How to Determine if the Provider is Active and Get the Provider Enrolled in Medicare Part B

Table of Contents Determine If the Provider Has an Active Enrollment How to Enroll the Provider in Medicare Part B Determine If the Provider Has an Active Enrollment Navigate to the Medicare Fee-For-Service Public Provider Enrollment [...]

Flu, COVID-19 and PPV Vaccines

During this webinar, we'll review the coverage, coding and billing guidelines for influenza, pneumococcal and COVID-19 vaccine administration and billing.

The Utilization of the KX Modifier on Dental Claims

The Utilization of the KX Modifier on Dental Claims National Government Services wants to bring to your attention the usage of the KX modifier for the submission of Medicare claims for dental services that are inextricably linked to covered [...]

Rural Tobacco Disparity

Rural Tobacco Disparity Tobacco use and exposure to SHS are major causes of preventable disease, disability and mortality in the United States and are responsible for approximately 480,000 deaths annually; another 16 million people are living [...]

Behavioral Health Telehealth In-Person Requirements

Behavioral Health Telehealth In-Person Requirements National Government Services has been receiving questions regarding the behavioral health telehealth requirement that the initial telehealth service include an in person visit within the [...]

Report a Change of Ownership, Acquisition/Merger or Consolidation

Table of Contents Step 1: Determine You Are in the Right Place Step 2: Understand Type of CHOW Change of Ownership Acquisition/Merger Consolidation CHOW Reminders Step 3: Make Changes via Enrollment Application Change of [...]

Screening for Cardiovascular Disease and Abdominal Aortic Aneurysm

During this webinar, we'll review the coverage, coding, and billing guidelines for cardiovascular disease (CVD) screening blood tests, intensive behavioral therapy for CVD, and ultrasound screening for abdominal aortic aneurysm preventive services.

December 2024

In This Issue National Government Services Articles for Part A and Part B Providers Two Weeks to Prepare to Use NGSConnex for Beneficiary Eligibility Information A/B DME MAC Collaborative Lower Limb Orthoses Webinar November is Lung [...]

Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)

Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q) This stringent claim editing process helps ensure that Medicare does not make payments for services rendered to beneficiaries who are not eligible due to being [...]

Termination of the Hospice Benefit Component of the VBID Model on 12/31/2024

Termination of the Hospice Benefit Component of the VBID Model on 12/31/2024 After carefully considering recent feedback about the increasing operational challenges of the Hospice Benefit Component and limited and decreasing participation [...]

Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2025

Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2025 Table of Contents Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2025 Advantages of Being a Medicare-Participating [...]

Medicare Participating Physician or Supplier Agreement Form (CMS-460)

Introduction

Medicare Part B 101 Manual: Introduction Medicare Program for Part B Providers Table of Contents Introduction Medicare Administrative Contractors Medicare Contracting Reform Providers Responsible for Knowing Guidelines Medicare Part A [...]

Get Help with Rejected/Denied Enrollment Application

Table of Contents Get Help with Rejected/Denied Enrollment Application Determine the Application Status Understand Rejection or Denial Related Content [Return to Top] Get Help with Rejected/Denied Enrollment Application The CMS IOM [...]

Get Help with Rejected/Denied Enrollment Application

Table of  Contents   Get Help with Rejected/Denied Enrollment Application Determine the Application Status Understand Rejection or Denial Related Content Get Help with Rejected/Denied Enrollment Application The CMS IOM [...]

Get Help with Rejected/Denied Enrollment Application

Table of Contents Get Help with Rejected/Denied Enrollment Application Determine the Application Status Understand Rejection or Denial Related Content  Get Help with Rejected/Denied Enrollment Application The CMS IOM Publication [...]

Requests for Additional Information

Table of Contents Requests for Additional Information Paper Application Submissions PECOS Application Submissions [Return to Top] Requests for Additional Information While processing the application(s), National Government [...]

Provider Contact Center

Provider Contact Center Table of Contents Want to talk to us? Make the Most of Your Call Customer Care Representative Assistance Interactive Voice Response System NGSConnex Online Inquiry System Written Correspondence and Inquiries [...]

Interactive Voice Response System

Interactive Voice Response System State IVR Number Hours Available* Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont 877-567-7205 Monday–Friday: 6:00 a.m.–7:00 p.m. ET [...]

MLN Connects® Newsletter: December 5, 2024

MLN Connects® Newsletter: December 5, 2024 News Clinical Laboratory Fee Schedule: CY 2025 Final Payment Determinations CMS Roundup (November 29, 2024) Advanced Primary Care Management Services: Get Information about Billing Medicare Flu [...]

