Return/Reject

Medicare Part B 101 Manual Return/Reject While it's easy to group processed claims as either approved or denied, there are differences in the way claims are returned unpaid by Medicare. Only claims that are filed with complete and correct [...]

Health Professional Shortage Area

Medicare Part B 101 Manual Health Professional Shortage Area What is a HPSA? What is the HPSA Incentive Bonus? Who is Eligible for the Incentive Bonus? How is the Bonus Billed? What Else You Should Know To Learn More [Return to [...]

Assignment of Benefits

Medicare Part B 101 Manual Assignment of Benefits Table of Contents Assignment of Benefits Mandatory Assignment Collecting from Medicare Patients on Assigned Claims Related Content [Return to Top] Assignment of Benefits An [...]

Advance Beneficiary Notice of Noncoverage for Not Reasonable and Necessary Denials

Medicare Part B 101 Manual Advance Beneficiary Notice of Noncoverage for Not Reasonable and Necessary Denials Table of Contents Limited Coverage Medical Necessity Expectations ICD-10-CM Coding Reasons for Noncoverage Beneficiary [...]

Set Up a Beneficiary's Medicare Secondary Payer Record

Table of Contents Background: Set Up a Beneficiary’s Medicare Secondary Payer Record Step 1: Provider Receives New MSP Information for a Beneficiary Step 2: Check for a Matching Medicare Secondary Payer Record for the Beneficiary in the [...]

Modifier 90 Reference to Outside Laboratory

Modifier 90: Reference to Outside Laboratory Modifier 90 is to be used when the billing laboratory refers a specimen to another laboratory for testing. In these cases, the billing laboratory is titled the “referring laboratory” while the [...]

Initiate Patient Status Lookup

Initiate Patient Status 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 Beneficiary panel, [...]

Hospice Payment Rates

MSP Post-Pay Overpayments

Forms You’ll Need Jurisdiction K CT-MA-ME-NH-NY-RI-VT Medicare Part B MSP Overpayment Request Form Jurisdiction 6 IL-MN-WI Medicare Part B MSP Overpayment Request Form JK or J6 Medicare Secondary Payer Part B Voluntary [...]

Cognitive Assessment and Care Plan Information

Cognitive Assessment and Care Plan Information Select Cognitive Assessment & Care Plan Information from the left-side navigation. The Cognitive Assessment & Care Plan information panel provides information for the following HCPCS [...]

Part B Deductible

Part B Deductible Select Part B Deductible from the left-side navigation. The information displayed in this section will provide the current year’s Part B deductible amount and if available up to four years of additional historical deductible [...]

Beneficiary Eligibility Information Panel

Beneficiary Eligibility Information Panel Table of Contents Beneficiary Eligibility Information Panel Printable View Initiate a New Search [Return to Top] Beneficiary Eligibility Information Panel The Beneficiary Eligibility [...]

Flu Vaccine

Flu Vaccine Select Flu Vaccine from the left-side navigation. You will find the patient's flu vaccination history in this section. The Medicare beneficiary must have active Part B coverage and must not have a date of death on file at the [...]

Hepatitis Screening

Hepatitis Screening Select Hepatitis Screening from the left-side navigation. The Hepatitis Screening panel provides information for the following HCPCS codes. 86704 ‒ Hepatitis B core antibody (HBcAb); total 86706 ‒ Hepatitis B surface [...]

Hospice Payment Rates

Hospice Payment Rates National Government Services publishes hospice rate sheets you can use to validate hospice payments based on your service location. Although FISS is the official payment made by the Medicare Program, you can use the rates [...]

Accelerated and Advanced Payment Program

COVID-19 Accelerated/Advanced Payment Revised Repayment Terms On 3/28/2020, CMS expanded the existing CAAP to a broader group of Medicare Part B Providers. The CMS CAAP Program was established to increase case flow to Medicare providers and [...]

Bankruptcy Notifications

Notify us if you file bankruptcy. If you have filed a bankruptcy petition or are involved in a bankruptcy proceeding, National Government Services requests that you notify us immediately so that we can properly coordinate with the CMS and the [...]

Complete a Voluntary Refund

Table of Contents Forms Used for Providers NOT on Automatic Immediate Recoupments and Check(s) Are Attached to This Form(s) Option 1: Completing the Voluntary Refund Form High Volume Spreadsheet Instructions Option 2: Large [...]

How Should I Respond?

An overpayment may be identified and self-reported by a provider via clerfical error reopening or an overpayment, may be discovered by Medicare contractors as part of the claim and reimbursement review process. The key to reporting and repaying [...]