Initiate Audit and Reimbursement Document Submissions

Initiate Audit and Reimbursement Document Submissions Table of Contents Initiate Audit and Reimbursement Document Submissions Step 1: Provider Details Step 2: Audit & Reimbursement Step 3: Document Submission Step 4: Submit [...]

A&R Inquiries

A&R Inquiries Table of Contents A&R Inquiries Email Notification View/Initiate an A&R Inquiry Response Inquiry Details Step 1: Response Description Step 2: Attachments Step 3: Submit Response What to do if you [...]

Initiate a Prior Authorization Request

Initiate a Prior Authorization Request Table of Contents Initiate a Prior Authorization Request Request Details Requestor’s Information Rendering Physician Information Attachments [Return to Top] Initiate a Prior Authorization [...]

A/B and DME Collaborative General Documentation Requirements

A/B and DME Collaborative General Documentation Requirements The A/B and DME Collaborative General Documentation Requirements YouTube Video is available. Posted 3/27/2024

MLN Connects® Newsletter: March 28, 2024

MLN Connects® Newsletter: March 28, 2024 Proposed Payment Rule FY 2025 Inpatient Rehabilitation Facility Prospective Payment System Proposed Rule News CMS Roundup (Mar 22, 2024) Hospital Price Transparency: Tools to Help Hospitals [...]

April 2024

In This Issue National Government Services Articles for Part A and Part B Providers Attention Electronic Billers Attention! New CMS-588 Electronic Funds Transfer Authorization Agreement (11/23) Version Important Reminder: Change [...]

Submitting Credit Balance Reports

Submitting Credit Balance Reports Table of Contents Submitting Credit Balance Reports Initiate a Credit Balance Report Credit Balance Certification Page [Return to Top] Submitting Credit Balance Reports This function allows [...]

Medicare Preventive Services Resource Guide Medicare covers many preventive services to keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep Medicare beneficiaries [...]

DSMT: Documentation & Physician Order Requirements

DSMT: Documentation & Physician Order Requirements Table of Contents DSMT: Documentation & Physician Order Requirements Documentation & Physician Order Requirements Provider Actions Related Content [Return to Top] DSMT: [...]

Claim Timely Filing Job Aid

Claim Timely Filing Job Aid Table of Contents Claim Timely Filing Job Aid Timely Filing Limits Date of Service Considerations Timely Filing Limits Chart Timely Filing Exceptions Related Content [Return to Top] [...]

Preventive Services

Medicare Preventive Services Resource Guide

Medicare Preventive Services Resource Guide Medicare covers many preventive services to keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep Medicare beneficiaries [...]

Medicare Secondary Payer Calculator

RC 55A00 or 55A01 Denials for Denosumab

National Government Services is aware of an issue that is causing claims to deny in error with reason code 55A00 or 55A01. The claims involved are for Denosumab (J0897) - Billing and Coding article – A52399 and are firing on edit 5XX84.

Part A Claims Returning to Provider (RTP) RC 38361

Claims are continuing to incorrectly RTP even when the prior claims are not No Pay Claims.

Rural Health Claims Impacted by FS2540

This utility will adjust Rural Health claims - 71X TOB Reimbursed incorrectly with the implementation of FS2540 in the A20232CP release Installed to production on 5/15/23 Note: changes for FS2540 were backed out with FS2540R1 on 6/13/23. [...]

Temporary Relief Available for Providers on Medical Review That Have Been Impacted by CHOPD

Temporary Relief Available for Providers on Medical Review That Have Been Impacted by CHOPD Per the direction of CMS, as of 3/27/2024, National Government Services may grant extensions for responses to ADRs to providers under active medical [...]

You Asked, We Listened – Enhanced Website Search

You Asked, We Listened – Enhanced Website Search We often hear from our customers that our website search function returns too many results when searching for a specific topic. We’re happy to share, we’ve enhanced our search function to help [...]

Submission of EDI Enrollment Forms

Submission of EDI Enrollment Forms We’ve added validation within the EDI Enrollment Form submission process that will verify provider information as the form is being completed. Previously, this validation was completed after submission, and [...]

