Instructions for Unfinished PECOS Enrollment Application(s)

Table of Contents Instructions for Unfinished PECOS Enrollment Application(s) Instructions for Unfinished PECOS Application(s) Instructions for Application Status “Pending E-Signature” Submitted Enrollment Application(s) on Behalf of an [...]

Skilled Nursing Facility Billing Basics

This session will focus on the basics of skilled nursing facility (SNF) inpatient and outpatient billing, including consolidated billing guidelines. Learn about the required fields on SNF claims, timeframes for claim submission and how proper [...]

Report a Change of Information

Report change of enrollment information timely. Changes can be either submitted electronically via PECOS or by mail with the paper CMS-855A and/or CMS-588 EFT agreement. A change in the Tax ID with no ownership change will need to submit [...]

Report a Change of Information

Report change of enrollment information timely. Changes can be either submitted electronically via PECOS or by mail with the paper CMS-855A and/or CMS-588 EFT agreement. A change in the Tax ID with no ownership change will need to submit [...]

Report a Change of Information

Table of Contents Report a Change of Information PECOS Submission Related Content Paper Submission Related Content [Return to Top] Report a Change of Information Report change of enrollment information [...]

Coming Soon ‒ The CY 2025 Medicare Physician Fee Schedule

Coming Soon ‒ The CY 2025 Medicare Physician Fee Schedule The CY 2025 MPFS will soon be available on the Fee Schedule Lookup tool located on NGSMedicare.com, after the CY 2025 physician fee schedule regulation is put on display. Once the Fee [...]

Ambulance Transports Included in SNF Consolidated Billing

Ambulance Transports Included in SNF Consolidated Billing Transport Description Medical Necessity Met Ambulance Billing Modifiers and Other Considerations Who is Responsible for Payment? Reference(s) SNF to [...]

Ambulance Transports Excluded from SNF Consolidated Billing

Ambulance Transports Excluded from SNF Consolidated Billing When a Medicare beneficiary is a resident in a SNF under a Part A stay, not all ambulance transports are included in the PPS (prospective payment system) payment for a SNF. SNF [...]

Ambulance Medical Necessity Reminder for ESRD Patients

Ambulance Medical Necessity Reminder for ESRD Patients National Government Services receives a significant amount of dialysis facility ambulance transports that do not meet medical necessity criteria. Documentation must explicitly describe the [...]

Related Content

Related Content Ambulance Services Center MLN® Booklet: Medicare Ambulance Transports Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, [...]

Billing for A0426 or A0428

Billing for A0426 or A0428 National Government Services has been receiving electronic claims with the 2300 REF segment (G1 qualifier) for prior authorization, however, the value entered in REF02 is a ZIP code. This segment is intended for the [...]

Medical Necessity of Ambulance Services

Medical Necessity of Ambulance Services Table of Contents Medical Necessity of Ambulance Services What You Can Do Nearest Appropriate Facility: GY Modifier What You Can Do Related Content [Return to Top] Medical [...]

Prior Authorization of Repetitive Scheduled Non-Emergent Ambulance Transport

Ambulance Medical Necessity

Ambulance Medical Necessity According to the Centers for Medicare & Medicaid Services’ (CMS) Internet Only Manual (IOM) 100-02, Medicare Benefit Policy Manual, Chapter 10, Ambulance Services; (400 KB) 10.2 - Necessity and Reasonableness [...]

Responsibility of Providing a Properly Executed Physician Certification Statement/Certificate of Medically Necessity

Responsibility of Providing a Properly Executed Physician Certification Statement/Certificate of Medically Necessity Recent National Government Services educational efforts have highlighted an issue between facilities and the ambulance [...]

Proper Claim Submission for Repetitive, Scheduled, Non-Emergent Ambulance Transports

Proper Claim Submission for Repetitive, Scheduled, Non-Emergent Ambulance Transports The CMS implemented the prior authorization of RSNAT. NGS J6 states Illinois, Minnesota, and Wisconsin were added to the RSNAT Model effective with dates [...]

Membership Rosters

Membership Rosters Member Lists JK Part A J6 Part A Federally Qualified Health Center (All States) Revised 11/4/2024

Introduction to Medicare Part I

Are you new to the Medicare Program? Attend our Introduction to Medicare Part I and II Webinars! Each session will be 1 hour with 15 minutes of Q&A. Part I will focus on: Jurisdictions, NGS Website/Medicare Education, Medicare Enrollment [...]

Billing Medicare Part A When Veteran’s Administration Eligible Medicare Beneficiaries Receive Services in Non-VA Facilities

Billing Medicare Part A When Veteran’s Administration Eligible Medicare Beneficiaries Receive Services in Non-VA Facilities Table of Contents Background Beneficiary Chooses to Use Medicare Beneficiary Chooses to Use VA Benefits VA [...]

