MLN Connects® for Thursday, April 22, 2021

MLN Connects® for Thursday, April 22, 2021 COVID-19: Partnership to Vaccinate Dialysis Patients & Health Care Personnel View this edition as a: Webpage | PDF News Dialysis Facilities: Partnership to Vaccinate Dialysis Patients [...]

MLN Connects® Newsletter for Thursday, July 1, 2021

MLN Connects® Newsletter for Thursday, July 1, 2021 Quality Payment Program: 2021 APM Incentive Payments View this edition as a: Webpage | PDF News Quality Payment Program: 2021 APM Incentive Payments Compliance Inhalant Drugs: [...]

MLN Connects® Special Edition for Thursday, July 1, 2021

MLN Connects® Special Edition for Thursday, July 1, 2021 CMS Proposes Changes to Reduce Health Care Disparities Among Patients with Chronic Kidney Disease and End-Stage Renal Disease Proposed changes mark Innovation Center’s first direct [...]

MLN Connects® Newsletter for Thursday, August 25, 2022

MLN Connects® Newsletter for Thursday, August 25, 2022 Medicare Secondary Payer: Manual Updates News Interns and Residents Information System XML Format: Updated Vendor List Claims, Pricers, & Codes Integrated Outpatient [...]

Treatment Plans for Cardiac Rehabilitation Services

Treatment Plans for Cardiac Rehabilitation Services ​​​​​​​In order for cardiac rehabilitation services to be covered under Medicare, an individualized treatment plan is required. The individualized treatment plan is a written plan tailored to [...]

Mental Health Crisis Help

Appropriate Use Criteria Program

Capable Recipients for the Advance Beneficiary Notice of Noncoverage

Capable Recipients for the Advance Beneficiary Notice of Noncoverage The purpose of the ABN is to inform a Medicare beneficiary before he or she receives specified items or services that, in this circumstance, Medicare certainly or probably [...]

Medicare Advance Written Notices of Noncoverage Booklet

Provider Compliance Tips for Polysomnography (Sleep Studies)

August and September 2022 LCD, Billing and Coding Article Updates

August and September 2022 LCD, Billing and Coding Article Updates Routine Foot Care and Debridement of Nails – L33636 Under the Limitations section, the active care requirement for systemic conditions has been revised to remove “qualified [...]

Prepare and Submit a Cost Report

MLN Connects® Newsletter for Thursday, June 30, 2022

MLN Connects® Newsletter for Thursday, June 30, 2022 No Surprises Act: Fact Sheets for Your Patients News CMS Issues Significant Updates to Improve the Safety and Quality Care for Long-Term Care Residents & Calls for Reducing Room [...]

MLN Connects® Special Edition for Wednesday, July 27, 2022

MLN Connects® Special Edition for Wednesday, July 27, 2022 3 Final FY 2023 Payment Rules: Hospices, Inpatient Psychiatric Facilities, & Inpatient Rehabilitation Hospices: Learn What’s New for Fiscal Year 2023 Inpatient Psychiatric [...]

MLN Connects® Special Edition for Friday, July 29, 2022

MLN Connects® Special Edition for Friday, July 29, 2022 Skilled Nursing Facilities: Final FY 2023 Payment Rule Skilled Nursing Facilities: Learn What’s New for Fiscal Year 2023 CMS Seeks Public Feedback to Improve Medicare Advantage [...]

MLN Connects® Newsletter for Thursday, September 1, 2022

MLN Connects® Newsletter for Thursday, September 1, 2022 Payment Allowances for Influenza Vaccine News CORRECTION: Monkeypox & Smallpox Vaccines: Include Product Code on Claims COVID-19: Novavax Vaccine Authorized for Patients [...]

Prior Authorization Exemption Status Inquiry Tool Alert

Prior Authorization Exemption Status Inquiry Tool Alert National Government Services continues to see PARs submitted by exempt providers. In an effort to prevent unnecessary submission, NGS has developed a self-service inquiry tool that can [...]

