Determine if Medicare is Primary or Secondary for a Beneficiary's Services

Table of Contents Determine if Medicare is Primary or Secondary for a Beneficiary's Services Step 1: Collect MSP Information from the Beneficiary During an MSP Screening Process Step 2: Check for Open MSP Records for a Beneficiary in [...]

Fundamentals of Medicare

Track the Status of Your Application

How to Search You may track the status of your provider enrollment application (PECOS or paper) submissions via the: Check Provider Enrollment Application Status tool by: Case number/web tracker id or NPI and TIN combination [...]

Provider Enrollment Application Process Timeline

All MACs, including National Governments Services, have a goal to finalize an Internet-based PECOS application within 15 days and a CMS-855 paper application within 30 days, if all required information is available. About the Application [...]

PECOS Application Status Tool

The status of your application is indicated by the step that is highlighted. If an application fee is required, an additional step will be added and the system will generate five steps. Your application was successfully [...]

Identify the Proper Order of Payers for a Beneficiary's Services

Table of Contents Background Step 1: Check for Open Medicare Secondary Payer Records for the Beneficiary in the Common Working File Step 2: Collect MSP Information from the Beneficiary  Step 3: Compare the MSP Information you [...]

Checking Eligibility and Knowing Your Point of Contact

Checking Eligibility and Knowing your Point of Contact Table of Contents Checking Eligibility and Knowing your Point of Contact How to Verify Patient Eligibility Related Content Listed below are the different patient eligibility and [...]

Go Paperless Today - Protect Your Bottom Line

Go Paperless Today ‒ Protect Your Bottom Line Every day is a great day to choose electronic solutions rather than paper. Make today the day you go electronic. If you are sending paper to National Government Services, change that now. You can [...]

Medicare Home Health Collaboration with Other Provider Types

Medicare Home Health Collaboration with Other Provider Types Table of Contents The Medicare Home Health Benefit Therapy Providers and the Home Health Benefit Durable Medical Equipment Suppliers and the Home Health Benefit Hospice and the [...]

One Week Until Beneficiary Eligibility Information Leaves the IVR

One Week Until Beneficiary Eligibility Information Leaves the IVR  As we’ve communicated, beginning 11/18/2024, beneficiary eligibility information will not be offered on the IVR. This includes all beneficiary eligibility information that [...]

CERT Program Information

CERT Program Information What Is the CERT Program? The CMS implemented the CERT program to measure improper payments in the Medicare FFS program. CERT selects a stratified random sample of claims submitted to Part A/B MACs and DME MACs [...]

CERT Tools

CERT Tools   Centers for Medicare & Medicaid Services CERT Page  CERT C3HUB provider website CERT Reports Revised 11/13/2024

CERT Tools

CERT Tools Centers for Medicare & Medicaid Services CERT Page  CERT C3HUB provider website CERT Reports  Revised 11/13/2024

Announcement About Medicare Participation for Calendar Year 2025

Announcement About Medicare Participation for Calendar Year 2025 The Centers for Medicare & Medicaid Services has posted the Announcement About Medicare Participation for Calendar Year 2025. Posted 12/2/2024

Checking Medicare Eligibility

Checking Medicare Eligibility To determine the last date a patient received tobacco cessation counseling, providers can check patient eligibility through these online tools and services: Table of Contents NGSConnex HIPAA Eligibility [...]

Provider Enrollment: Reminder for Open Enrollment and Participation Agreement

Provider Enrollment: Reminder for Open Enrollment and Participation Agreement The 2025 Annual Participation Open Enrollment Period is approaching for another year. While this is an important time (from mid-November to December 31) for [...]

Register Now for the 2024 Preventive Services Virtual Conference!

Register Now for the 2024 Preventive Services Virtual Conference! Dive deep into critical preventive services topics! All Part B Providers! Register now for the National Government Services Medicare Part B 2024 Preventive Services Virtual [...]

Explore Our Exciting Sessions at the 2024 Preventive Services Virtual Conference!

