MLN Connects® Special Edition for Thursday, December 26, 2019

MLN Connects® Special Edition for Thursday, December 26, 2019 Feedback on Scope of Practice The Centers for Medicare & Medicaid Services (CMS) is seeking additional input and recommendations regarding elimination of specific Medicare [...]

MLN Connects® for Thursday, May 23, 2019

MLN Connects® for Thursday, May 23, 2019 MLN Connects® for Thursday, May 23, 2019 View this edition as a PDF News No Shortcuts to Safer Opioids Prescribing: CDC Commentary CMS Takes Action to Lower Prescription Drug Prices and [...]

MLN Connects® for Thursday, May 9, 2019

MLN Connects® for Thursday, May 9, 2019 MLN Connects® for Thursday, May 9, 2019 View this edition as a PDF News DMEPOS Competitive Bidding: Registration and Bid Window for Round 2021 Comprehensive Strategy to Foster Innovation for [...]

MLN Connects® for Thursday, May 2, 2019

MLN Connects® for Thursday, May 2, 2019 MLN Connects® for Thursday, May 2, 2019 View this edition as a PDF News New Medicare Card: Transition Period Ends in 8 Months Addressing Social Determinants of Health Will Help Achieve [...]

MLN Connects® for Thursday, July 18, 2019

MLN Connects® for Thursday, July 18, 2019 MLN Connects® for Thursday, July 18, 2019 View this edition as a PDF News Is Your Vendor/Clearinghouse Submitting Your Claims with the MBI? DMEPOS Competitive Bidding: Round 2021 Bid [...]

MLN Connects® for Thursday, July 11, 2019

MLN Connects® for Thursday, July 11, 2019 MLN Connects® for Thursday, July 11, 2019 View this edition as a PDF News New Medicare Card: Transition Period Ends in Less Than 6 Months HHS To Transform Care Delivery for Patients with [...]

MLN Connects® for Thursday, June 27, 2019

MLN Connects® for Thursday, June 27, 2019 MLN Connects® for Thursday, June 27, 2019 View this edition as a PDF News Medicare Shared Savings Program: Submit Notice of Intent to Apply by June 28 MIPS Data Validation and Audit for [...]

MLN Connects® for Thursday, June 20, 2019

MLN Connects® for Thursday, June 20, 2019 MLN Connects® for Thursday, June 20, 2019 View this edition as a PDF News New Medicare Card: 75% of Claims Submitted with MBI IRF: Voluntary Appeals Settlement Options CMS Proposes to [...]

MLN Connects® for Thursday, June 6, 2019

MLN Connects® for Thursday, June 6, 2019 MLN Connects® for Thursday, June 6, 2019 View this edition as a PDF News Medicare Shared Savings Program: Submit Notice of Intent to Apply Beginning June 11 Promoting Interoperability Program: [...]

MLN Connects® for Thursday, May 30, 2019

MLN Connects® for Thursday, May 30, 2019 MLN Connects® for Thursday, May 30, 2019 View this edition as a PDF News New Medicare Card Flyer for Your Patients Programs of All-Inclusive Care for the Elderly Final Rule Hospice [...]

National Government Services Proposed Local Coverage Determinations for Comment

National Government Services Proposed Local Coverage Determinations for Comment The following proposed LCDs are open for comment from 6/6/2019‒7/20/2019 and are listed on the Local Coverage Determination Open Meeting Announcement agenda: [...]

Sleep Study Scoring and Testing Physician Letter

Sleep Study Scoring and Testing Physician Letter CGS and Noridian, the DME MAC for J6 and JK respectively, have issued a new Dear Physician letter in regard to sleep study scoring and testing. The letters were issued by these contractors as [...]

External Counterpulsation Billing (G0166)

External Counterpulsation Billing (G0166) National Government Services has discovered providers are billing invalid places of services for G0166 (External Counterpulsation, per treatment session) as per The Centers for Medicare & Medicaid [...]

September is Prostate Cancer Awareness Month

September is Prostate Cancer Awareness Month Prostate cancer is the most common non skin cancer among men in the United States. It is a disease that in which malignant cancer cells form in the tissues of the prostate. Prostate cancer is [...]

