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Service Specific Post Payment Review of Darbepoetin Alfa Injection, 1 microgram (Non-ESRD Use)

National Government Services Part B MR Department analyzes national and local data to identify possible improper payment for Medicare services. In an effort to reduce the Part B CERT error rate, the MR Department will be conducting a service [...]

Announcing Service Specific Post-Payment Audits of Hyperbaric Oxygen (HBO) Services for J6 A Regions: IL, WI, and MN

Edit Reason Code: 5FPJP Bill Type = 13X CPT/HCPCS/Modifiers: G0277 Overview The Medical Review Department of National Government Services will be performing service specific post-payment reviews for claims submitted to Medicare Part A. When a [...]

Hospice Beneficiary Election Statement Addendum Frequently Asked Questions

Hospice Beneficiary Election Statement Addendum Frequently Asked Questions National Government Services, in collaboration with Palmetto GBA, CGS and CMS, developed these FAQs to assist providers in a better understand of the federal [...]

Multi-Jurisdictional Contractor Advisory Committee (CAC)/Subject Matter Expert Meeting

Multi-Jurisdictional Contractor Advisory Committee (CAC)/Subject Matter Expert Meeting March 10, 2022 Topic: SIJ Interventions and Procedures Questions for SIJ Interventions For all questions, answers must be based on clinical literature [...]

MLN Connects® Special Edition for Thursday, January 7, 2021

MLN Connects® Special Edition for Thursday, January 7, 2021 Physician Fee Schedule Update On December 27, the Consolidated Appropriations Act, 2021 modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS): Provided a [...]

MLN Connects® for Thursday, January 7, 2021

MLN Connects® for Thursday, January 7, 2021 COVID-19 Vaccines: CDC Long-Term Care Facility Toolkit View this edition as a: Webpage | PDF News COVID-19 Vaccines: CDC Long-Term Care Facility Toolkit MLN Web-Based Training: Complete [...]

Home Health Aide Services and the Intermittent or Part-Time Rule

Home Health Aide Services and the Intermittent or  Part-Time Rule Job Aid The CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 7, Section 50.2 states: The reason for the visits by the home health aide must [...]

PDGM Resources

PDGM Resources MLN Matters Article MM11081 – "Home Health Patient-Driven Groupings Model (PDGM) - Split Implementation" MLN Matters Article MM11395 – "Home Health Patient-Driven Groupings Model - Revised and Additional Manual Instructions" [...]

Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment

Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment This edit is applied to claims when a RAP and final episode claim are submitted at the same time or when a RAP is submitted when there is one for the same [...]