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Posting Date: 09/12/2023
Helpful Contacts
Medicare Helpful Contacts and Partner Resources Medicare Helpful Contacts Medicare Partner Resources
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Posting Date: 02/02/2021
Submit an Appeal Electronically via esMD
Submit an Appeal Electronically via esMD CMS developed a mechanism for contractors to receive first level appeals electronically from providers via a secure gateway known as Electronic Submission of Medical Documentation, or esMD. Some [...]
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Posting Date: 02/02/2021
Submit an Appeal Electronically via esMD
Submit an Appeal Electronically via esMD CMS developed a mechanism for contractors to receive first level appeals electronically from providers via a secure gateway known as Electronic Submission of Medical Documentation, or esMD. Some [...]
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Posting Date: 02/02/2021
Submit an Appeal Electronically via esMD
Submit an Appeal Electronically via esMD CMS developed a mechanism for contractors to receive first level appeals electronically from providers via a secure gateway known as Electronic Submission of Medical Documentation, or esMD. Some [...]
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Posting Date: 09/01/2023
September 2023
In This Issue National Government Services Articles for Part A and Part B Providers Introducing PECOS 2.0 Duplicate Claim Editing Information Two Interactive Voice Response System Features Ending 9/30/2023 October 2023 Release "Dark [...]
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Posting Date: 08/01/2023
August 2023
In This Issue National Government Services Articles for Part A and Part B Providers CR13220 - Technical Revisions Only to the National Coverage Determination (NCD) Manual, Publication (Pub) 100-03 Tip Sheet for Medicare Providers on [...]
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Posting Date: 03/01/2023
April 2023
In This Issue National Government Services Articles for Part A and Part B Providers Appealing a Denied Claim New Version of PC-ACE: April 2023 Type of Bill Code is a Requirement for All Prior Authorization Requests Change in Pricing [...]
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Posting Date: 03/01/2023
March 2023
In This Issue National Government Services Articles for Part A and Part B Providers LCD, Billing and Coding Article Updates for March 2023 Chimeric Antigen Receptor (CAR) T-cell Therapy Billing Instructions April 2023 Release "Dark [...]
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Posting Date: 06/25/2021
Outpatient Department Prior Authorization UTN Alert
Each UTN is Valid for One-Time Use The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient department procedures: Panniculectomy, Rhinoplasty, Vein Ablation, Blepharoplasty [...]
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Posting Date: 06/25/2021
Outpatient Department Prior Authorization Type of Bill Alert
Providers Who Submit a Type of Bill 13X Are Required to Submit a Prior Authorization Request for the OPD PA Services The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient [...]
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Posting Date: 09/10/2021
UTN Alert: Implanted Spinal Neurostimulator Trial and Permanent UTN
UTN Alert: Implanted Spinal Neurostimulator Trial and Permanent UTN The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient department procedures: Panniculectomy, [...]
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Posting Date: 03/30/2023
Type of Bill Code is a Requirement for All Prior Authorization Requests
Type of Bill Code is a Requirement for All Prior Authorization Requests The National Government Services PA Department has seen an increase in cases that are submitted without a TOB code. PA staff conducts outreach to obtain this code; [...]
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Posting Date: 02/21/2022
Outpatient Department Prior Authorization Implanted Spinal Neurostimulators Alert
Outpatient Department Prior Authorization Implanted Spinal Neurostimulators Alert Implanted Spinal Neurostimulator Prior Authorization National Government Services Medical Review initiated a prior authorization review outpatient department [...]
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Posting Date: 09/14/2023
MLN Connects® Newsletter: September 14, 2023
MLN Connects® Newsletter: September 14, 2023 News Inflation Reduction Act Continues to Lower Out-of-Pocket Prescription Drug Costs for Drugs with Price Increases Above Inflation CMS Roundup (Sept 8, 2023) New Provider [...]
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Posting Date: 10/31/2019
Billing for Originating Site
Billing for Originating Site Originating Site An originating site is the location of an eligible Medicare beneficiary at the time the telehealth services is being furnished via a telecommunications system. Medicare beneficiaries are eligible [...]
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Posting Date: 10/31/2019
Distant Site
Distant Site The term “distant site” means the site where the physician or practitioner providing the professional service is located at the time the service is provided via a telecommunications system. Medicare distant site practitioners who [...]
