P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Business Function State Mailing Address Additional Documentation Requests CT, MA, ME, NH, NY, RI, VT National Government Services, Inc. P.O. Box 7108 Indianapolis, IN [...]

PECOS Enrollment Process and Advantages

Skilled Services

Skilled Services Table of Contents Skilled Services Skilled Nursing Examples of skilled nursing Skilled Therapy Skilled Respiratory Nonskilled Service Examples Examples of personal care services General Skilled [...]

Dental Services

Dental Services If you're a new or seasoned provider billing dental services to Fee-for-Service Medicare or Original Medicare, this article guides you through recently clarified payment provisions for dental services in 2023, the provider [...]

MLN Connects® Newsletter: July 11, 2024

MLN Connects® Newsletter: July 11, 2024 Proposed Rules Physician Fee Schedule CY 2025 Proposed Rule Hospital Outpatient Prospective Payment System & Ambulatory Surgical Center Payment System CY 2025 Proposed Rule Mitigating the Impact [...]

Hospice Quality Reporting Letters

Hospice Quality Reporting Letters CMS notified MACs of hospice providers that either chose not to participate in the Hospice QRP or failed to meet the Hospice QRP reporting requirements for the data collection period of 1/1/2023 to 12/31/2023 [...]

Home Health Certifying Provider Change

Home Health Certifying Provider Change Home health certifying physician or NPP changes can occur anytime for a variety of reasons. Some examples may include practitioner retirement or vacation and patient choice. Regardless of the [...]

Hospice Transfers

Hospice Transfers The purpose of a hospice transfer is to allow the beneficiary the opportunity to transfer to another agency without affecting the current benefit period and providing continuity of care. Instead of the beneficiary revoking [...]

Billing Hospice Transfers

Billing Hospice Transfers Once a beneficiary elects to receive care under the Medicare hospice benefit, he or she waives rights to Medicare payments for hospice care provided by any other hospice other than the one they have chosen/designated. [...]

MLN Connects® Newsletter: July 18, 2024

MLN Connects® Newsletter: July 18, 2024 News Final Part Two Guidance to Help People with Medicare Prescription Drug Coverage Manage Prescription Drug Costs Medicare Ground Ambulance Data Collection System: Submit Comments by September [...]

A/B DME MAC Collaborative Webinar: Positive Airway Pressure Devices

A/B DME MAC Collaborative Webinar: Positive Airway Pressure Devices Physicians/Practitioners! Are you Ordering PAP Devices for Your Patients? This is your opportunity to hear directly from the Medicare contractors regarding Medicare’s [...]

Requests for Additional Information

Requests for Additional Information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Site Visits

Site Visits Site visits may be required for certain providers and will be unannounced; the contractor representatives must disclose to the provider appropriate identifying credentials and explain the purpose of the visit. CMS has implemented [...]

Requests for Additional Information

Requests for Additional Information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Site Visits

Site Visits Site visits may be required for certain providers and will be unannounced; the contractor representatives must disclose to the provider appropriate identifying credentials and explain the purpose of the visit. CMS has implemented [...]

Requests for Additional Information

Requests for Additional Information While processing the application(s) National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

PECOS Self-Service Application Status

PECOS Self-Service Application Status You may run simple search queries to retrieve and view the status of your PECOS application. Individual View the enrollment application status of an individual provider in an organization or private [...]

Check Provider Enrollment Application Status

Check Provider Enrollment Application Status You may run simple search queries to retrieve and view the status of your CMS-855 application via two options. Case number/web tracker id NPI and TIN combination Related Content Check [...]

Interactive Voice Response System

Interactive Voice Response System You may check the status of your provider enrollment application (PECOS or paper) submission via the IVR by: Case number/web tracker id or NPI and TIN combination Related Content Interactive [...]

Dental Claim Cross Over

Dental Claim Cross Over Medicare contractors coordinate with the MSP Contractor, GHI, to automatically cross over claim payment information for their policyholders as a courtesy. An eligibility file furnished by the supplemental insurer is [...]

Three Ways to Protect Your Medicare Enrollment Information

Three Ways to Protect Your Medicare Enrollment Information Protect your enrollment information from Medicare fraud with these three steps: Keep your Medicare Provider Enrollment, Chain, and Ownership System (PECOS) user ID and password [...]