Explore Our Exciting Sessions at the 2024 Preventive Services Virtual Conference! View All Our Sessions and Register Now! As we gear up for the National Government Services Medicare Part B 2024 Preventive Services Virtual Conference, we [...]

Next Week - 2024 Preventive Services Virtual Conference!

Next Week – 2024 Preventive Services Virtual Conference! We hope you’re as excited as we are about the upcoming National Government Services Medicare Part B 2024 Preventive Services Virtual Conference, taking place on December 9th to 11th! [...]

Submitting Electronic Medical Records

Submitting Electronic Medical Records National Government Services can accept medical records submitted on a CD or thumb drive however, submitting via our free, secure, web-based portal NGSConnex is preferred and far more advantageous for [...]

Medicare Part A Rebuttal Form

Medicare Part B Rebuttal Form

Provider Enrollment Appeals Cover Sheet

Provider Enrollment Appeals Cover Sheet

Common Working File Incorrectly Rejecting for Edit 538H

National Government Services is informing Part A and Part B providers of an error in CWF in the Eligibility Database, incorrectly identifying some beneficiaries as incarcerated and rejecting new claims for Edit 538H. This may also generate [...]

Pricing <5>

table, td, th table { border-collapse: collapse; width: 50%; } Pricing <5> When Pricing is selected, the IVR will When Pricing is selected, the IVR will play the following: "To obtain pricing information, visit NGSMedicare.com and [...]

Submitting Electronic Medical Records via CD or Thumb Drive

Submitting Electronic Medical Records via CD or Thumb Drive National Government Services can accept medical records submitted on a CD or thumb drive however, submitting via our free, secure, web-based portal NGSConnex is preferred and far more [...]

Eligibility

Eligibility information is no longer available via the IVR. To obtain Eligibility information login to NGSConnex and select Eligibility Lookup. If you haven’t already registered for NGSConnex, you can obtain detailed step-by-step instructions [...]

Documentation Submission Responsibilities

Documentation Submission Responsibilities When medical records are requested, the billing provider is responsible to obtain sufficient documentation to support the medical necessity of the service(s) billed. If the documentation is [...]

Part B Claims Impacted by CWF CLIA File Issue

The CWF Host has recognized an issue in the CLIA file and has successfully reloaded the corrected CLIA file.

Correct or Adjust a Claim Due to an MSP-Related Issue

Table of Contents Background Step 1: Identify the Fiscal Intermediary Shared System Direct Data Entry Status Location of the Claim and the Reason for the Claim Correction or Change Status Location TB9997 (Returned to Provider Claims) [...]

Correcting Reason Code 37253

Correcting Reason Code 37253 To ensure home health claim information aligns with OASIS data, the iQIES OASIS claim data match is essential. If no matching assessment is found in iQIES when a claim is submitted, it will be returned with reason [...]

Hospital Acquired Conditions and Present on Admission Resource for Physicians

Hospital Acquired Conditions and Present on Admission Resource for Physicians Did you know that documentation about your patient’s inpatient stay is vital for accurate submission of an inpatient hospital claim to Medicare? This resource [...]

Revalidation Application Checklist

Revalidation Application Checklist Use the Revalidation Application Checklist to assist when revalidating your enrollment information. The general checklist will allow you to understand requirements while the PECOS and CMS-855 paper [...]

Verify Bank Account Information

National Government Services receives numerous electronic funds transfer banking rejections each year due to frozen or closed bank accounts. To prevent interruption in Medicare payment, billing providers verify an active bank account is [...]

November 2024

In This Issue National Government Services Articles for Part A and Part B Providers Local Coverage Determination Open Meeting Reminder – Beginning 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR NGSConnex: Overview, [...]

Prevent Revalidation Processing Delays

When National Government Services receives a revalidation application, we often determine additional information is needed to process the application. In those cases, a request for additional information is sent which is commonly referred to as [...]

How to Search on the Medicare Revalidation List Tool for Due Date

Table of Contents How to Search on the Medicare Revalidation List Tool for Due Date Find a Provider By NPI By Name Associated Datasets [Return to Top] How to Search on the Medicare Revalidation List Tool for Due Date [...]