Opt Out Affidavits Database

Opt Out Affidavits Database Need to verify if a provider has opted out of Medicare? A resource for a list of opt out providers is located on the Medicare Opt Out Affidavits Database, verify status with effective date range. Instructions for [...]

October 2019 Release Dark Days for the Common Working File Hosts

October 2019 Release Dark Days for the Common Working File Hosts For the upcoming October 2019 Release, CWF will be observing dark days starting Friday, 10/4/2019 through Sunday, 10/6/2019 to accommodate the anticipated duration of this [...]

October 2019 Fiscal Intermediary Standard System Direct Data Entry Screen Changes

October 2019 Fiscal Intermediary Standard System Direct Data Entry Screen Changes The following updates will be made to existing screens and implemented on 10/1/2019. Entry added for new Bone Density HCPCS 0508T eligibility dates to MAP175M. [...]

New Version of PC-ACE: July 2019

New Version of PC-ACE: July 2019 PC-ACE Version 4.3 contains several CMS mandates and product enhancements including but not limited to the items listed below. CR11132 ‒ Update to Mammography Editing CR11192 ‒ April 2019 Integrated [...]

New Version of PC-ACE: October 2019

New Version of PC-ACE: October 2019 PC-ACE Version 4.4 contains several CMS mandates and product enhancements including but not limited to the items listed below. CR11321 - Implement Operating Rules - Phase III Electronic Remittance Advice [...]

New Version of PC Print: July 2019

New Version of PC Print: July 2019 PC Print version 7.1.0 will soon be available on our website. This version contains the following enhancement: Change Request 11204 contains the RARC and CARC published by WPC through March 2019 [...]

New Version of PC Print: October 2019

New Version of PC Print: October 2019 PC Print version 7.1.1 will soon be available on our website. This version contains the following enhancements:   CR11252 contains the RARC and CARC published by WPC through July 2019  [...]

Travel Allowance for Laboratory Services

Travel Allowance for Laboratory Services We have seen an increase in incorrect billing for laboratory service travel allowances. Please see below helpful HCPCS billing information and a link to the CMS IOM on appropriate billing for [...]

Revised Fee for Indium In 111 Capromab Pendetide

Revised Fee for Indium In 111 Capromab Pendetide Effective 1/1/2019, National Government Services is updating the fee for A9507 to $1,5804.00 based on the published price for the kit of this radiopharmaceutical agent.   Posted 6/28/2019

Revised fee for Indium In 111 Capromab Pendetide

Revised fee for Indium In 111 Capromab Pendetide Effective 1/1/2019, National Government Services is updating the fee for A9507 to $1,5804.00 based on the published price for the kit of this radiopharmaceutical agent.   Posted 6/27/2019

Reminder: Use Anesthesia Modifiers Appropriately

Reminder: Use Anesthesia Modifiers Appropriately National Government Services requires placement of pricing modifiers in the first modifier position to process your anesthesia claims correctly. Modifiers for anesthesia pricing must be [...]

Reminder: Important Notice Regarding Handwriting on Claims Submitted to Medicare

Reminder: Important Notice Regarding Handwriting on Claims Submitted to Medicare As a reminder, National Government Services will return to the provider any paper claim submitted with handwriting on the face of the claim that is not a [...]

RAP Overpayment Demand Letters Sent in Error

RAP Overpayment Demand Letters Sent in Error Attention Home Health Agencies As of 10/1/2019, due to the implementation of CR10776, HHAs may have received a demand letter for a RAP overpayment. This letter instructed HHAs to either write [...]

Provider Enrollment Application Fee Amount for CY 2020

Provider Enrollment Application Fee Amount for CY 2020 On November 12, CMS issued a notice: Provider Enrollment Application Fee Amount for Calendar Year 2020 [CMS–6089–N (https://go.usa.gov/xppFM)]. Effective January 1, 2020, the application [...]

Part A East Qualified Independent Contractor (QIC) Telephone Discussion and Reopening Process Demonstration

Part A East Qualified Independent Contractor (QIC) Telephone Discussion and Reopening Process Demonstration C2C Innovative Solutions, Inc., the Part A East QIC, is currently offering providers telephone discussions and reopenings under this [...]

Determine/Pay Application Fee

Blepharoplasty, Eyelid Surgery, Brow Lift and Related Services

General Documentation Requirements for Blepharoplasty, Blepharoptosis Repair, and Brow Ptosis Repair Documented subjective patient complaints which justify functional surgery (vision obstruction, unable to do daily tasks, etc. Documented [...]