Annual Logon ID Recertification for New York/Connecticut Regions

All users who access the FISS DDE system are required by the CMS to recertify their access annually. National Government Services will designate one state at a time to complete the annual logon recertification. To complete the recertification [...]

Common Working File (CWF) Host Dark Days for January 2025 Release

Common Working File (CWF) Host Dark Days for January 2025 Release  For Production, 1/1/2025 – Observe Holiday – No Cycle, CWF will be observing the Gray Day on Thursday, 1/2/2025 and Dark Days starting Friday, 1/3/2025 through Sunday, [...]

Provider Contact Center

Provider Contact Center Table of Contents Want to talk to us? Make the Most of Your Call Customer Care Representative Assistance Interactive Voice Response System NGSConnex Online Inquiry System Written Correspondence and Inquiries [...]

Provider Contact Center

Provider Contact Center Table of Contents Want to talk to us? Make the Most of Your Call Customer Care Representative Assistance Interactive Voice Response System NGSConnex Online Inquiry System Written Correspondence and Inquiries [...]

Provider Contact Center

Provider Contact Center Table of Contents Want to talk to us? Make the Most of Your Call Customer Care Representative Assistance Interactive Voice Response System NGSConnex Online Inquiry System Written Correspondence and Inquiries [...]

Interactive Voice Response System

Interactive Voice Response System State IVR Hours Available* Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont 877-869-6504 Monday–Friday: 6:00 a.m.–7:00 p.m. ET Saturday: [...]

Interactive Voice Response System

Interactive Voice Response System Toll-Free Number 877-309-4290 Hours Available* Monday–Friday: 6:00 a.m.–7:00 p.m. ET Saturday: 7:00 a.m.–3:00 p.m. ET *IVR hours represent general availability for access to all menu options. The IVR is [...]

Interactive Voice Response System

Interactive Voice Response System State IVR Number Hours Available* Alaska, Arizona, California, Hawaii, Idaho, Nevada, Oregon, Washington, American Samoa, Guam, Northern Mariana Island 866-277-7287 [...]

Billing Protections for Qualified Medicare Beneficiaries

Incarcerated or Unlawfully present in the US claim rejections (U538H, U538Q)

Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q) This stringent claim editing process helps ensure that Medicare does not make payments for services rendered to beneficiaries who are not eligible due to being [...]

January 2025 EDI Front End Quarterly Release

January 2025 EDI Front End Quarterly Release Please be advised that while the Centers for Medicare & Medicaid Services mandated release for January 2025 will be installed the weekend of 1/5/2025, the code set updates included with this [...]

Screening Mammography, Pap Test and Pelvic Exam

Ensure that your patients obtain the preventive services they are eligible for by knowing the Medicare coverage, coding and billing guidelines for screening mammograms, pap tests and pelvic examinations, as well as where to find more [...]

Correct a Beneficiary's MSP Record

Table of Contents Background Step 1: Provider Receives Information Indicating Medicare Is the Primary Payer for a Beneficiary's Services Step 2: Prepare and Submit a Medicare Primary Claim With the Reason Medicare Is the Primary Payer [...]

Provisional Period of Enhanced Oversight for New Hospices

Provisional Period of Enhanced Oversight for New Hospices In recent years, CMS has reported a significant increase in fraudulent hospice billing practices, which cost the Medicare program millions of dollars annually. The CMS has initiated a [...]

Overcoming Barriers to Tobacco Counseling

Overcoming Barriers to Tobacco Counseling Healthcare providers may face different challenges when implementing tobacco cessation counseling into a clinical practice routine. These various factors influence the healthcare professionals’ [...]

Understanding the Approval Recommendation Process for Certified Providers

Understanding the Approval Recommendation Process for Certified Providers The certified provider completes and submits a CMS-855 enrollment application and all supporting documentation to its MAC, including any state require documentation and [...]

Certified Provider and State Survey Agency

Certified Provider and State Survey Agency Table of Contents Certified Provider and State Survey Agency Certified Providers/Suppliers Certified Providers and Certified Suppliers That Enroll Via the Form CMS-855A Certified Suppliers [...]

Understanding the Approval Recommendation Process for Certified Providers

Understanding the Approval Recommendation Process for Certified Providers The certified provider completes and submits a CMS-855 enrollment application and all supporting documentation to its MAC, including any state require documentation [...]