Prior Authorization Exemption Status Inquiry Tool Alert

Prior Authorization Exemption Status Inquiry Tool Alert National Government Services continues to see PARs submitted by exempt providers. In an effort to prevent unnecessary submission, NGS has developed a self-service inquiry tool that can [...]

Seasonal Influenza Vaccines Pricing

Seasonal Influenza Vaccines Pricing For Medicare billing purposes, the flu season runs from August to July of the following year. Medicare Part B covers one flu shot per flu season, if medically necessary, more than one per season may be [...]

Billing for Qutenza Administration (REVISED)

Billing for Qutenza Administration (REVISED) Qutenza is topical high concentration (8%) capsaicin which is administered by a physician. The FDA approved this treatment for neuropathic pain associated with PHN in 2009 and for neuropathic pain [...]

Prior Authorization Exemption Status Inquiry Tool

MLN Connects® Special Edition for Monday, September 12, 2022

MLN Connects® Special Edition for Monday, September 12, 2022 News Updated COVID-19 Vaccines Providing Protection Against Omicron Variant Available at No Cost Posted 9/12/2022

MLN Connects® Newsletter for Thursday, September 15, 2022

MLN Connects® Newsletter for Thursday, September 15, 2022 Make Your Voice Heard News Make Your Voice Heard Request for Information Seeks Public Comment to Promote Efficiency, Reduce Burden, & Advance Equity within CMS Programs [...]

Password Reset Requirements Checklist

Password Reset Requirements Checklist The following information will assist you in successfully resetting your password and eliminate any unnecessary disconnects. You should note that passwords expire every 60 days and can be reset prior to [...]

Changing Your EDI Password

Changing Your EDI Password EDI passwords have to be regularly changed or reset to maintain data security. You should note that passwords expire every 60 days and can be changed or reset prior to expiration. Follow these steps to change your [...]

EDI Self-Service Gateway Password Portal

EDI Self-Service Gateway Password Portal The EDI Gateway Self-Service Password Portal is a simple/secure, web-based process for changing or resetting passwords for EDI Trading Partners. There are differences in the steps for these password [...]

MLN Connects® Newsletter for Thursday, September 22, 2022

MLN Connects® Newsletter for Thursday, September 22, 2022 Encourage Preferred Flu Vaccines for Patients 65+ News Flu Shot: Encourage Preferred Vaccines for Patients 65+ Cataract Surgery: Comparative Billing Report Do You Only Order or [...]

Notice Regarding Targeted Probe and Educate Topic: Breast Ultrasound

Notice Regarding Targeted Probe and Educate Topic: Breast Ultrasound National Government Services has received approval from CMS to deny related claims (modifier 26 and/or TC) in accordance to the CMS IOM Publication 100-08, Medicare Program [...]

Billing and Coding and Medical Policy Article Updates September/October 2022

Billing and Coding and Medical Policy Article Updates September/October 2022 Billing and Coding: Bevacizumab and biosimilars (A52370) Based on Transmittal 11594, (CR 12885) October 2022 Update of the Hospital OPPS, HCPCS code C9142 has been [...]

Reminder: Documenting Physical Therapy Services

Reminder: Documenting Physical Therapy Services Insufficient documentation causes most improper payments. Visit our CERT Alerts webpage for Topic specific articles that provide instructions and resources for submitting appropriate [...]

Removal of HCPCS Code

Removal of HCPCS Code Prior Authorization Update Effective immediately, for claims with dates of service on or after 1/7/2022, the Centers for Medicare & Medicaid Services is removing current procedural terminology code 67911 (correction [...]

Appropriate Use Criteria

MLN Connects® Newsletter for Thursday, September 29, 2022

MLN Connects® Newsletter for Thursday, September 29, 2022​​​​​​​ News Resources & Flexibilities to Assist with Public Health Emergency in Puerto Rico Resources & Flexibilities to Assist with Public Health Emergency in Florida [...]