New Provider Center

New Provider Center National Government Services: A Medicare Administrative Contractor – Who Are We? A MAC is a private health care insurer to whom the CMS has awarded geographic jurisdiction to process FFS Medicare claims for beneficiaries [...]

New Provider Center

New Provider Center National Government Services: A Medicare Administrative Contractor Who Are We? A MAC is a private health care insurer to whom the CMS has awarded geographic jurisdiction to process FFS Medicare claims for beneficiaries [...]

New Provider Center

New Provider Center National Government Services: A Medicare Administrative Contractor – Who Are We? A MAC is a private health care insurer to whom the CMS has awarded geographic jurisdiction to process FFS Medicare claims for beneficiaries [...]

New Provider Center

New Provider Center National Government Services: A Medicare Administrative Contractor – Who Are We? A MAC is a private health care insurer to whom the CMS has awarded geographic jurisdiction to process FFS Medicare claims for beneficiaries [...]

November is Lung Cancer Awareness Month

November is Lung Cancer Awareness Month Lung cancer is the leading cause of cancer death in the United States and worldwide. Although education, research and treatment options for lung cancer have dramatically improved in recent years, lung [...]

Submitting Revalidation via PECOS

During this webinar, we’ll provide an understanding of how to utilize the Centers for Medicare & Medicaid Services (CMS) Internet-based Provider Enrollment Chain & Ownership System (PECOS) to be comfortable in navigating the system to submit a [...]

Submitting Revalidation via PECOS

During this webinar, we’ll provide an understanding of how to utilize the Centers for Medicare & Medicaid Services (CMS) Internet-based Provider Enrollment Chain & Ownership System (PECOS) to be comfortable in navigating the system to submit a [...]

PECOS: View and Manage Reassignments through Group Enrollment

During this webinar, we’ll provide an understanding of how to view and manage reassignments through the group enrollment in Provider Enrollment, Chain and Ownership System (PECOS), including to add or terminate reassignments. Individual [...]

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.

PECOS: Manage Signatures and Additional Information Requests

During this webinar, we’ll give direction for the Provider Enrollment, Chain and Ownership System (PECOS) application on understanding how to manage signatures and respond to additional information request from submitted applications.

Registration Now Open for the 2024 Preventive Services Virtual Conference!

Registration Now Open for the 2024 Preventive Services Virtual Conference! We are thrilled to announce that registration is now open for the National Government Services Medicare Part B 2024 Preventive Services Virtual Conference, taking place [...]

Intensive Outpatient Program

Intensive Outpatient Program Table of Contents IOP vs. Partial Hospitalization Program Provider Types Eligible to Provide IOP Medicare Beneficiary Eligible for IOP Services Active Treatment and Treatment Plan Covered IOP Services [...]

Introduction

Section 1: Introduction Introduction Disclaimer National Government Services produced this material as an informational reference for providers furnishing services in our contract jurisdiction. NGS employees, agents and staff make no [...]

Federal Government Administration

Section 1: Introduction Table of Contents Federal Government Administration Who Is CMS? CMS' Goals Program Objectives Access to Quality Care Services to Beneficiaries Program Administration CMS Structure CMS [...]

Fundamentals of Medicare: State Responsibilities

Section 1: Introduction State Responsibilities Facilities desiring to participate in either the Medicare or Medicaid programs must meet participation conditions for certification. State agencies certify to the DHHS whether providers satisfy, [...]

LCD Open Meeting Records

Open Meeting Records Jurisdiction 6 and Jurisdiction K Open Meeting Records Meeting Date Audio Transcript 10/24/2024- J6/JK Open Meeting Recording Transcript  7/18/2024 - J6/JK Open Meeting [...]

Fundamentals of Medicare: Participating Providers

Section 1: Introduction Participating Providers Providers receiving Medicare reimbursement are known as “participating providers.” To become a participating provider, a provider must be in compliance with applicable provisions of Title VI of [...]

Voluntary and Involuntary Termination of Provider Agreement

Section 1: Introduction Voluntary and Involuntary Termination of Provider Agreement Table of Contents Voluntary and Involuntary Termination of Provider Agreement Voluntary (Provider-Requested) Termination of Agreement Involuntary [...]

Disclosure of Health Insurance Information

Section 1: Introduction Disclosure of Health Insurance Information Providers have restrictions on the information that they may disclose. The CMS IOM, Publication 100, Medicare General Information, Eligibility and Entitlement Manual, Chapter [...]

Privacy Act

Section 1: Introduction Privacy Act The purpose of the Privacy Act of 1974 (Act), Title 5, United States Code, Section 552a, is to balance the government’s need to maintain information about individuals with the rights of individuals to be [...]

National Provider Identifier

Section 1: Introduction National Provider Identifier The NPI is a HIPAA Administrative Simplification standard. The NPI is a unique identification number for covered health care providers that have replaced the legacy provider number. [...]

