MLN Connects® Newsletter: December 7, 2023

MLN Connects® Newsletter: December 7, 2023 News Citrix Bleed Vulnerability: Act Now Marriage and Family Therapists & Mental Health Counselors: Enroll in Medicare Now Health Professional Shortage Area: CY 2024 Bonus Payments [...]

Reminder: OPPS Provider-Based Edits

Reminder: OPPS Provider-Based Edits Are you having issues with the recently implemented provider-based billing edits impacting OPPS facilities with multiple service locations? Certain edits were implemented on/after 8/1/2023 to ensure you are [...]

CR13468 - Payment of Codes for Chemotherapy Administration and Nonchemotherapy Injections and Infusions

CR13468 - Payment of Codes for Chemotherapy Administration and Nonchemotherapy Injections and Infusions Posted 12/8/2023

Physicians/Practitioners! Are You Ordering Oxygen for Your Patients?

Physicians/Practitioners! Are You Ordering Oxygen for Your Patients? This is your opportunity to hear directly from the Medicare contractors regarding documentation required for coverage criteria to be met and allow your patients to receive [...]

A/B MACs Team Up with DME MACs for Glucose Monitor and Supplies Webinar on August 25

A/B MACs Team Up with DME MACs for Glucose Monitor and Supplies Webinar on August 25 Local A/B MACs and the DME MACs are excited to announce a collaboration webinar coming Thursday, August 25. This webinar will focus on what providers need to [...]

Remittance Advice Codes: What Are They and Where to Find What They Mean

Remittance Advice Codes: What Are They and Where to Find What They Mean Table of Contents Claim or Service Line Level Adjustments: Using Group Codes, Claim Adjustment Reason Codes and Remittance Advice Remark Codes Group Codes Claim [...]

Related Content

Related Content Centers for Medicare & Medicaid Services (CMS) Telehealth web page CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 CMS IOM Publication 100-04, Medicare Processing Manual, Chapter 12, Section 190 [...]

Molecular Pathology Procedures Reminder

Molecular Pathology Procedures Reminder National Government Services has been receiving many claims submitted for redetermination that were submitted for Group 3 Molecular Pathology Procedures. The Group 3 codes from LCD (L35000/A56199) are [...]

Physical, Occupational and Speech and Language Pathology Therapy Services: Prevent Easily Avoidable Errors

Physical, Occupational and Speech and Language Pathology Therapy Services: Prevent Easily Avoidable Errors Evaluation/Plan of Care Documentation Elements The POC must contain, at a minimum, the following required elements: Diagnoses [...]

National Government Services Proposed LCDs For Comment

National Government Services Proposed LCDs For Comment The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 6/9/2022 through 7/23/2022. These [...]

CMS Medically Unlikely Edits

January 2024

In This Issue National Government Services Articles for Part A and Part B Providers New Version of PC-ACE: January 2024 January 2024 Billing and Coding Articles Updates Micro-invasive Glaucoma Surgery Update Improving Customer [...]

The Importance of Proper Documentation

The Importance of Proper Documentation The CERT contractor randomly selects claims providers submit to Medicare to determine if the claim was paid properly under Medicare coverage, coding and billing rules by requesting medical records. If the [...]

MLN Connects® Newsletter: December 14, 2023

MLN Connects® Newsletter: December 14, 2023 News CMS Releases Revised Guidance for Medicare Prescription Drug Inflation Rebate Program Medicare Part B Inflation Rebate Guidance: Use of the 340B Modifier — Revised Billing for Flu, [...]

Medicare Demand Letter Rebuttals

Medicare Demand Letter Rebuttals National Government Services has seen an influx of overpayment rebuttal inquiries and here’s what you need to know. Rebuttals should be rare and only approved if NGS has processed an account(s) receivable [...]

The New York Regional Office of CMS – Monthly Office Hours/Open Forum

The New York Regional Office of CMS – Monthly Office Hours/Open Forum The New York Regional Office of CMS (Region 2) conducts a monthly Office Hours/Open Forum meeting that allows physicians and their office staff to interact with and ask [...]

LCD and Billing and Coding Article Updates for November/December 2023

LCD and Billing and Coding Article Updates for November/December 2023 LCDs Effective 12/24/2023 Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound  (L39139/A58893) This is a [...]

Knowing Where to Look for EDI Enrollment Packet Data

Knowing Where to Look for EDI Enrollment Packet Data Periodically, EDI Enrollment will be publishing articles to help eliminate the number of EDI applications that are denied. Signature is Incorrect: All EDI documents require that the person [...]

Provider Enrollment Application Fee Amount for CY 2024

Provider Enrollment Application Fee Amount for CY 2024 The provider enrollment application fee for calendar year 2024 is $709. For more information, view CMS’ MLN Connects® Newsletter, Wednesday, November 22, 2023. Posted 12/21/2023

New A/B and DME Collaborative YouTube Video

New A/B and DME Collaborative YouTube Video The A/B DME MACs are offering a YouTube video on Therapeutic Shoes for Persons with Diabetes. This video provides guidance on coverage criteria, documentation requirements, certifying physicians and [...]

