submit Supporting Documentation

Submit Supporting Documentation We encourage you to submit cost reports and supporting documentation electronically whenever possible. In addition to the environmental benefits of this approach, it is also more time and cost efficient. The [...]

Part B Top Claim Errors Updated

Part B Top Claim Errors Updated Using data analysis we update the Top Claim Errors on a quarterly basis and provide: the error reason code; a description of the error; the error type; details that include steps you can take to [...]

Hospice Pricer Tool

Hospice Pricer Tool The CMS Web Pricer will assist in evaluating your hospice claim reimbursement. Revised 4/18/2024

MLN Connects® Newsletter: April 18, 2024

MLN Connects® Newsletter: April 18, 2024 News PrEP for HIV: Prepare for Potential Medicare Part B Coverage Events Clinical Laboratory Fee Schedule Upcoming Meetings: Register to Present, Speak, or Attend in Person by June 1 [...]

3/13/2024 Part B POE Advisory Group Meeting

3/13/2024 Part B POE Advisory Group Meeting Meeting Minutes Meeting Time: 10:00 a.m.‒12:00 p.m. ET Member Attendees: Doris Barnes, Aurelio Barraco, Madelon Berger, Ilka Collier, Eileen Conlan, Renay Coonan, Tracy Essling, Stephanie [...]