Medically Unlikely Edits and Related Billing Clarifications

Medically Unlikely Edits and Related Billing Clarifications An MUE is the maximum number of UOS allowable under most circumstances for a single HCPCS/CPT code billed by a provider for a particular date of service for a single beneficiary. [...]

Medical Review Targeted Probe and Educate ADRs

Medical Review Targeted Probe and Educate Additional Development Requests Medical Review NGS Medical Review Department will be performing service specific post-payment reviews for a random selection of claims billed to Medicare Part A and B. [...]

Resources

Resources CMS Medicare Dental Coverage Change Request (CR) 13181 Medicare Policy Updates for Dental Services as Finalized in the Calendar Year (CY) 2023 Physician Fee Schedule (MPFS) Final Rule Change Request (CR) 13190 Educational [...]

Provider Enrollment Revalidation Overview

During this webinar, learn about important changes in the revalidation process, how to determine Medicare enrollment revalidation due date and information to avoid disruption in Medicare billing.

Physical/Occupational Therapy Billing

Join us as we review billing guidelines for physical and occupational therapy. We'll review when to apply the KX modifier and the importance of appropriate medical documentation. National Government Services has a Local Coverage Determination [...]

General Information

General Information In certain circumstances, National Government Services or other contractors working under the CMS may need to request additional information with regard to claims submitted to the Medicare Program. The requests for [...]

Ways to Respond to ADRs

Ways to Respond to ADRs Table of Contents Ways to Respond to ADRs Utilizing Paperwork Segment and esMD Electronic Submission of Medical Documentation NGSConnex Portal Fax U.S. Mail, FedEx, UPS [Return to Top] Ways to Respond to ADRs [...]

Claim ADRs

Claim Additional Development Requests National Government Services will not be able to process your claim without additional documentation. The following are the most common situations when NGS would require additional documentation to process [...]

Other Audit Contractor ADRs

Other Audit Contractor Additional Development Requests An ADR may be requested from one of the contractors listed below. If you receive correspondence from any one of these contractors, please follow the instructions within their letter. [...]

Overpayments Due to Contractor Audit Reviews

Overpayments Due to Contractor Audit Reviews If you do not agree with any CMS contractor audits determination and you are a provider practicing in JK (CT, MA, ME, NH, NY, RI, VT) or J6 (IL, MN, WI), you may use the Medicare appeals process [...]

Provider Enrollment: Completing the CMS-855I Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855I provider enrollment paper application for a group member, sole proprietor, or sole owner and we’ll also focus on reassigning Medicare benefits.

Bone Mass Measurements

Preventive Services Guide Bone Mass Measurements Table of Contents Bone Mass Measurements Risk Factors Coverage Guidelines and Frequency Limits Coverage Criteria HCPCS/CPT Coding HCPCS/CPT Codes ICD-10 Codes Diagnosis [...]

Initial Preventive Physical Examination

Preventive Services Guide Initial Preventive Physical Examination The IPPE is also known as the “Welcome to Medicare Preventive Visit.” The goals of the IPPE are health promotion and disease detection and prevention. Table of Contents [...]

Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line

Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line Attention: Provider Enrollment and Credentialing Departments Revalidate before your due date to avoid a “Stay of Enrollment” or claim rejections which may [...]

Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line

Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line Attention: Provider Enrollment and Credentialing Departments Revalidate before your due date to avoid a “Stay of Enrollment” or claim rejections which may [...]

Hepatitis B Virus Screening

Preventive Services Guide Hepatitis B Virus Screening Hepatitis B is a virus that can damage the liver, it is spread through contact with infected blood or body fluids and can be transmitted through sex with an infected person or by sharing [...]

Hepatitis B Virus Vaccine and Administration

Preventive Services Guide Hepatitis B Virus Vaccine and Administration Hepatitis B is a virus that can damage the liver; it is spread through contact with infected blood or body fluids and can be transmitted through sex with an infected [...]

Screening for Sexually Transmitted Infections and HIBC to Prevent STIs

Preventive Services Guide Screening for Sexually Transmitted Infections and HIBC to Prevent STIs Table of Contents Screening for Sexually Transmitted Infections Coverage Criteria High/Increased Risk Factors Frequency Limits [...]

Hospice Claim Reporting Requirements for Attending and Certifying Physicians

Hospice Claim Reporting Requirements for Attending and Certifying Physicians ​​​​Under CMS' current guidelines, the hospice medical director or the hospice physician and the attending physician (if the beneficiary has one), must initially [...]

