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Posting Date: 09/12/2024
Understanding Authorized Official and Delegated Official Roles
Table of Contents Understanding Authorized Official and Delegated Official Roles Medicare Enrollment Records CMS Identity and Access Management System [Return to Top] Understanding Authorized Official and Delegated Official Roles [...]
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Posting Date: 09/12/2024
National Government Services Medicare Part B Care Management Services September Series
National Government Services Medicare Part B Care Management Services September Series According to the CDC, six in ten adults in the U.S. have a chronic disease and four in ten adults have two or more. As your Medicare Contractor for [...]
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Posting Date: 09/12/2024
MLN Connects® Newsletter: September 12, 2024
MLN Connects® Newsletter: September 12, 2024 News COVID-19: Updated Vaccines for 2024–2025 Season Rural Emergency Hospital Provisions, Conversion Process, & Conditions of Participation: Revised Guidance CMS Roundup (September 6, 2024) [...]
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Posting Date: 09/12/2024
Portable X-Ray Pricing Update
Portable X-ray pricing fees for CY 2024 will have new fees in production by 9/6/2024.
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Posting Date: 09/02/2022
Check Appeal Status
Check Appeal Status Table of Contents Check Appeal Status Check Status of Requests Submitted in NGSConnex Check Status of Requests Not Submitted in NGSConnex [Return to Top] Check Appeal Status Click the Appeals button from the [...]
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Posting Date: 09/13/2024
Ambulance Services and Establishing Medical Necessity for Part B Providers
This webinar will help the ambulance community understand the importance of medical necessity as it pertains to Medicare’s coverage guidelines.
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Posting Date: 10/26/2022
Provider Qualifications
Podiatry Billing Guide Provider Qualifications A doctor of podiatric medicine is a physician, but only with respect to those functions which he/she is legally authorized to perform in the State in which he/she performs them. The [...]
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Posting Date: 12/12/2014
Billing for FQHC MAO Plan Supplemental Payment (PPS Providers)
Billing for FQHC MAO Plan Supplemental Payment (PPS Providers) Medicare will provide supplemental payments to FQHCs that contract with MAOs to cover the difference, between the payment received from the MAO and the payment to which the FQHC [...]
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Posting Date: 09/13/2024
Credit Balance Reporting Reminder: Submissions for Quarter Ending 9/30/2024 Start Soon!
Credit Balance Reporting Reminder: Submissions for Quarter Ending 9/30/2024 Start Soon! CBR submissions can be submitted starting on 10/1/2024 and are due within 30 days to be considered timely. Remember, even if no monies are owed to Medicare [...]
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Posting Date: 10/26/2021
Introduction to Podiatry Services
Podiatry Billing Guide Introduction to Podiatry Services Foot Care Table of Contents Treatment of Subluxation of Foot Exclusions from Coverage Exceptions to Routine Foot Care Exclusion Systemic Conditions That Might Justify Coverage [...]
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Posting Date: 10/26/2022
Podiatry Local Coverage Determinations
Podiatry Billing Guide Podiatry Local Coverage Determinations Table of Contents LCD for Routine Foot Care and Debridement of Nails (L33636) LCD for Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory [...]
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Posting Date: 10/26/2022
Podiatry National Coverage Determinations
Podiatry Billing Guide Podiatry National Coverage Determinations The following are in reference to CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1. Part 1 Section 20.29 [...]
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Posting Date: 10/26/2022
Modifier Usage
Podiatry Billing Guide Modifier Usage 25 – Significant, Separately Identifiable E/M Service by the Same Physician on the Same Day of the Procedure or Other Service Medicare allows payment for an E/M service performed on the same [...]
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Posting Date: 10/26/2022
Podiatry Coding Tips
Podiatry Billing Guide Podiatry Coding Tips Coding Information Procedure codes may be subject to NCCI edits or OPPS packaging edits. Refer to CCI and OPPS requirements prior to billing Medicare. For services requiring a [...]
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Posting Date: 10/26/2022
Advance Beneficiary Notice of Noncoverage/National Correct Coding Initiative
Podiatry Billing Guide Advance Beneficiary Notice of Noncoverage/National Correct Coding Initiative ABN Services denied as not reasonable and medically necessary, under Section 1862(a) (1) of the Social Security Act, are subject to [...]
