New Medical Review Frequently Asked Questions

New Medical Review Frequently Asked Questions We’ve added Medical Review Frequently Asked Questions to our website. Visit our Help and FAQs web page for common questions and answers related to Medical Review and other topics including: EDI, [...]

Medical Review

Registration is Open for the National Government Services Medicare Fall 2021 Virtual Conference!

Registration is Open for the National Government Services Medicare Fall 2021 Virtual Conference! The National Government Services POE Team is holding our latest bi-annual virtual conference on Tuesday, 11/9/2021 and Wednesday, 11/10/2021. This [...]

National Government Services Medicare Fall 2021 Virtual Conference

National Government Services Medicare Fall 2021 Virtual Conference The National Government Services POE Team's biannual virtual conference is scheduled for Tuesday, 11/9/2021 and Wednesday, 11/10/2021. This two full-day virtual conference [...]

Save Time and Money by Submitting your Appeals (Reopenings & Redeterminations) Electronically

Save Time and Money by Submitting your Appeals (Reopenings & Redeterminations) Electronically Two easy ways to submit. National Government Services will now allow Medicare Part A and Part B providers to submit claim appeal requests, [...]

Improving Customer Experience in 2021

Improving Customer Experience in 2021 We are committed to improving your experience. Please watch this two-minute video that explains how each day we review comments from providers who submit surveys to let us know what is working well and how [...]

Provider Action To Be Taken Following the Provider-Based Mid-Build Audit

Provider Action To Be Taken Following the Provider-Based Mid-Build Audit The off-campus PBDs that were “mid-build” prior to 11/2/2015 received mid-build determination letters in January 2021 from the CMS mid-build audit contractor, Cahaba [...]

National Influenza Vaccination Week

National Influenza Vaccination Week National Influenza Vaccination Week is Observed 12/5/2021–12/11/2021 Influenza (flu) is a contagious respiratory illness caused by the influenza virus and causes mild to severe illness. Millions of people [...]

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 [...]

July and August 2022 Billing and Coding Article Updates

July/August 2022 Billing and Coding Article Updates Billing and Coding Articles Billing and Coding: Botulinum Toxins (A52848) Based on comments received, ICD-10-CM codes N39.41 and N39.46 have been added to the Group 4 ICD-10 code list [...]

Change Request 10484, Pub.100-20, Rev2357: Additional Instructions to Hospitals on the Election of a Medicare SSI Component of the DSH Payment Adjustment for Cost Reports FY 2004 and Earlier

Change Request 10484, Pub.100-20, Rev2357: Additional Instructions to Hospitals on the Election of a Medicare SSI Component of the DSH Payment Adjustment for Cost Reports FY 2004 and Earlier Please click on the following link to read the [...]

Appeal Submission Process for Claims with Multiple Line Items

Appeal Submission Process for Claims with Multiple Line Items We have identified instances where providers are submitting several appeals for one claim internal control number. If you need to appeal (redetermination) a claim with multiple [...]

MLN Connects® for Thursday, January 16, 2020

MLN Connects® for Thursday, January 16, 2020 Quality Payment Program: Learn About the MIPS 2020 Performance Period MLN Connects® for Thursday, January 16, 2020 View this edition as a PDF News CMS Reduces Psychiatric Hospital Burden [...]

MLN Connects® for Thursday, January 9, 2020

MLN Connects® for Thursday, January 9, 2020 Read the Latest Quality Payment Program Updates MLN Connects® for Thursday, January 9, 2020 View this edition as a PDF News Quality Payment Program: 2018 Performance Data Quality [...]

Notification to Providers: Preventive and Screening Services

Notification to Providers: Preventive and Screening Services Centralized billing is a process in which a provider, who provides mass immunization services for influenza virus and pneumococcal pneumonia virus (PPV) immunizations, can send all [...]

MLN Connects® for Thursday, February 27, 2020

MLN Connects® for Thursday, February 27, 2020 COVID-19 Coding Guidance MLN Connects® for Thursday, February 27, 2020 View this edition as a PDF News Quality Payment Program: MIPS 2019 Data Submission Period Open through March 31 [...]

Make Today the Day - Sign Up for Medicare Diabetic and Prevention Program Email Updates

Make Today the Day ‒ Sign Up for Medicare Diabetic and Prevention Program Email Updates The MDPP supplier Email Updates are the mechanism by which MDPP suppliers will receive important information and reminders, such as upcoming due [...]

Amending Medical Records

Amending Medical Records Amendments, Corrections and Delayed Entries in Medical Documentation    All services provided to beneficiaries are expected to be documented in the medical record at the time they are rendered. [...]

Did You Know that the Medicare Part B Overpayment Form Has Been Retired?

Did You Know that the Medicare Part B Overpayment Form Has Been Retired? Our records indicate some providers are still using the retired Medicare Part B Overpayment Form. The new process for provider-initiated non MSP overpayments is as [...]

Article Revisions: February 2020

Article Revisions: February 2020 The medical policies and related articles can be found in our Medical Policy Center. Billing and Coding: Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy (A57826) The [...]