Understanding Revalidation Application Requirement of Submission

Understanding Revalidation Application Requirement of Submission The 42 Code of Federal Regulations Section 424.515(b): requires that a provider/supplier must submit a CMS-855 application with complete information for revalidation by the due [...]

Understanding Revalidation Application Requirement of Submission

Understanding Revalidation Application Requirement of Submission The 42 Code of Federal Regulations Section 424.515(b): requires that a provider/supplier must submit a CMS-855 application with complete information for revalidation by the due [...]

MLN Connects® Newsletter: April 4, 2024

MLN Connects® Newsletter: April 4, 2024 Proposed Payment Rules FY 2025 Skilled Nursing Facility Prospective Payment System Proposed Rule FY 2025 Inpatient Psychiatric Facilities Prospective Payment System & Quality Reporting Updates [...]

New Provider Center

Get PECOS Access to Maintain Medicare Provider Enrollment Records

Get PECOS Access to Maintain Medicare Provider Enrollment Records Do you need to work on behalf of an individual provider and/or entity to update or submit Medicare enrollment information electronically through PECOS? There are certain [...]

Get PECOS Access to Maintain Medicare Provider Enrollment Records

Get PECOS Access to Maintain Medicare Provider Enrollment Records Do you need to work on behalf of an individual provider and/or entity to update or submit Medicare enrollment information electronically through PECOS? There are certain [...]

Related Content

Related Content WPC Health Care Code Lists Health Care Payment and Remittance Advice: Provides information on ERA and companion documents for assistance with receiving the Transaction 835. CMS IOM Publication, Medicare Claims [...]

General Information

General Information Since 2001, CMS has formally recognized qualified audiologists (specialty 64) to personally furnish diagnostic tests (Section 410.32(b)(2)(ii)) without supervision by a physician or NPP. The statute, at section 1861(ll)(3) [...]

Prevent an MSP Rejection on a Medicare Primary Claim

Table of Contents Prevent an MSP Rejection on a Medicare Primary Claim Step 1: Identify the MSP Record for the Beneficiary on the CWF that Needs Correction Step 2: Prepare a Medicare Primary Claim for the Beneficiary’s Services Step 3: [...]

Publications for People with Medicare

Publications for People with Medicare Medicare & You Handbook Medicare News Medicare Publications

G0179FrequencyCalculatorBottom

  The home health agency (HHA) certification code can be billed only when the patient has not received Medicare-covered home health services for at least 60 days. The HHA recertification code is used after a patient has received services for [...]

G0179FrequencyCalculatorTop

G0179 Frequency Calculator Use this calculator to determine the date the next recertification code G0179 may be billed. Enter the date of the last recertification or certification service that met the billing requirements for code G0179 or [...]

Laboratory Tests Billing Alert: Lipid Panel Test (80061) Completed on the Same Date of Service as an LDL Test (83721)

Laboratory Tests Billing Alert: Lipid Panel Test (80061) Completed on the Same Date of Service as an LDL Test (83721) National Government Services, Inc. Medical Review initiated a review of claims containing both a lipid panel test and [...]

What is Medicare Secondary Payer?

Medicare Secondary Payer is the term used for when a Medicare beneficiary has other insurance or coverage that is the primary payer, based on a federal MSP provision, for the beneficiary’s healthcare services. As a result, Medicare is the [...]

Provider Enrollment: Verify Bank Account Information to Prevent Interruption in Medicare Payment

Provider Enrollment: Verify Bank Account Information to Prevent Interruption in Medicare Payment National Government Services receives numerous electronic funds transfer banking rejections each year due to frozen or closed bank accounts. [...]

Provider Enrollment: Verify Bank Account Information to Prevent Interruption in Medicare Payment

Provider Enrollment: Verify Bank Account Information to Prevent Interruption in Medicare Payment National Government Services receives numerous electronic funds transfer banking rejections each year due to frozen or closed bank accounts. [...]

Prevent an MSP Rejection on a Medicare Primary Claim

Table of Contents Prevent an MSP Rejection on a Medicare Primary Claim Step 1 Step 2 Step 3 Related Content [Return to Top] Prevent an MSP Rejection on a Medicare Primary Claim If you submit a Medicare primary claim when there is [...]