Getting Access to PECOS

During this webinar, we’ll discuss how to obtain access to the Internet-based Provider Enrollment Chain & Ownership System (PECOS) and gain connection to provider enrollment record as well as understand other Centers for Mediacre & Medicaid [...]

Part B Overview of Medicare Dental Coverage

Medicare covers a limited number of dental services. The purpose of this webinar is to familiarize dental providers with Medicare Part B dental coverage. Discussion will include an overview of dental coverage, who can provide dental services, [...]

Institutional Providers: Revised CMS-855A version (09/24) Medicare Enrollment Application

Institutional Providers: Revised CMS-855A version (09/24) Medicare Enrollment Application  Available now is the revised CMS-855A (09/24) paper application that includes a section for SNF to comply with the 2023 Final rule in reporting [...]

LCD and Article Updates for September/October 2024

LCD and Article Updates for September/October 2024 A58152 Billing and Coding: Computed Tomography Cerebral Perfusion Analysis (CTP) The following ICD-10-CM diagnosis codes were added to Group 1- ICD-10-CM Codes That Support Medical necessity [...]

Alcohol Misuse and Counseling

Preventive Services Guide Alcohol Misuse and Counseling Table of Contents Alcohol Misuse and Counseling Two-Part Benefit Cost Sharing Reimbursement Nonparticipating Providers Common Claim Denial Reasons Related Content [Return [...]

Annual Wellness Visit Screening

Preventive Services Guide Annual Wellness Visit Screening Table of Contents Annual Wellness Visit Screening Coverage Criteria Two Types of AWV Elements Elements of Initial AWV Personalized Prevention Plan Services – [...]

Cardiovascular Disease Screening Tests

Preventive Services Guide Cardiovascular Disease Screening Tests Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. Table of [...]

Colorectal Cancer Screening

Preventive Services Guide Colorectal Cancer Screening Screenings are performed to diagnose colorectal cancer or to determine a beneficiary’s risk for developing colorectal cancer. Colorectal cancer screening may consist of several different [...]

Counseling to Prevent Tobacco Use

Preventive Services Guide Counseling to Prevent Tobacco Use Smoking is the leading preventable cause of disease, disability and death in the United States. It harms nearly every organ in the body and causes about one in every five deaths. [...]

Depression Screening

Preventive Services Guide Depression Screening Also Known as Screening for Depression in Adults Coverage Criteria Covered annually At least 11 months must have passed since last depression screening G0444: Annual depression [...]

Glaucoma Screening

Preventive Services Guide Glaucoma Screening Glaucoma is a group of eye diseases in which damage to the optic nerve results in loss of eyesight. Medicare beneficiaries over the age of 60 have an increased risk of developing glaucoma. CMS has [...]

Hepatitis C Virus Screening

Preventive Services Guide Hepatitis C Virus Screening Hepatitis C is a virus that can damage the liver; it is transmitted through infected blood or body fluids. The most common way people get infected is by sharing needles used to inject [...]

Human Immunodeficiency Virus Screening

Preventive Services Guide Human Immunodeficiency Virus Screening HIV attacks cells that help the body fight infection making a person vulnerable to other infections. Nearly 1.2 million Americans are now living with HIV infection and about [...]

Intensive Behavioral Therapy for Cardiovascular Disease

Preventive Services Guide Intensive Behavioral Therapy for Cardiovascular Disease CVD generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain or stroke. CMS has determined [...]

Intensive Behavioral Therapy for Obesity

Preventive Services Guide Intensive Behavioral Therapy for Obesity In 2003, the United States Preventive Services Task Force found good evidence that BMI “is reliable and valid for identifying adults at increased risk for mortality and [...]

Medical Nutrition Therapy

Preventive Services Guide Medical Nutrition Therapy MNT is a dietary intervention that is used to prevent or treat health conditions that are caused by or made worse by unhealthy eating habits. Table of Contents Eligibility Criteria [...]

Prostate Cancer Screening

Preventive Services Guide Prostate Cancer Screening Prostate cancer is the second most common cancer in men in the United States, after skin cancer. Older men, African-American men and men who have a family history of prostate cancer have a [...]

Screening for Cervical Cancer with Human Papillomavirus Tests

Preventive Services Guide Screening for Cervical Cancer with Human Papillomavirus Tests Cervical cancer is commonly caused by the HPV. The USPSTF found that regular screening greatly reduces the rate of cervical cancer and the number of [...]

Screening Pelvic Examinations

Preventive Services Guide Screening Pelvic Examination A pelvic examination is a type of gynecologic examination for women. Some of the conditions that health care providers look for during a pelvic examination include infections, fibroids, [...]

