Anesthesia Furnished in Conjunction with Colonoscopy (Modifier 33 Versus Modifier PT) Policy Update

Anesthesia Furnished in Conjunction with Colonoscopy (Modifier 33 Versus Modifier PT) Policy UpdateIn the CY 2018 PFS Final Rule, the CMS modified reporting and payment for anesthesia services furnished in conjunction with and in support [...]

Provider Enrollment for Part A Providers

Provider Enrollment for Part A ProvidersHave you changed location? Remember to update your address and phone number in PECOS so National Government Services departments can reach you if needed.How do I update my information?Part A providers can [...]

Provider Enrollment Application Fee Amount for CY 2021

Provider Enrollment Application Fee Amount for CY 2021On 11/23/2020, CMS issued a notice: Provider Enrollment Application Fee Amount for Calendar Year 2021. Effective 1/1/2021, the application fee is $599 for institutional providers (as that [...]

Reopenings for Minor Errors and Omissions

Reopenings for Minor Errors and OmissionsA clerical error/omission reopening is an action taken to change an initial determination to correct minor errors or omissions outside of the Medicare appeal process.Reopening [...]

Electronic Data Interchange Help Desk E-mail Inquiry Form Assistance

EDI E-mail Inquiry Form Assistance*Required Field - An asterisk adjacent to the form field indicates that completion is required.Line of BusinessList the line of business for this inquiry or issue. Choose from the drop-down box.Medicare [...]

Protected Health Information and Personally Identifiable Information Email Guidelines

Protected Health Information and Personally Identifiable Information Email GuidelinesThe following information is considered PHI and PII. Note: These lists are not all-inclusive. If additional information is required to research an inquiry, [...]

Reminder: Medicare Prior Authorization Information Not Valid for Part B Submission – Claims Will Reject as Unprocessable

Reminder: Medicare Prior Authorization Information Not Valid for Part B Submission – Claims Will Reject as UnprocessableThis notice is being published as a reminder to all Medicare Part B providers. When you are submitting a claim to National [...]

Integrating Behavioral Health Care with Primary Care

Integrating Behavioral Health Care with Primary CareWhat is BHI? Medicare Behavioral Health Integration is a service for your patient that does not require the use of a behavioral health care team.Primary care physicians who are treating [...]

Psychiatric Collaborative Care Education for the Provider and Beneficiary

Psychiatric Collaborative Care Education for the Provider and BeneficiaryDid you know that the psychiatric CoCM integrates primary and behavioral health care and is considered an effective strategy in improving outcomes for beneficiaries [...]

End-Stage Renal Disease Laboratory Tests Job Aid

End-Stage Renal Disease Laboratory Tests Job AidDialysis Type: Hemodialysis, CCPD, IPD, HemofiltrationNon-AMCC Laboratory TestsFrequency/CPT CodesTest Name/AbbreviationPer treatment:85013 or 8501485018VariousHematocrit (Hct)Hemoglobin [...]

What Physicians Need to Know: Home Health Patient-Driven Groupings Model

What Physicians Need to Know: Home Health Patient-Driven Groupings ModelIn November 2018, CMS finalized a new case-mix classification model, the PDGM, effective beginning 1/1/2020. The PDGM relies more heavily on clinical characteristics and [...]

Medicare & You

Medicare & YouDownload the official Medicare & You handbook with important information about what’s covered by Medicare, preventive services, health plans, prescription drug plans, and your rights and appeals.

National Correct Coding Initiatives Edits - Physicians

Correcting and Avoiding Reason Code C7080: Inpatient Overlap

Correcting and Avoiding Reason Code C7080: Inpatient OverlapThis edit is applied to a home health episode claim that overlaps an inpatient claim in the system. A home health agency may bill for a visit on the day of inpatient admission and/or [...]

Home Health Prospective Payment System Booklet

Counting 90-Day Election Periods

Counting 60-Day Election Periods

Counting 60-Day Election Periods - Leap Year

Billing Hospice Physician, Nurse Practitioner and Physician Assistant Services (Related To Terminal Diagnosis)

Hospice Notice of Change of Ownership

Hospice Claim Submission Job Aid

Notification Letters

Notification Letters Prior to the start of the TPE, providers are being placed on medical review will receive a notification letter. The notification will have the edit name, the reason for review, instructions for sending in the ADR and [...]

LVAM Request Form

Counting 90-Day Election Periods - Leap Year

Who May File an Appeal?

Who May File an Appeal?Any of the following persons or entities is considered a party to an appeal of a claim for items or services payable under Medicare and, therefore, may appeal the initial claim determination and any subsequent appeal [...]

What Documents are Needed

What Documents are NeededYou are required to submit all necessary medical documentation to support the services billed on your claim as part of your participation agreement; you must submit a complete medical record when requesting an appeal. [...]

Comprehensive Error Rate Testing Program

Medical Policy Contact Information

Medical Policy Contact Information

Medical Policy Contact Information

Medical Policy Contact Information

Dental Codes Billed As Principal Diagnosis Code Cause Claim Rejections

Claims Submitted With Dental Codes As Principal Diagnosis Will RejectOn 1/3/2021, EDI added a new edit to the EDI Front-End. If an 837I claim contains principal diagnosis code 2300 HI with qualifier ABK (principal diagnosis) that is a dental [...]

Overpayment E-mail-Part A

Immediate Recoupment Request Form - Electronic/E-mail Automatic Response Please do not reply to this message. This e-mail address is automated, unattended, and cannot help with questions or requests. Thank you for using the National [...]

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E-mail Account Validation To get started, please validate your e-mail address account information. Step 1:  Please enter your e-mail address:

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Learn About Deactivation of Billing Privileges, Suspension of Payment and Reactivation

This site area gives you access to important information about deactivation of billing privileges, suspension of payment and reactivation.

PC-ACE Pro Patch for NHIC Text

PC-ACE Pro 2.31 Patch For NHIC

DMEPOS Resources

Note: Codes that have a $0 (zero) fee schedule amount will not display a search result. Locality/Area and County Information for Illinois Locality/Area Counties 12 Bond, Calhoun, Clinton, Jersey, [...]

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Overpayment E-mail-Federally Qualified Health Center

Immediate Recoupment Request Form - Electronic/E-mail Automatic Response Please do not reply to this message. This e-mail address is automated, unattended, and cannot help with questions or requests. Thank you for using the National [...]

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E-mail Password Submit a registered e-mail address below and the password will be e-mailed to you.

Clinical Social Worker Resources

Psychiatric Services Calculator

Overpayment E-mail-Home Health and Hospice

Immediate Recoupment Request Form - Electronic/E-mail Automatic Response Please do not reply to this message. This e-mail address is automated, unattended, and cannot help with questions or requests. Thank you for using the National [...]

Overpayment Results-Federally Qualified Health Center

Immediate Recoupment Request Form - Electronic/E-mail Automatic Response Thank you for using the National Government Services Immediate Recoupment Request Form - Electronic/E-mail. Your request has been received and will be processed within [...]

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Note: For 2011 dates of service, the beneficiary responsibility is generally 45% of the MPFS allowed amount. For 2012 dates or service, the beneficiary responsibility is generally 40% of the MPFS allowed amount. *The reduction figure is based [...]

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