Legacy Provider Numbers/Provider Transaction Access Numbers (PTANs)

Section 1: Introduction Legacy Provider Numbers/Provider Transaction Access Numbers Table of Contents Legacy Provider Numbers/Provider Transaction Access Numbers State Code Facility Type Third-Digit Specialty Unit Designations [...]

Medicare Administrative Contractors

Section 1: Introduction Medicare Administrative Contractors What's A MAC Who are the MACs Table of Contents Medicare Administrative Contractors Who Is National Government Services? The Focus of the Provider Outreach & Education [...]

Fundamentals of Medicare: Information References

Section 1: Introduction Information References Table of Contents Information References Telephone Inquiries Interactive Voice Response Eligibility Information Claim Status Information Check and Remittance Information General [...]

Acronyms

Section 1: Introduction Acronyms An acronym is a term formed from the initial letter or letters of each of the major parts of a compound term. Listings of common Medicare acronyms are found on the CMS website. Reviewed 6/4/2024

Fundamentals of Medicare: Glossary of Terms

Section 1: Introduction Glossary of Terms Beneficiary: An individual who is eligible for Medicare. Benefit Period: The way that Medicare measures the use of hospital and SNF inpatient days. Claim: A bill for services rendered by a provider [...]

The History of Medicare

Section 2: Medicare Basics The History of Medicare During the 30 years following the passage of the SSA in 1935, many attempts were made to include health insurance as part of the Social Security system. It was not until the bill H.R. 6675 [...]

What Is the Medicare Program and How Is It Funded?

Section 2: Medicare Basics What Is the Medicare Program and How Is it Funded? Medicare is a federally funded health insurance program for: People age 65 or older Certain individuals under age 65 who qualify due to disability People with [...]

Medicare Eligibility and Premiums

Section 2: Medicare Basics Medicare Eligibility and Premiums The following groups of people are eligible for Medicare: Individuals aged 65 or older (or their spouse) who have worked at least 40 quarters, or ten years, in Medicare-covered [...]

The Social Security Administration and Medicare Enrollment

Section 2: Medicare Basics The Social Security Administration and Medicare Enrollment The SSA office has the responsibility for handling Medicare enrollment and managing premium billing and payment. Premiums may be deducted from a [...]

The Medicare Card

Section 2: Medicare Basics The Medicare Card Once a person is enrolled in Medicare, they are issued a card that indicates they are covered by Medicare. The Medicare card is red, white and blue in color. It is issued (and can be reissued) [...]

Medicare Part A

Section 2: Medicare Basics Medicare Part A Table of Contents Medicare Part A Benefit Periods—Medicare Part A Ending a Benefit Period Benefit Period Examples [Return to Top] Medicare Part A Medicare Part A is referred to as Hospital [...]

Inpatient Hospital Care

Section 2: Medicare Basics Inpatient Hospital Care Table of Contents Inpatient Hospital Care Inpatient Benefit Days and Cost-Sharing Full Days—Renewable Coinsurance Days—Renewable Lifetime Reserve Days—Nonrenewing Inpatient [...]

Skilled Nursing Facility Inpatient Care

Section 2: Medicare Basics Skilled Nursing Facility Inpatient Care Table of Contents Skilled Nursing Facility Inpatient Care Requirements for Coverage Technical Requirements Medical Requirements Inpatient SNF/Swing Bed Benefit [...]

Home Health Care Benefit

Section 2: Medicare Basics Home Health Care Benefit Table of contents Home Health Care Benefit Responsibilities of Hospitals Discharging Medicare Beneficiaries Home Health Prospective Payment System Responsibilities of Providers [...]

The Hospice Benefit

Section 2: Medicare Basics The Hospice Benefit Table of Contents The Hospice Benefit Requirements for Coverage Hospice Benefit Days and Costs Hospice Services Noncovered Hospice Services [Return to Top] The Hospice Benefit [...]

Medicare Part B Medical Insurance

Section 2: Medicare Basics Medicare Part B—Medical Insurance Table of Contents Medicare Part B—Medical Insurance Part B Costs Medicare Deductible, Coinsurance and Premium Rates Covered Part B Services Covered Physicians’ Services [...]

Fundamentals of Medicare - Medicare Program Exclusions

Section 2: Medicare Basics Medicare Program Exclusions No payment can be made under Medicare Part A or Medicare Part B for certain items and services. The list below includes the general Medicare program exclusions. For details regarding [...]

Medicare Advantage Organizations

Section 2: Medicare Basics Medicare Advantage Organizations Table of Contents What are Medicare Health Plans? Medicare Managed Care Plans [Return to Top] What are Medicare Health Plans? Medicare health plans provide different ways [...]

Medicare Secondary Payer

Section 2: Medicare Basics Medicare Secondary Payer Table of Contents Medicare Secondary Payer MSP Provisions MSP Billing - General Benefits Coordination & Recovery Center Contacting the BCRC [Return to Top] Medicare [...]