Ultrasound Screening for Abdominal Aortic Aneurysm

Preventive Services Guide Ultrasound Screening for Abdominal Aortic Aneurysm An ultrasound screening for AAA is a procedure using sound waves (or such other procedures using alternative technologies, of commensurate accuracy and cost, as [...]

Screening Pap Tests

Preventive Services Guide Screening Pap Tests Cervical cytology, also called a Pap test, looks for abnormal changes in cells in the cervix, which is part of a woman’s reproductive organs. Screening for cervical cancer via a Pap test is very [...]

PC-ACE

Provider Enrollment: Reduce Development Requests for Additional Action

Provider Enrollment: Reduce Development Requests for Additional Action In an effort to reduce the request of additional information and/or documentation on provider enrollment applications, verify all required actions are complete prior to [...]

Tobacco Counseling via Telehealth

Tobacco Counseling via Telehealth Health equity in telehealth is the opportunity for everyone to receive the health care they need and deserve, regardless of social or economic status. Telehealth helps improve access to healthcare for various [...]

Evaluation and Management Services

Evaluation and Management Services E/M services are professional face to face services rendered by a physician or NPP in various sites or POS. The nature and amount of physician work and documentation will vary by type of service, place of [...]

General Principles of Medical Record Documentation

What Should Be Provided if Medical Records Are Requested for Review? The following should be considered if applicable to the service being reviewed. This is not intended to be an all-inclusive list. Progress/visit notes Physician orders [...]

Related Resources

Related Resources MLN®Booklet: Evaluation and Management Services Guide AMA CPT Guidelines CMS IOM Publication 100-04, Medicare Claims Processing Manual,Chapter 12, Section 30.6 MLN®Fact Sheet: Complying with Medicare [...]

General Principles of Medical Record Documentation

General Principles of Medical Record Documentation   The medical record should be complete and legible. The documentation of each patient encounter should include: The reason for the encounter and relevant history, physical [...]

Diabetes Screening

Preventive Services Guide Diabetes Screening Table of Contents Diabetes Screening Eligibility for Diabetes Screening Category One Category Two Coverage Criteria and Frequency Limits HCPCS/CPT Coding Diagnosis Coding Cost [...]

Provider Enrollment: Completing the CMS-855B Paper Application

During this webinar, we'll provide an understanding of how to complete the CMS-855B provider enrollment paper application for a clinic, group, or supplier.

October 2024

In This Issue National Government Services Articles for Part A and Part B Providers Common Working File Host Dark Days for October 2024 Release LCD and Article Updates for August/September 2024 October 2024 EDI Front End Quarterly Release [...]

9/30/2024

Self-Service Pulse: What You Need To Know This Week As your MAC, National Government Services wants to provide you with a comprehensive source containing the most current information available for our self-service tools. ​​​​​​ The [...]

Diabetes Self-Management Training

Preventive Services Guide Diabetes Self-Management Training According to the Centers for Disease Control and Prevention, approximately 38.4 million Americans have diabetes and 27.2 million people aged 65 years or older (48.8%) have been [...]

Provider Enrollment: Completing the CMS-855A Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855A provider enrollment paper application.

CO-246

Avoiding/Correcting This Error This is not an error. The CPT/HCPCS code reported is used for reporting purposes only. These reporting codes are given by CMS for providers to use when documenting certain incentive plans, etc.

CO-246

Avoiding/Correcting This Error This is not an error. The CPT/HCPCS code reported is used for reporting purposes only. These reporting codes are given by CMS for providers to use when documenting certain incentive plans, etc.

CO-B7

Avoiding/Correcting This Error There is an issue with the billing and/or rendering provider credentialing information per provider enrollment, provider information submitted on the claim and/or or the services provided are not allowed per the [...]

CO-B7

Avoiding/Correcting This Error The billing or rendering provider NPI is not actively enrolled with Medicare on the date(s) of service billed on the claim. Please verify the provider's Medicare effective date in PECOS. If the provider shows [...]

CO-16

Avoiding/Correcting This Error The CPT/HCPCS code reported is not valid for the date(s) of service billed on the claim. This may also mean that the digits or alpha characters in the code are incorrectly reported. Please review the claim and [...]

OA-18

Avoiding/Correcting This Error A duplicate claim submission occurs when a provider resubmits a claim either on paper or electronically for a single encounter and the service is provided by the same provider to the: same beneficiary; for the [...]

OA-18

Avoiding/Correcting This Error A duplicate claim submission occurs when a provider resubmits a claim either on paper or electronically for a single encounter and the service is provided by the same provider to the: same beneficiary; for the [...]