MLN Connects® Newsletter for Thursday, June 16, 2022

MLN Connects® Newsletter for Thursday, June 16, 2022 ICD-10-CM Diagnosis Codes: Fiscal Year 2023 News Comprehensive Error Rate Testing Program Report: Sample Reduced for Reporting Year 2023 Men’s Health: Talk to Your Patients About [...]

MLN Connects® Newsletter for Thursday, June 9, 2022

MLN Connects® Newsletter for Thursday, June 9, 2022 Learn about the CMS National Quality Strategy News CMS National Quality Strategy: A Person-Centered Approach to Improving Quality Strategy to Strengthen Behavioral Health Care [...]

MLN Connects® Newsletter for Thursday, June 2, 2022

MLN Connects® Newsletter for Thursday, June 2, 2022 ICD-10-PCS Procedure Codes: Fiscal Year 2023 News Medicare Shared Savings Program: Application Deadlines for January 1 Start Date Claims, Pricers, & Codes ICD-10-PCS Procedure [...]

MLN Connects® Newsletter for Thursday, May 26, 2022

MLN Connects® Newsletter for Thursday, May 26, 2022 Biosimilars: Interchangeable Products May Increase Patient Access News COVID-19: New Administration Code for Pfizer Pediatric Vaccine Booster Dose Biosimilars: Interchangeable [...]

Physicians/Practitioners Who Order Ambulance Transport: Helping Your Patients With Prior Authorization

Physicians/Practitioners Who Order Ambulance Transport: Helping Your Patients With Prior Authorization The RSNAT Prior Authorization Model is a Medicare Fee-for-Service program that was recently instituted throughout the National Government [...]

MLN Connects® Newsletter for Thursday, June 23, 2022

MLN Connects® Newsletter for Thursday, June 23, 2022 Medical Records Correspondence Address News Ambulance Prior Authorization Model Expands August 1 Orthoses Referring Providers: Comparative Billing Report in June Medical Records [...]

June/July 2022 Billing and Coding and Self-Administered Drug Article Updates

June/July 2022 Billing and Coding and Self-Administered Drug Article Updates Billing and Coding Articles Billing and Coding: Bevacizumab and biosimilars (A52370) Based on compendia review, ICD-10 code C45.2 has been added to the Group 1 [...]

Attention Ambulance Suppliers: Important Information on Claim Denials

Attention Ambulance Suppliers: Important Information on Claim Denials If you are billing claims with either A0426 or A0428, please continue to read. National Government Services has been receiving electronic claims with the 2300 REF segment [...]

A/B Rebilling Facts

A/B Rebilling Facts The following information applies to inpatient hospital admissions on/after 10/1/2013 per final rule CMS-1599-F. Background When a Medicare Part A payment cannot be made because an inpatient admission is found to not be [...]

Condition Code G0 Reminder

Condition Code G0 Reminder National Government Services has noticed an increase in the number of claims reporting CC G0 (zero) inappropriately. Please review the following information so that your claims are not rejected or denied due to [...]

Federally Qualified Health Centers Behavioral Health Claims Job Aid

Federally Qualified Health Centers Behavioral Health Claims Job Aid Historically, FQHCs reported behavioral health with codes 90805, 90807 and 90809 with revenue code 0900. However, those codes terminated effective 12/31/2012. Effective [...]

Federally Qualified Health Centers Contracting with Medicare Advantage Plans

Federally Qualified Health Centers Contracting with Medicare Advantage Plans Requirements to Receive Wrap-Around Payments from Medicare The FQHC must have a written contract with the Medicare Advantage (MA) plan that contain the terms [...]

MLN Connects® Newsletter for Thursday, May 5, 2022

MLN Connects® Newsletter for Thursday, May 5, 2022 COVID-19 Patients Can Get Free Over-the-Counter Tests from Participating Providers News COVID-19: Patients Can Get Free Over-the-Counter Tests from Participating Providers [...]

J6 Medicare Secondary Payer Part B Carrier Voluntary Refund Form

MLN Connects® Newsletter for Thursday, July 7, 2022

MLN Connects® Newsletter for Thursday, July 7, 2022 Expanding Access to Emergency Care Services in Rural Communities News Taking Action to Expand Access to Emergency Care Services in Rural Communities People with Disabilities: Help [...]

