Appeals Decision Tree

Complete a Voluntary Refund

A voluntary refund is when you have self-identified you have been overpaid and you need to refund the excess funds to Medicare. All checks are made payable to National Government Services. Whenever possible the refund to Medicare should be [...]

Complete a Voluntary Refund

A voluntary refund is when you have self-identified you have been overpaid and you need to refund the excess funds to Medicare. All checks are made payable to National Government Services. All checks are made payable to National Government [...]

Complete a Voluntary Refund

A voluntary refund is when you have self-identified you have been overpaid and you need to refund the excess funds to Medicare. All checks are made payable to National Government Services. Whenever possible, the refund to Medicare should be [...]

5010 Top Page for Part B

EDI Front End Rejection Code Lookup Tool To view easy-to-understand descriptions associated with the reject code(s) returned on the Status Information segment (STC) of the version 5010 277CA – Claim Acknowledgement, enter the following code [...]

Person(s) with Medicare

Person(s) with Medicare  Home Contacts & Resources Coverage & Billing Education Medicare Plans News

Cardiac Positron Emission Tomography Pricing Change

Cardiac Positron Emission Tomography Pricing Change Effective 1/1/2020 there nine CPT codes that describe PET as noted in the lists below. Of the nine listed codes, six (group 1) are new for 2020 and are contractor priced codes for the TC and [...]

Don’t Forget the CMS-588 Electronic Funds Transfer Authorization Agreement

Don’t Forget the CMS-588 Electronic Funds Transfer Authorization Agreement The CMS-588 Electronic Funds Transfer Authorization Agreement is to be submitted for billing providers upon initial enrollment, change in bank information and during [...]

Opioid Treatment Add-on Code G2078 and G2079 MUE Values

Opioid Treatment Add-on Code G2078 and G2079 MUE Values The July 2020 quarterly update for the NCCI added an MUE value of one for OTP HCPCS codes G2067-G2075 and G2078 and G2079. It was later determined by CMS that the incorrect MUE value was [...]

October 2020 Release "Dark Days" for the Common Working File Hosts

October 2020 Release "Dark Days" for the Common Working File Hosts For the upcoming October 2020 Release: For Production, CWF will be observing dark days starting Friday, 10/2/2020 through Sunday, 10/4/2020 to accommodate the anticipated [...]

October 2020 Fiscal Intermediary Standard System Direct Data Entry Screen Changes

October 2020 Fiscal Intermediary Standard System Direct Data Entry Screen Changes The DDE CWF Inquiry Screen (MAP175M) will display the ABPM and will include the technical and professional dates for HCPCS 93784. The MBI Eligibility FROM and [...]

Registered Dietitians and COVID-19 Allowances for Billing

Registered Dietitians and COVID-19 Allowances for Billing National Government Services has received clarification from CMS in regard to registered dietitians/nutritionists billing. When CPT codes 98966‒98968 were originally opened to coverage [...]

Radiopharmaceuticals Invoice or Acquisition Cost Submission Reminder

Radiopharmaceuticals Invoice or Acquisition Cost Submission Reminder National Government Services has identified situations where claims are being submitted for radiopharmaceuticals without an invoice or acquisition cost provided. For [...]

Quality Innovation Networks - Quality Improvement Organizations Quality Initiatives

Quality Innovation Networks - Quality Improvement Organizations Quality Initiatives CMS leads a national health care quality improvement network of Quality Innovation Networks – Quality Improvement Organizations (QIN-QIOs). Locally, an [...]

Providers' Obligation to Report and Refund Medicare Overpayments with Appropriate Forms

Providers' Obligation to Report and Refund Medicare Overpayments with Appropriate Forms Healthcare providers have an obligation to report and refund federal program overpayments and continue to do so, but National Government Services would [...]

Provider Enrollment Reconsideration Request Reminders

Provider Enrollment Reconsideration Request Reminders National Government Services has been receiving reconsiderations of provider enrollment credentialing requests that do not fall into the appropriate criteria for reconsiderations due to the [...]

Proper Billing for Telehealth Services Claims

Proper Billing for Telehealth Services Claims We have received a high volume of paper CMS-1500 claim forms for telehealth services with dates of service during the PHE that we have to reject because they are improperly coded with two different [...]

Prior Authorization Request Reminders

Prior Authorization Request Reminders Effective for dates of service on or after 7/1/2020, a PAR is required for certain OPD services. For additional information on the Medicare Prior Authorization Program go to our website > log in to any [...]

Prior Authorization Program Becomes Effective for Dates of Service on/after 7/1/2020

Prior Authorization Program Becomes Effective for Dates of Service on/after 7/1/2020 The CMS is implementing a prior authorization program for certain hospital outpatient department services effective for dates of service on or after 7/1/2020. [...]

Reminder: Providers on Automatic Immediate Recoupments

Reminder: Providers on Automatic Immediate Recoupments If you are set up for automatic recoupments, please refrain from submitting checks and overpayment forms. Submitting receipts run the risk of money being offset and your check being [...]