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Posting Date: 10/26/2021
Related Content
Related Content CMS IOM Publication 100-01, Medicare General Information, Eligibility and Entitlement, Chapter 5, Section 70.3 CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 290: Foot Care CMS [...]
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Posting Date: 10/26/2021
Biopsy to Prove Onychomycosis in Routine Foot Care
Biopsy to Prove Onychomycosis in Routine Foot Care National Government Services has been made aware of a situation where podiatrists have been approached by laboratories stating that they need to biopsy their patients to make sure they have [...]
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Posting Date: 02/26/2024
Ambulance Duplicate Claim Denials
Ambulance Duplicate Claim Denials Duplicate trips may be reported on the same claim if the ZIP code for the point of pick-up for both trips is the same. If separate claims are submitted for the same beneficiary on the same day with the same [...]
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Posting Date: 06/01/2023
How to Avoid and Correct Duplicate Claim Denials
How to Avoid and Correct Duplicate Claim Denials A duplicate claim submission occurs when a physician or other qualified healthcare professional resubmits a claim either on paper or electronically for a single encounter and the service is [...]
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Posting Date: 09/16/2024
Care Management: Principal Care Management Services
As part of a continued series, National Government Services (NGS) is raising awareness on the benefits of care management. During this webinar, we’ll discuss principal care management services for patients with a single chronic condition and [...]
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Posting Date: 09/16/2024
Third Quarter Top Ten EDI Part B Edits
Third Quarter Top Ten EDI Part B Edits Using data analysis we’ve updated the Top Ten EDI Edits for the third quarter. Visit Quarterly Top Ten EDI Part B Edits to view the edits and their description, and learn how you can quickly identify the [...]
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Posting Date: 09/16/2024
Third Quarter Top Ten EDI Institutional Edits
Third Quarter Top Ten EDI Institutional Edits Using data analysis, we’ve updated the Top Ten EDI Edits for the third quarter. Visit Quarterly Top Ten EDI Institutional Edits to view the edits and their description, and learn how you can [...]
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Posting Date: 07/11/2022
Meeting Minutes
Meeting Minutes Jurisdiction 6 Illinois, Minnesota, Wisconsin Jurisdiction K Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont Jurisdiction 6 and Jurisdiction K Combined Meeting 8/8/2024 4/4/2024 12/7/2023
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Posting Date: 07/05/2022
Audit and Reimbursement
Audit and Reimbursement Cost Report Filing State/Region Contact Information Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont Bobbi Jo Luciano Office: South Portland, ME [...]
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Posting Date: 09/16/2024
Podiatry Services - Routine Foot Care and Debridement of Nails
While the Medicare Program generally excludes routine foot care services from coverage, there are specific indications or exceptions under which there are program benefits. Medicare payment may be made for routine foot care when the patient has [...]
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Posting Date: 01/02/2024
Medicare Part B Final Rule 2024
Medicare Part B Final Rule 2024 CMS announced finalized policy changes for Medicare payments under the PFS, and other Medicare Part B topics, effective on or after 1/1/2024. The CY 2024 PFS final rule is one of several final rules that [...]
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Posting Date: 11/07/2022
Who Can Bill for Diabetes Self-Management and Medical Nutrition Therapy?
Who Can Bill for Diabetes Self-Management and Medical Nutrition Therapy? Table of Contents Who Can Bill for Diabetes Self-Management and Medical Nutrition Therapy? Who Can Bill for DSMT Billable Codes for Diabetes Self-Management Training [...]
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Posting Date: 11/07/2022
Common Questions for Diabetes Self-Management Training and Medical Nutrition Therapy
Common Questions for Diabetes Self-Management Training and Medical Nutrition Therapy Table of Contents Diabetes Programs Billing for Services DSMT and MNT Telehealth Services Related Content [Return to Top] Diabetes Programs [...]
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Posting Date: 11/07/2022
Common Questions for Diabetes Self-Management Program Accreditation
Common Questions for Diabetes Self-Management Program Accreditation Does my organization need to be accredited to bill for DSMT services? Answer: Yes. In order to bill Medicare for DSMT services, your organization’s DSMT program must be [...]
