-
Posting Date: 04/11/2025
Being Compliant by Avoiding Claim Denials, Reopenings and Redeterminations
National Government Services is committed to reducing provider burden associated with Medicare claim denials, reopenings and appeals. Don’t wait until you receive the claim denials that will increase your time, effort, and cost to have the [...]
Read More -
Posting Date: 01/08/2018
Urgent Care
Urgent Care Please explain the concepts of split/shared and incident to E/M services in the urgent care setting. Answer: The urgent care setting is defined by CMS as a nonfacility setting. This means the split/shared concept does not [...]
Read More -
Posting Date: 01/28/2021
Transitional Care Management
Transitional Care Management Please clarify responsibility for the TCM interactive contact. Can this be performed by a hospital-employed nurse prior to discharge? Answer: The provider who is billing the TCM service is responsible for the [...]
Read More -
Posting Date: 05/11/2022
Time-Based Services
Time-Based Services Please define rules for using time to level-set a service. Answer: In both the office and observation/inpatient setting, the provider’s time is calculated based on pre-visit, intra-visit, and post-visit activities [...]
Read More -
Posting Date: 01/28/2022
Telehealth Services
Telehealth Services Please explain Medicare’s definition of a telehealth service. Answer: Medicare defines a telehealth service as a service provided by a Medicare-enrolled practitioner from an approved distant site for a beneficiary who [...]
Read More -
Posting Date: 06/09/2017
Smoking Cessation
Smoking Cessation Please clarify appropriate codes for smoking cessation services. Answer: CPT codes 99406 and 99407 may be used for smoking and tobacco-use cessation counseling visits. Please clarify what constitutes a session which [...]
Read More -
Posting Date: 01/04/2023
Skilled Nursing Facility Services
Skilled Nursing Facility Services Please define rules for initial and subsequent SNF services, when the same provider has treated the patient at another site on the same date of service. Answer: This depends on the site of the prior [...]
Read More -
Posting Date: 08/29/2017
Separately Identifiable Service
Separately Identifiable Service Please define the appropriate use of modifier 57 to identify a separately payable E/M with an initial decision for surgery. Answer: Modifier 57 is added to an E/M service that resulted in an initial [...]
Read More -
Posting Date: 01/28/2022
Provider Specialty
Provider Specialty Should each MD in the same practice bill with two different taxonomy codes based on whether functioning as a cardiologist or electrophysiologist? Answer: Yes, providers should be billing with their taxonomy codes. The [...]
Read More -
Posting Date: 04/01/2022
Prolonged Services
Prolonged Services Note: View the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.15.2 and Section 30.6.15.3 for CPT codes [...]
Read More -
Posting Date: 10/26/2022
Nonphysician Practitioner Services
Nonphysician Practitioner Services In addition to the frequently asked questions below, please view NGS’ Nonphysician Practitioners-Reducing Costly Appeals; Increase Provider Revenue article for related information. Is it permissible for [...]
Read More -
Posting Date: 01/27/2022
New vs. Established Patients
New vs. Established Patients How does CMS define a patient as “new” versus “established”? Answer: In 2023, the definition of a “new” patient differs based on whether the patient is being treated in an office or an observation/ inpatient [...]
Read More -
Posting Date: 01/28/2022
Preoperative Clearance
Preoperative Clearance What requirements must be met for a preoperative clearance visit to be considered medically necessary and billable? Answer: CMS does not set requirements for medical clearance; these are established by individual [...]
Read More -
Posting Date: 02/21/2020
IPPE and AWV Services
IPPE and AWV Providers are reminded that the IPPE and AWV are Medicare-covered services within their own benefit category. As such, they are not subject to standard “incident to” billing guidelines and must be billed by the performing [...]
Read More -
Posting Date: 04/29/2021
Medical Decision Making
Medical Decision Making In a split/shared service, when a medical record includes a plan of care developed by the physician, based on a history and/or examination performed by the NPP and a personal review of diagnostic findings, [...]
Read More -
Posting Date: 04/18/2025
The National Correct Coding Initiative and Medically Unlikely Edits for Part B Providers
This webinar will assist Part B providers with navigating tables for the National Correct Coding Initiative and the medically unlikely edits. We'll also review the proper modifiers to use to avoid denials. There will be time for your questions [...]
Read More -
Posting Date: 01/27/2022
Examination
As of 1/1/2023, CMS has eliminated prior specifications for the scope of examination and associated documentation in the outpatient office and hospital settings. The provider is expected to perform and document a medically necessary and [...]
Read More -
Posting Date: 01/27/2022
General E/M Information
General E/M Information Please explain the terms “auxiliary personnel” and “clinical staff” in the context of Medicare services. Answer: These terms are often used in defining which staff members can perform Medicare services [...]
Read More