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Posting Date: 10/31/2019
General Information
General InformationTelehealth services require use of an interactive audio and video telecommunications system that permits real-time communication between the provider at the distant site and the Medicare beneficiary at the originating [...]
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Posting Date: 10/31/2019
Originating Site
Originating Site An originating site is the location of an eligible Medicare beneficiary at the time the telehealth services is being furnished via a telecommunications system. Medicare beneficiaries are eligible for telehealth services only [...]
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Posting Date: 10/31/2019
Facility Fee for Originating Site
Facility Fee for Originating Site The originating site facility fee is a separately billable Part B payment. The payment amount to the originating site is the lesser of 80 percent of the actual charge or 80 percent of the originating site [...]
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Posting Date: 10/31/2019
Billing and Payment for Distant Site Professional Fee
Billing and Payment for Distant Site Professional Fee Claims for distant site telehealth services are submitted to the Part B MAC that processes claims for the performing physician/practitioner’s service area. Physicians/practitioners submit [...]
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Posting Date: 10/31/2019
List of Covered Medicare Telehealth Services
List of Covered Medicare Telehealth Services Several conditions must be met for Medicare to make payments for telehealth services under the Physician Fee Schedule. The service must be on the list of Medicare telehealth services and meet [...]
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Posting Date: 10/31/2019
G0 Modifier Required for Telehealth for Individuals with Acute Stroke
G0 Modifier Required for Telehealth for Individuals with Acute Stroke Effective for claims with dates of service on and after 1/1/2019, Medicare will accept HCPCS modifier G0 to identify telehealth services furnished for purposes of diagnosis, [...]
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Posting Date: 10/31/2019
GT Modifier
GT Modifier Effective 10/01/2018, the GT modifier (via interactive audio and video telecommunications systems) is only required on institutional claims for distant site services billed under CAH Method II (claim type 085X). The GT modifier is [...]
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Posting Date: 10/31/2019
Clarification of Telehealth for DSMT
Clarification of Telehealth for DSMT Individual and group DSMT services may be paid as a Medicare telehealth service. Effective for claims with dates of service on and after 1/1/2019, Medicare allows all ten hours of the initial DSMT training [...]
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Posting Date: 10/31/2019
ESRD-Related Services as a Telehealth Service
ESRD-Related Services as a Telehealth Service Effective for DOS on/after 1/1/2019, renal dialysis facilities and the homes of ESRD beneficiaries receiving home dialysis may be originating sites and will not apply originating site geographic [...]
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Posting Date: 04/19/2022
Ambulatory Surgical Center Pass-Through Devices
Ambulatory Surgical Center Pass-Through Devices What is a Pass-Through Device? Pass-through status is determined for newly FDA-approved drug and device products on an individual basis. Drugs and devices qualifying for pass-through status [...]
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Posting Date: 09/14/2023
MLN Connects® Newsletter: COVID-19: Updated mRNA Vaccines for Patients 6 Months & Older – September 14, 2023
MLN Connects® Newsletter: COVID-19: Updated mRNA Vaccines for Patients 6 Months & Older – September 14, 2023 News COVID-19: Updated mRNA Vaccines for Patients 6 Months & Older Posted 9/14/2023
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Posting Date: 09/15/2023
New YouTube Video: Surgical Dressings and Supplies: Part A/B and DME Collaborative Presentation
New YouTube Video: Surgical Dressings and Supplies: Part A/B and DME Collaborative Presentation The Part A/B and DME MACs are offering a YouTube video on Surgical Dressings and Supplies. This video offers information on the coverage criteria [...]
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Posting Date: 12/09/2022
Interested in Becoming a Home Health or Hospice Provider Outreach and Education Advisory Group Member?
Interested in Becoming a Home Health or Hospice Provider Outreach and Education Advisory Group Member? Are you someone who would be interested in helping shape the education provided by your MAC? We want to hear from you! Join us to [...]
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Posting Date: 09/08/2023
Don’t Let Your Flu Vaccination Claims Deny!
Don’t Let Your Flu Vaccination Claims Deny! The 2023-2024 flu vaccine season has begun. At the beginning of each flu season, National Government Services sees an increase in claim denial volume for flu vaccinations. This notice is being [...]