Help Prevent Bank Account Fraud

Help Prevent Bank Account Fraud The provider should be aware of the following to help prevent bank account fraud if no authorized individual from your entity submits a change to enrollment. Contact your MAC immediately if: remittances [...]

“Payer Only” Codes Submitted on Part A Medicare Claims

“Payer Only” Codes Submitted on Part A Medicare Claims This article is to inform Part A providers of an editing change impacting claims submitted with “payer only” codes. As of 7/3/2024, new edits cause claims to RTP when a “payer only” [...]

Provider Enrollment Appeals Process

Provider Enrollment Appeals Process Table of Contents Provider Enrollment Appeals Process Corrective Action Plans Requirements for CAP Submission Reconsiderations Requirements for Reconsideration Request Submission Related Content [...]

Rebuttal for Deactivation of Medicare Billing Privileges

Rebuttal for Deactivation of Medicare Billing Privileges Pursuant to 42 CFR, Section 424.545(b), a provider or supplier whose Medicare billing privileges have been deactivated may file a rebuttal in accordance with 42 CFR, Section 405.374. A [...]

Rebuttal for Deactivation of Medicare Billing Privileges

Rebuttal for Deactivation of Medicare Billing Privileges Pursuant to 42 CFR, Section 424.545(b), a provider or supplier whose Medicare billing privileges have been deactivated may file a rebuttal in accordance with 42 CFR, Section 405.374. A [...]

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction 6 HH+H Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Home Health Services - Medical Necessity ICD-10 Z47-Z47.89 N/A 55H3V– The documentation did [...]

837D Edit Spreadsheet

Requests for Additional Information

Requests for Additional Information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Approval Pending Regional Office Review

Approval Pending Regional Office Review For ASC and PXRS: When credentialing, you will receive an approval pending regional office review status in PECOS, if there is a change processed that requires a tie-in notice (Centers for Medicare [...]

Approval Pending Regional Office Review

Approval Pending Regional Office Review For ASC and PXRS: When credentialing, you will receive an approval pending regional office review status in PECOS, if there is a change processed that requires a tie-in notice (Centers for Medicare [...]

National Government Services Will Send Email Updates from a New Email Address Beginning 8/7/2024

National Government Services Will Send Email Updates from a New Email Address Beginning 8/7/2024 Starting 8/7/2024, National Government Services will send email updates to you from a new email address, noreply@noreply.ngsmedicare.com instead [...]

MLN Connects® Newsletter: July 25, 2024

MLN Connects® Newsletter: July 25, 2024 News CMS Announces Resources & Flexibilities to Assist with Public Health Emergency in Texas CMS Oral Health Cross-Cutting Initiative Fact Sheet Doctors & Clinicians: Utilization Data on [...]

Calculating the Batch Receipt Date

Calculating the Batch Receipt Date When a file is received in the EDI Gateway, the date and time received are applied as the receipt date of the claim(s).  A business day is considered 12:00 a.m. to 4:59:59 p.m. ET Monday through Friday. [...]

Health Benefits of Quitting Smoking and Helping Your Patients Kick the Habit

Health Benefits of Quitting Smoking and Helping Your Patients Kick the Habit Smoking leads to multiple diseases and potentially death, but it is preventable! Anyone at any age can benefit from quitting smoking. Medicare covers tobacco [...]

LCD and Article Updates for August 2024

LCD and Article Updates for August 2024 Articles L33394/A52423 – Drugs and Biologicals Provided off-label coverage of Infliximab for microscopic colitis and retirement of Bortezomib article, effective 8/1/2024. The article has been revised to [...]

How to Submit a Hardship Request

How to Submit a Hardship Request To request a hardship consideration, submit with a letter and any supporting documentation describing the hardship and why it justifies the exception for your application. Your hardship request will not be [...]

How to Obtain a Refund

How to Obtain a Refund A refund will only be granted in the following instances: The application fee was not required for the application submitted A hardship request was subsequently approved and a fee was paid An application was [...]

Paper Enrollment Process

Paper Enrollment Process Paper-based enrollment applications are available. Submitting your enrollment via paper is an option, but PECOS is the preferred method to process the application with streamlining features. Determine which CMS 855 [...]