Revalidate My Enrollment

Step 1: Determine You Are in the Right Place Medicare provider enrollment revalidation is part of the Patient Protection and Affordable Care Act, Section 6401(a), which established a requirement for all enrolled providers/suppliers to [...]

Revalidate My Enrollment

Step 1: Determine You Are in the Right Place Medicare provider enrollment revalidation is part of the Patient Protection and Affordable Care Act, Section 6401(a), which established a requirement for all enrolled providers/suppliers to [...]

Deactivation of Billing Privileges/Suspension of Payment

Reasons for Deactivation of Medicare Billing Privileges/Suspension of Payment (not all inclusive) Inactivity Failure to complete revalidation within required time frame Unreported provider address and/or bank information Inactivity [...]

Deactivation of Billing Privileges/Suspension of Payment

Reasons for Deactivation of Medicare Billing Privileges/Suspension of Payment (not all inclusive) Inactivity Failure to complete revalidation within required time frame Unreported provider address and/or bank information [Return to [...]

Revalidate My Enrollment

Table of Contents Step 1: Determine You Are in the Right Place What’s ahead for your next Medicare enrollment revalidation? How will you know if you are due for revalidation? Step 2: Complete the Medicare Application Step 3: [...]

No Documentation Received

No Documentation Received National Government Services has experienced an increasing number of CERT errors due to “no documentation” received. The provider either does not respond to the CERT documentation request letter(s), or the provider [...]

Signature Requirements

Signature Requirements National Government Services has experienced an increasing number of CERT errors due to “signature requirements” not being met. Providers are not signing orders, certification/recertification forms or office visit notes. [...]

Appeals Process after Claims Correction or Denial

Appeals Process after Claims Correction or Denial CERT Process The CERT contractor randomly selects claims submitted to Medicare. Medical records are requested from the providers and then reviewed by health care professionals. The review is [...]

Physical Therapy Services

Physical Therapy Services Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means something was missing from the medical records. Below is a list of the most common reasons CERT determined there was [...]

Home Prothrombin Time International Normalized Ratio Monitoring for Anticoagulation Management

Home Prothrombin Time International Normalized Ratio Monitoring for Anticoagulation Management Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means that something was missing from the medical records. [...]

Psychological and Neuropsychological Testing

Psychological and Neuropsychological Testing Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means that something was missing from the medical records.  Below is a list of the most common reasons CERT [...]

Pulmonary Rehabilitation Program Services

Pulmonary Rehabilitation Program Services Insufficient Documentation Causes Most Improper Payments Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT [...]

Patient Discharge Disposition Code

Patient Discharge Disposition Code Improper payments due to discharge disposition codes are costly to the Medicare Program and are easily preventable. The CERT contractor has issued errors related to the discharge disposition codes that may [...]

Debridement Services

Debridement Services Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was [...]

Chronic Care Management

Chronic Care Management Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records.  Below is a list of the most common reasons CERT determined there was [...]

Total Joint Arthroplasty

Total Joint Arthroplasty Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records. Providers can help prevent CERT errors on total joint arthroplasty by [...]

Botulinum Toxin Injections for Chronic Headaches

Botulinum Toxin Injections for Chronic Headaches Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT [...]

Home Health Care Requirements for a Plan of Care

Home Health Care Requirements for a Plan of Care The HHA must be acting upon a physician plan of care that meets the requirements of this section for HHA services to be covered. For HHA services to be covered, the individualized plan of care [...]

Chiropractic Services

Chiropractic Services Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was [...]

Amending Medical Records

Amending Medical Records Amendments, Corrections and Delayed Entries in Medical Documentation    All services provided to beneficiaries are expected to be documented in the medical record at the time they are rendered. [...]

Continuous Cycling Peritoneal Dialysis

Continuous Cycling Peritoneal Dialysis We have experienced an increasing number of CERT errors due to documentation requirements not being met. Below is a list of the most common reasons CERT determined there was insufficient documentation [...]