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Posting Date: 09/14/2023
Save the Dates! National Government Services Fall 2023 Virtual Conference for Part B Providers
Save the Dates! National Government Services Fall 2023 Virtual Conference for Part B Providers Understanding Medicare Compliance 11/6/2023-11/8/2023 We’re excited to announce our Medicare Part B 2023 Fall Virtual Conference! This three-day [...]
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Posting Date: 07/25/2023
Attention all OPPS Providers: Provider-Based Department Edits Being Implemented on/after 8/1/2023
Attention All OPPS Providers: Provider-Based Department Table of Contents Edits Being Implemented on/after 8/1/2023 Reason Code 34977: Practice address issue Reason Code 34978: PO and/or PN modifier missing Reason Code 34984: ER [...]
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Posting Date: 07/07/2023
URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations
URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations Table of Contents Urgent: Provider Compliance Required Effective 8/1/2023 Requirements Claim Filing Requirements Final Reminders Related Content [Return to [...]
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Posting Date: 12/17/2019
ESRD Facilities: Clarification for Providing Dialysis Services to Patients Acute Kidney Injury
ESRD Facilities: Clarifications for Providing Dialysis Services to Patients Acute Kidney Injury Effective 1/1/2017. ESRD facilities (hospital-based and freestanding) may furnish renal dialysis services to beneficiaries with AKI (both adult and [...]
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Posting Date: 09/12/2017
JK: Medicare Paid Hospital Providers Twice for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient IPPS Hospital Stays
Medicare Paid Hospital Providers Twice for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient IPPS Hospital Stays Table of Contents Provider Action Payment Window Policy and Under Arrangement Policy [...]
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Posting Date: 12/22/2020
Professional Services During a Patient Hospice Election
Professional Services during a Patient Hospice Election Table of Contents Article Overview Hospice Election Medicare Payment During Hospice Election Determining the Correct Entity to Bill Separately Payable Part B Services Hospice and [...]
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Posting Date: 09/18/2023
Direct Data Entry Users May Need to Adjust Screen Size
Direct Data Entry Users May Need to Adjust Screen Size CMS recently issued Change Request 13138 “Implementation to Expand Monetary Amount Fields Related to Billing and Payment to Accommodate 10-Digits in Length ($99,999,999.99) - Phase 1”. [...]
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Posting Date: 10/14/2021
Drugs and Biologicals - Coverage and Billing
Drugs and Biologicals – Coverage and Billing Medicare Part B will provide coverage for drugs that are furnished “incident to” a physician’s service. Coverage applies to drugs are not usually self-administered by the patients who take them. In [...]
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Posting Date: 02/10/2015
Outpatient Therapy Functional Reporting
Outpatient Therapy Functional Reporting Table of Contents Outpatient Therapy Functional Reporting Reporting Episode - similar to the therapy episode of care Required Functional Reporting Discharge Reporting Unique Functional Reporting [...]
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Posting Date: 01/12/2021
Home Health Referrals
Home Health Referrals The certifying physician or allowed nonphysician practitioner, and/or the acute/post-acute care facility referring the patient for home care must ensure that the medical record justifies the referral for Medicare home [...]
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Posting Date: 06/02/2020
Modifier CS and COVID-19 Billing
Modifier CS and COVID-19 Billing How should the CS modifier, which removes application of beneficiary cost-sharing (deductible and co-payment), be applied to telehealth services and/or E/M visits? The CS modifier should be applied for certain [...]
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Posting Date: 07/20/2023
Submitter Type - Provider
Submitted Type – Provider When Provider is selected as the submitter type the four objectives below are displayed. Select one objective based on the description provided and then click Next. Outlined in the following sections [...]
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Posting Date: 07/20/2023
Submitter Type - Billing Service
Submitter Type – Billing Service When Billing Service is selected as your submitter the three objectives below are displayed. Select one objective based on the description provided and then click Next. Outlined in the following [...]
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Posting Date: 07/20/2023
Selecting the Contractor Code
Selecting the Contractor Code Select the contract in which the provider of service is enrolled in the Medicare Program in the Contract Code field. Click the drop-down arrow to display the available contractor codes. Select the [...]