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Posting Date: 11/07/2022
Medical Nutrition Therapy Tool for Billing
Medical Nutrition Therapy Tool for Billing CMS considers DSMT and MNT complementary services. This means Medicare will cover both DSMT and MNT without decreasing either benefit as long as the referring physician determines that both are [...]
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Posting Date: 11/07/2022
Medicare Diabetes Prevention Program
Medicare Diabetes Prevention Program Table of Contents Background What is the Medicare Diabetes Prevention Program? Overview of MDPP What is Covered Through the Model? How Does the Model Pay for MDPP Services? What Does this [...]
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Posting Date: 06/13/2022
Remote Physiological Monitoring and Cardiovascular Monitoring Service and Billing Information
Remote Physiological Monitoring and Cardiovascular Monitoring Service and Billing Information Table of Contents Remote Physiological Monitoring Services CPT Codes: 99091, 99453, 99454, 99457, 99458 Remote Physiological Monitoring [...]
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Posting Date: 09/17/2024
National Government Services Contractor Advisory Committee Meeting
National Government Services Contractor Advisory Committee Meeting There will be a multi-jurisdictional CAC meeting held on Thursday 10/17/2024 at 3:00-5:00 p.m. ET, 2:00-4:00 p.m. CT. Meeting details can be found on the National Government [...]
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Posting Date: 09/19/2024
Laboratory and Diagnostic Services: Documentation Responsibilities
Laboratory and Diagnostic Services: Documentation Responsibilities When National Government Services is conducting a pre-pay or post-pay review of claims and services, we may request additional documentation. The billing provider must obtain [...]
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Posting Date: 11/01/2021
Global Surgery
Global Surgery Table of Contents Definition of a Global Surgical Package Where can I find the postoperative periods for covered surgical procedures? What services are included in the global surgery payment? What services are not [...]
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Posting Date: 08/10/2023
Duplicate Claim Editing Information
Duplicate Claim Editing Information Part B Duplicate Claim Edit National Government Services implemented a Part B duplicate claim edit in our EDI front-end processing system for Part B providers. Providers are notified that a claim is a [...]
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Posting Date: 09/19/2024
Part A Incorrect Dialysis Payments
We have recently become aware of an issue which began on 7/15/2024 where ESRD claims with demo code 94P were finalizing with incorrect payment amounts (overpayments as well as underpayments). The incorrect payment amount is a result of FISS [...]
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Posting Date: 09/19/2024
Care Management: Chronic Care Management Services
As part of a continued series, we’re raising awareness of the benefits of care management. During this webinar, we’ll focus on chronic care management services for patients with chronic conditions. We’ll share resources and review proper [...]
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Posting Date: 10/15/2021
Physician Dialysis Services
Physician Dialysis Services Table of Contents Physician Dialysis Services Monthly Capitation Payment Coding Claim Submission Tips Billing for a Partial Month Documentation Requirements Related Content [...]
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Posting Date: 11/23/2021
Oncology Care Model
Oncology Care Model Note: If you did not register for the CMS OCM during the open application and selection period, then you are not a part of this program. The names of those practices and payers participating in OCM can be found on the OCM [...]
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Posting Date: 11/29/2021
Spinraza (nusinersen) Billing
Spinraza (nusinersen) billing Spinraza (nusinersen) is a medication that was approved in December 2016 by the U.S. FDA for the treatment of all forms of SMA. HCPCS code J2326 - Inj, nusinersen, 0.1mg should be used to report Spinraza. [...]
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Posting Date: 02/22/2023
Chimeric Antigen Receptor (CAR) T-cell Therapy
Chimeric Antigen Receptor (CAR) T-cell Therapy Table of Contents NCD 110.24: Chimeric Antigen Receptor (CAR) T-cell therapy: Billing Instructions Overview Billing and coding CAR T-cell therapy for inpatient services Clinical [...]
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Posting Date: 09/19/2024
MLN Connects® Newsletter: September 19, 2024
MLN Connects® Newsletter: September 19, 2024 News Resources & Flexibilities to Assist with the Public Health Emergency in Louisiana Skilled Nursing Facilities: Report Your Expanded Ownership, Management, & Related Party Data [...]