MLN Connects® Special Edition for Tuesday, June 21, 2022

MLN Connects® Special Edition for Tuesday, June 21, 2022 Home Health & ESRD Proposed CY 2023 Payment Rules Home Health Agencies: Calendar Year 2023 Proposed Rule — Submit Comments by August 16 ESRD Facilities: Calendar Year 2023 [...]

Reminder: 340B-Acquired Drug Claim Appeal Requests

Reminder: 340B-Acquired Drug Claim Appeal Requests Beginning 1/1/2018, separately payable Part B drugs (assigned status indicator “K”), other than vaccines (assigned status indicator “L” or “M”) and drugs on pass-through payment status [...]

Billing Not Otherwise Classified Codes

Billing Not Otherwise Classified Codes When billing NOC codes, if you give a comparable code for the service performed, please include the actual name of the surgical or medical procedure. In some cases, this will eliminate the need to develop [...]

MLN Connects® Special Edition for Thursday, July 7, 2022

MLN Connects® Special Edition for Thursday, July 7, 2022 CMS Proposes Physician Payment Rule to Expand Access to High-Quality Care On July 7, CMS issued the Calendar Year 2023 Physician Fee Schedule (PFS) proposed rule, which would [...]

MLN Connects® Special Edition for Friday, July 15, 2022

MLN Connects® Special Edition for Friday, July 15, 2022 CMS Proposes Rule to Advance Health Equity, Improve Access to Care & Promote Competition and Transparency CMS is proposing actions to advance health equity and improve access to care [...]

MLN Connects® Special Edition for Thursday, April 7, 2022

MLN Connects® Special Edition for Thursday, April 7, 2022 Returning to Certain Pre-COVID-19 Policies & Coverage of Monoclonal Antibodies for Alzheimer's Disease Stakeholder Call CMS Returning to Certain Pre-COVID-19 Policies in [...]

Your Feedback In Action – Medical Policies

Your Feedback In Action – Medical Policies We frequently receive comments through our customer experience surveys that providers cannot find an associated LCD or billing and coding article for a specific procedure within our Medical Policies [...]

You Asked – We Listened: Locating our Contact Information

You Asked – We Listened: Locating our Contact Information We often receive comments through our customer experience surveys that providers are not able to find our contact information. NGS contact information is located in the Resources [...]

Changing or Resetting Your EDI Gateway Password

Changing or Resetting Your EDI Gateway Password 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 [...]

MLN Connects® Newsletter for Thursday, July 21, 2022

MLN Connects® Newsletter for Thursday, July 21, 2022 988 Suicide & Crisis Lifeline Available Nationwide News 988 Suicide & Crisis Lifeline Available Nationwide COVID-19: Novavax Vaccine, Adjuvanted — New Codes Allergy & [...]

MLN Connects® Newsletter for Thursday, July 14, 2022

MLN Connects® Newsletter for Thursday, July 14, 2022 COVID-19: FDA Authorizes Pharmacists to Prescribe PAXLOVID with Certain Limits News COVID-19: FDA Authorizes Pharmacists to Prescribe PAXLOVID with Certain Limits COVID-19: Moderna [...]

MLN Connects® Newsletter for Thursday, September 23, 2021

MLN Connects® Newsletter for Thursday, September 23, 2021 COVID-19: Compare Nursing Homes by Vaccination Rate View this edition as a: Webpage | PDF News CMS Launches New Medicare.gov Feature to Compare Nursing Homes by [...]

MLN Connects® Newsletter for Thursday, October 14, 2021

MLN Connects® Newsletter for Thursday, October 14, 2021 Pneumococcal Conjugate Vaccine, 20 Valent View this edition as a: Webpage | PDF News Pneumococcal Conjugate Vaccine, 20 Valent DATA 2000 Waiver Training Payments Still [...]

MLN Connects® Newsletter for Thursday, December 9, 2021

MLN Connects® Newsletter for Thursday, December 9, 2021 CY 2022 Medicare Deductible, Coinsurance, & Premium Rates News PECOS: Multi-Factor Authentication Requirement Delayed HHS Seeks Public Comments to Advance Equity & [...]