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Posting Date: 07/25/2023
National Government Services CAC Meeting Notice on KidneyIntelX Test
National Government Services CAC Meeting Notice on KidneyIntelX Test Information has been posted on our website in regards to the National Government Services l Contractor Advisory Committee Meeting regarding KidneyIntelX Test to be [...]
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Posting Date: 03/22/2018
Purpose of FISS/DDE Provider Online Guide
Introduction Purpose of FISS/DDE Provider Online Guide This provider online guide was created to assist National Government Services providers in using the FISS/DDE Provider Online System. FISS/DDE is: an application that allows remote [...]
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Posting Date: 07/25/2023
Attention All OPPS Providers with Provider-Based Department(s): Permanent Edit Implementation Begins on/after 8/1/2023
Attention All OPPS Providers: Provider-Based Department Edits Being Implemented on/after 8/1/2023 Certain edits are being implemented on/after 8/1/2023 to ensure you are billing your provider-based locations correctly. The edits are FISS [...]
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Posting Date: 07/20/2023
Attestation
Attestation At the start of an EDI Guided Enrollment submission, you will need to read and accept the attestation in order to proceed.
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Posting Date: 07/20/2023
I Am a Billing Service and “I Want to Use a Provider's PIN From their Letter of Authorization (LOA)”
I Am a Billing Service and “I Want to Use a Provider's PIN From their Letter of Authorization (LOA)” This selection will prompt you to complete the Logon Request with PIN Form. This objective is for a third party who wishes to request, [...]
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Posting Date: 07/27/2023
MLN Connects® Newsletter: July 27, 2023
MLN Connects® Newsletter: July 27, 2023 News CMS Continues Work on Behavioral Health Discarded Drugs and Biologicals: Updated FAQs on JW & JZ Modifiers Expanded Home Health Value-Based Purchasing Model: July 2023 Interim Performance [...]
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Posting Date: 04/04/2018
Reason Codes
Chapter I: Online System Terminology Reason Codes Purpose Reason codes direct the outcome of an edit or process within FISS—they are the traffic cops of the system. Each reason code, when assigned, sends the claim to a specific [...]
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Posting Date: 04/25/2016
View a Report (R2)
Chapter VII: Online Reports View Submenu (04) View a Report (R2) Purpose This option allows the provider to go directly to MAP1661 for report viewing. Task To access the View a Report option from the Fiscal Intermediary (FISS)/Direct [...]
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Posting Date: 04/18/2016
FISS UB-04 Data Entry Payer Codes
Resources FISS UB-04 Data Entry Payer Codes The following payer codes may be reported in the CD field on CLAIM PAGE 03 of the online UB-04 claim entry record. Payer Code Description 1 Medicaid 2 Blue [...]
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Posting Date: 09/10/2018
How to Adjust a Claim
Resources How to Adjust a Claim To adjust a claim using the FISS/DDE Provider Online System, follow these steps: Step Action 1 Select the CLAIMS CORRECTION (03) submenu from the MAIN MENU 2 Key the [...]
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Posting Date: 09/10/2018
FISS Claim Change/Condition Reason Codes
Resources FISS Claim Change/Condition Reason Codes The following adjustment/cancel claim change reason codes may be reported in the COND CODE field on CLAIM PAGE 01 of the adjustment/cancel claim record. For Adjustment Claims Only (TOB [...]
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Posting Date: 09/10/2018
How to Cancel a Claim
Resources How to Cancel a Claim To cancel a claim on the FISS/DDE Provider Online System, follow these steps: Step Action 1 Select the CLAIMS CORRECTION (03) submenu from the MAIN MENU 2 Key the [...]
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Posting Date: 09/18/2018
Online System Menu Quick-Reference
Resources Online System Menu Quick-Reference Main Menu Inquires Submenu (01) Claims/Attachments Submenu (02) 01 – Inquires 02 – Claims/Attachments 03 – Claims Correction 04 – Online Reports View 10 [...]
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Posting Date: 04/15/2018
Document Control Number
Chapter I: Online System Terminology Document Control Number Purpose The FISS DDE Provider Online System refers to the claim control number as a DCN. The DCN provides a reference number for the control and monitoring of each claim. To [...]
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