MLN Connects® Newsletter: December 21, 2023

MLN Connects® Newsletter: December 21, 2023 News CMS Roundup (Dec 15, 2023) Opioid Use Disorder Screenings & Treatment: Medicare Pays for Services Opioid Treatment Programs: New Information for 2024 Skilled Nursing Facility [...]

Tobacco Counseling via Telehealth

Tobacco Counseling via Telehealth Health equity in telehealth is the opportunity for everyone to receive the health care they need and deserve, regardless of social or economic status. Medicare Part B covers intermediate and intensive tobacco [...]

Announcing Service Specific Post-Payment Audits of Individual Psychotherapy Services for J6 A Regions: IL, WI and MN

Edit Reason Code: 5FSEP Bill Type = 13X, 85X CPT/HCPCS/Modifiers:90832- 90834 Overview The Medical Review Department of National Government Services will be performing service specific post-payment reviews for claims submitted to Medicare [...]

Tips for Documenting Homebound Status

Tips for Documenting Homebound Status Comprehensive and accurate documentation is crucial to providing safe and effective care to Medicare beneficiaries. National Government Services' medical review team reviews this documentation while making [...]

Physicians and Nonphysician Practitioners: Revised CMS-855I Medicare Enrollment Application Required November 1 (Combined CMS-855I and CMS-855R)

Physicians and Nonphysician Practitioners: Revised CMS-855I Medicare Enrollment Application Required November 1 (Combined CMS-855I and CMS-855R) If you don’t use PECOS, use the revised CMS-855I (Medicare Enrollment Application - Physicians and [...]

Update: End Stage Renal Disease Claim Adjustments Needed Due to CWF Error in Date of First Dialysis

Update: End Stage Renal Disease Claim Adjustments Needed Due to CWF Error in Date of First Dialysis As of 7/18/2023, CMS has identified that the CWF continues to have some inaccurate dates for the first date of dialysis. We will advise when [...]

I Am a Provider and “I Want to Complete an EDI Registration Form”

I Am a Provider and “I Want to Complete an EDI Registration Form” This selection will prompt you to complete the EDI Registration Form. This option is for providers who wish to submit claim files using a third party such as a billing service [...]

I Am a Provider and “I Want to Complete a Connex Registration Form”

I Am a Provider and “I Want to Complete a Connex Registration Form” This selection will prompt you to complete the Connex Registration Form. This option is for providers who wish to send claims or receive remits through the NGSConnex portal. [...]

Clearinghouse

Clearinghouse When Clearinghouse is selected as your submitter type the following objective will be displayed. Select the objective and then click Next. I am a Clearinghouse and “I want to complete an EDI Registration Form” This objective [...]

Common Questions

Common Questions What is the Entity Name? This is the EXACT provider’s name that was submitted in section 2 of the CMS-855/PECOS enrollment application when applying to participate with Medicare.   What information should be put in [...]

I Am a Provider and “I Want to Connect Directly to the Part A FISS/DDE System”

I Am a Provider and “I Want to Connect Directly to the Part A FISS/DDE System” This selection will prompt you to complete the Logon Request Form. This option is for providers who need to request, modify, reinstate, or add additional access to [...]

I Am a Provider and “I Want to Allow a 3rd Party Billing Service to Bill for Me Using the Part A FISS DDE System”

I Am a Provider and “I Want to Allow a 3rd Party Billing Service to Bill for Me Using the Part A FISS DDE System” This selection will prompt you to complete the Letter of Authorization Form. This option is for providers who wish to allow [...]

I Am a Billing Service and “I Want to Complete an EDI Registration Form”

I Am a Billing Service and “I Want to Complete an EDI Registration Form” This selection will prompt you to complete the EDI Registration Form. This objective is for billing services who need to obtain a new TPID or make a change to an [...]

Hierarchy of Medicare Regulations

Hierarchy of Medicare Regulations Have you wondered how Medicare determines what is covered? Below you will find the hierarchy of how Medicare regulations are created. Social Security Act Title XVIII of the Social Security Act is [...]

MLN Connects® Newsletter: October 19, 2023

MLN Connects® Newsletter: October 19, 2023     News 2024 Medicare Parts A & B Premiums and Deductibles Help CMS Improve Provider Resources — Respond by November 9 CMS Health Information Handler Helps You Submit [...]

PC-ACE Software Instructions, Resources and Guides

PC-ACE Software Instructions, Resources and Guides Creating a 276 Claim Status Request in PC-ACE and Importing and Reading the 277 Claim Status Report PC-ACE Software – For Professional Users: Importing and Reading the 999 & 277CA Files [...]

PC-ACE Software Instructions, Resources and Guides

PC-ACE Software Instructions, Resources and Guides Creating a 276 Claim Status Request in PC-ACE and Importing and Reading the 277 Claim Status Report PC-ACE - For Institutional Users: Importing and Reading the 999 and 277CA Files PC-ACE [...]