Diabetes Awareness

Drugs and Biologicals

Sleep Studies

Timely Filing

Medically Unlikely Edits

Free Medicare Home Health YouTube Videos

Free Medicare Home Health YouTube Videos National Government Services has a plethora of educational Medicare Home Health YouTube videos regarding billing and documentation. These videos are free, short in length and very informative. They [...]

Free Medicare Hospice YouTube Videos

Free Medicare Hospice YouTube Videos National Government Services has an array of educational Medicare Hospice YouTube videos regarding billing and documentation. These videos are free, short in length and very informative. They contain [...]

Home Health Benefit

Coding and Edits

Do You Only Order or Certify Services? Use Revised Enrollment Form CMS-855O by January 1

Do You Only Order or Certify Services? Use Revised Enrollment Form CMS-855O by January 1 The revised Enrollment for Eligible Ordering/Certifying Physicians and Other Eligible Professionals (Form CMS-855O) is required beginning 1/1/2023. We’ll [...]

MLN Connects® Newsletter for Thursday, October 6, 2022

MLN Connects® Newsletter for Thursday, October 6, 2022​​​​​​​ News Resources & Flexibilities to Assist with Public Health Emergency in South Carolina Implementation of Inflation Reduction Act Provision Addressing Medicare Payments [...]

Billing Medicare for a Denial - Condition Code 21

Billing Medicare for a Denial - Condition Code 21 Medicare will not pay for services excluded by statute. For claims submitted to Medicare, these excluded services that are not a Medicare benefit may be: Not submitted to Medicare at all [...]

Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System

Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System This notice is to remind providers on the correct process for deleting a revenue code line in FISS DDE. If providers have claim [...]

Billing

Lung Cancer Screening

Drugs and Biologicals

Pain Management

Introducing our new Medicare Topic: Tobacco Cessation

Introducing our new Medicare Topic: Tobacco Cessation Visit our new designated Tobacco Cessation Medicare Topic for everything health care providers need to know about Medicare coverage for tobacco cessation counseling including coverage [...]

Tobacco Cessation

Frequently Asked Questions

MLN Connects® Newsletter: October 13, 2022

MLN Connects® Newsletter: October 13, 2022 News Protect Your Patients in October: Give Them a Flu Shot and COVID-19 Vaccine Vacating Differential Payment Rate for 340B-Acquired Drugs in 2022 Outpatient Prospective Payment System Final [...]

Drugs and Biologicals Frequently Asked Questions

Drugs and Biologicals Frequently Asked Questions We’ve added new frequently asked questions to our website. View answers to common questions about Drugs and Biologicals to ensure you have the information needed to properly submit claims for [...]

The Home Health and Hospice Targeted Probe and Educate Process

The Home Health and Hospice Targeted Probe and Educate Process Medical Review conducts TPE on claims from all providers under the Medicare Program. Protect your revenue by gaining more knowledge regarding TPE audits. Providers targeted for [...]

Provider Outreach and Education Events

Provider Outreach and Education Events Our Provider Outreach and Education team offers a wealth of educational sessions for a variety of Medicare topics throughout the year. Because there are so many choices, we’ve improved the Search [...]

A/B and DME Collaborative Glucose Monitors and Supplies

A/B and DME Collaborative Glucose Monitors and Supplies View the A/B and DME Collaborative Glucose Monitors and Supplies YouTube Video for coverage criteria, documentation requirements and resources for glucose monitors and supplies. Posted [...]

MLN Connects® Newsletter: October 20, 2022

MLN Connects® Newsletter: October 20, 2022 News Skilled Nursing Facility Provider Preview Reports: Review by November 14 Help Your Patients Make Informed Health Care Decisions Ambulance Fee Schedule: CY 2023 Ambulance Inflation Factor [...]