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Posting Date: 09/19/2024
Billing Errors on 2024/2025 Influenza Season Claims
Billing Errors on 2024/2025 Influenza Season Claims The influenza season runs from August 1st of each year until July 31st the following year. Every influenza vaccine is assigned a new NDC each season. This season, some codes no longer have a [...]
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Posting Date: 01/19/2022
Learn About MDPP
Learn About MDPP The MDPP expanded model includes an evidence-based set of services aimed to help prevent the onset of type 2 diabetes among Medicare beneficiaries with an indication of prediabetes. MDPP services is available to eligible [...]
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Posting Date: 01/19/2022
Framework for Prevention and Goals
Framework for Prevention and Goals CMS along with the CDC provides a framework for diabetes prevention efforts. It brings together partners from the public and private sectors to prevent or delay type 2 diabetes. The MDPP is structured [...]
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Posting Date: 01/19/2022
Delivering a Lifestyle Change for Medicare Beneficiaries
Delivering a Lifestyle Change for Medicare Beneficiaries Providers play a vital role in beneficiary referrals. Although a referral is not required, a provider’s assessment during the AWV or the IPPE is strongly recommended by NGS. Providers [...]
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Posting Date: 01/19/2022
Receiving CDC Recognition and Medicare Enrollment
Receiving CDC Recognition and Medicare Enrollment Organizations who wish to furnish MDPP services to beneficiaries and bill Medicare for those services must enroll in Medicare as an MDPP supplier. To become a Medicare-enrolled MDPP supplier, [...]
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Posting Date: 01/19/2022
MDPP Codes and Payment Amounts 2023
MDPP Codes and Payment Amounts 2023 HCPCS G-codes are used when submitting claims to bill Medicare for payment. MDPP HCPCS G-codes may be used only one time per eligible beneficiary (except for G9890 and G9891). The initial session (G9873) [...]
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Posting Date: 02/06/2024
MDPP Codes and Payment Amounts 2024
MDPP Codes and Payment Amounts 2024 Medicare pays up to 22 visits billed with codes G9886 and G9887, combined, in a 12-month period: Months 1–6: one in-person/distance learning visit every week (up to 16) Months 7–12: one [...]
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Posting Date: 01/19/2022
MDPP Billing Information
MDPP Billing Information In addition to the usual information that needs to be completed to file a claim for a Medicare Part B service to your MAC, you will need to complete the following items of the CMS-1500 form or electronic equivalent [...]
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Posting Date: 01/19/2022
Contact Information and Resources
Contact Information and Resources Inquiry Type Examples Help Desk Contact Information Process of MDPP CDC Recognition Credential via CDC, check status of application for CDC recognition or submitting [...]
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Posting Date: 09/20/2024
Chiropractic Billing and Documentation
During this webinar, we will discuss chiropractic coverage, coding guidelines and the importance of documentation in order to support billing for these services.
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Posting Date: 11/15/2021
Prevent Revalidation Processing Delays
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 [...]
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Posting Date: 08/01/2024
Medicare University
Medicare University National Government Services offers a variety of teleconferences, webinars and face-to-face educational sessions on Medicare-related topics including rules and regulations throughout the year. Medicare University (MU), our [...]
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Posting Date: 09/10/2024
Expected Timeframes for Therapy Services
Expected Timeframes for Therapy Services CMS and CPT guidelines for provider time spent and documented on therapy services may vary, depending on the definition of the service and the context in which it is performed. Therapy services [...]
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Posting Date: 09/23/2024
The National Correct Coding Initiative and Medically Unlikely Edits for Part B Providers
This webinar will assist Part B providers with navigating tables for the National Correct Coding Initiative and the medically unlikely edits. We'll also review proper modifiers to use to avoid denials. There will be time for your questions [...]
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Posting Date: 01/29/2020
EDI and How it Works
EDI and How it Works EDI is an electronic communication method that enables fast, accurate and reliable exchange of data between the computer systems of organizations that do business together by using the same standardized message formatting, [...]
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Posting Date: 09/23/2024
Benefits of EDI and Real Time Claim Status
Table of Contents Benefits of EDI and Real Time Claim Status Real Time Claim Status and Response - A Faster Better Option [Return to Top] Benefits of EDI and Real Time Claim Status There are a number of advantages to enrolling and [...]
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