Certified Provider and State Survey Agency

Certified Provider and State Survey Agency Table of Contents Certified Provider and State Survey Agency Certified Providers/Suppliers Certified Providers and Certified Suppliers That Enroll Via the Form CMS-855A Certified Suppliers That [...]

MLN Connects® Newsletter: December 12, 2024

MLN Connects® Newsletter: December 12, 2024 News FY 2024 Medicare Fee-for-Service Improper Payment Rate Revised Home Health Change of Care Notice Form Effective February 1 Skilled Nursing Facility Value-Based Purchasing Program: December [...]

Your Lunchtime Treat! Listen to the Navigating Medicare: Part A Insights for Providers Podcast

Your Lunchtime Treat! Listen to the Navigating Medicare: Part A Insights for Providers Podcast “Lunch, listen and learn” twice a month with Medicare Part A! We have more than 15 Part A podcasts geared toward our Part A providers and their [...]

Intermittent Issues with NGSMedicare.com on 12/15/2024

Intermittent Issues with NGSMedicare.com on 12/15/2024 We will experience intermittent outages with NGSMedicare.com on Sunday, 12/15/2024 due to maintenance. NGSMedicare.com will be fully operational on Monday, 12/16/2024. We apologize for [...]

HCPCS 82947 RTPs End-Stage Renal Dialysis Providers

As of 1/1/2024, Medicare has covered HbA1c tests for diabetic screening (HCPCS 82947) when billed with ICD-10 Z13.1. Some of these claims submitted by ESRD providers have been RTP'd in error.

End Stage Renal Disease Claims Returning to Providers with Reason Code 31773

Due to an issue with the October 2024 release, ESRD facility claims, type of bill 72X, are RTPing in error.

Claim Billing Guidance

Claim Billing Guidance With the end of the PHE, as of 5/11/2023, this information no longer applies. We will keep the information available for PHE-related services that occurred prior to the expiration date that have not yet been billed. [...]

Join Us to Learn About NGSConnex

Join Us to Learn About NGSConnex We’re hosting a series of webinars focused on our free, secure internet portal, NGSConnex. During each session, we’ll review what NGSConnex has to offer. We’ll discuss registration, access, navigation and [...]

Expedited Requests

Expedited Requests The requester may submit for an expedited review of the PAR if it is determined that a delay could seriously jeopardize the beneficiary’s life, health, or ability to regain maximum function. If the medical documentation does [...]

Reminder for Correcting Hospice Edits for Certifying Physicians (17729, 17730)

Reminder for Correcting Hospice Edits for Certifying Physicians (17729, 17730) Reason Codes 17729 and 17730: Refer to specific hospice claim edits related to certifying physicians. Adjustments: Should be submitted for correcting input [...]

MLN Connects® Newsletter: December 19, 2024

MLN Connects® Newsletter: December 19, 2024 News MBI Lookup Tools: CMS Seeks Input by February 17 CMS Roundup (December 13, 2024) Long-Term Care Hospital Provider Preview Reports: Review by January 15 Inpatient Rehabilitation Facility [...]

Radiopharmaceutical Reimbursement

Radiopharmaceutical Reimbursement National Government Services has reviewed the radiopharmaceutical pricing methodology set forth in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Section 303(h) which states that [...]

Preventive Services Overview

Medicare covers many preventive services to keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep your patients from getting certain diseases. Register today for a [...]

Using the Medicare Coverage Database: How to Find Important Medicare Coverage Information

Are you responsible for looking up whether a service is covered in the Medicare program at your facility but you're not sure where to look for the most relevant information? Have you received national coverage determination (NCD) or local [...]

Initiate Eligibility Lookup

Initiate Eligibility Lookup Click the Eligibility Lookup button from the NGSConnex homepage.   In the Select a Provider panel, click the Select button next to the applicable provider account.   In the Select a [...]

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.

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.

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 [...]

Let's Chat About Provider Enrollment Revalidation

During this session, you’ll have the opportunity to ask questions about all accepts of provider enrollment. Answers will be provided by a panel of subject-matter experts. As this is a question-and-answer session, there is no presentation available.

Medicare Secondary Payer: Preparing and Submitting Claims – Part 1

Join us for Part 1 of a two-part webinar. In Part 1, we will review Medicare Secondary Payer (MSP) claim coding and how to prepare/submit an MSP claim. This includes a review of the claim entry pages in the Fiscal Intermediary Standard System [...]