MLN Connects® Newsletter: PFS, OPPS/ASC, & OPPS 340B-Acquired Drug Final Rules - November 2, 2023

MLN Connects® Newsletter: PFS, OPPS/ASC, & OPPS 340B-Acquired Drug Final Rules - November 2, 2023 Final Rules CMS Finalizes Physician Payment Rule that Advances Health Equity CMS Makes Hospital Prices More Transparent and Expands [...]

How to Prevent Duplicate Appeal and Clerical Error Reopening Requests in NGSConnex

How to Prevent Duplicate Appeal and Clerical Error Reopening Requests in NGSConnex Do you currently submit your appeal requests and reopening requests through NGSConnex? If so, did you know you are required to verify whether a request was [...]

Five Levels of Appeals

Levels of Appeals and Time Limits for Filing Table of Contents Five Levels of Appeals: Overview Level One – Redetermination Level Two – Reconsideration (QIC) Level Three – Administrative Law Judge (ALJ) Level Four – Medicare [...]

Medical Review Portal in NGSConnex

Medical Review Portal in NGSConnex If you submit fee-for-service claims to National Government Services and you are a registered NGSConnex account holder, you can respond to Medical Review ADRs and submit supporting documentation [...]

Medical Documentation Signature Requirements

Medical Documentation Signature Requirements Table of Contents Medical Documentation Signature Requirements Missing Signature Illegible Signature Signatures for Amendments, Corrections and Delayed Entries Related Content [Return to [...]

Address Corrections for Providers

Address Corrections for Providers An ADR is sent to the provider’s or physician’s address that is listed in PECOS. This is the last address that was submitted to the MAC’s Provider Enrollment Department and approved by CMS. Questions [...]

Additional Developmental Request Letters Overview

Additional Development Request Letters Overview National Government Services may require additional information in order to appropriately process claims submitted to the Medicare Program. These requests for additional information letters are [...]

How to Find and Respond to TPE ADR

How to Find and Respond to TPE ADR Once you receive notification your facility is being placed on medical review, you’ll receive instructions on how to find the ADR. The ADR is a request to submit documentation for review to ensure proper [...]

Methods for Submitting an ADR

Methods for Submitting an ADR Table of Contents Submitting Documentation NGSConnex Mailing an ADR CD/DVD esMD Fax [Return to Top] Submitting Documentation NGSConnex is the preferred method of submission. National [...]

Results Letters

Results Letters After National Government Services reviews the requested claims for your facility/office, you’ll receive a Results Letter with results from that round of TPE review. The Results Letter will contain the number of claims that [...]

Appeals

Appeals Appeals Overview Providers, suppliers and beneficiaries may appeal claim determinations made by National Government Services. The appeals process aims to ensure the correct adjudication of claims. The CMS governs appeals activities [...]

LCD and Article Updates for November 2024

LCD and Article Updates for November 2024 Local Coverage Determinations and Billing and Coding Articles The following Local Coverage Determinations and Billing and Coding Articles have been finalized and will become effective on the specific [...]

Get Help Completing My Enrollment Application

Since your organization can apply for Medicare enrollment in two ways, online through the PECOS system and on paper, it is important to know where to go to learn about the expected processes and guidelines. There are two main areas where you [...]

Get Help Completing My Enrollment Application

Since your organization can apply for Medicare enrollment in two ways, online through the PECOS system and on paper, it is important to know where to go to learn about the expected processes and guidelines. There are two main areas where you [...]

Counseling to Prevent Tobacco Use

In an effort to raise awareness and increase utilization of tobacco use counseling, we’ll focus on the effects of nicotine dependence including affected health consequences during this webinar. Medicare coverage, coding, billing and [...]

Initiate Part B Reopenings or Non-MSP Overpayment Adjustments in NGSConnex

Initiate Part B Reopenings or Non-MSP Overpayment Adjustments in NGSConnex Did you know that you can save time and money by requesting a Part B clerical error reopening electronically via NGSConnex? You will save time because electronic [...]

17729 and 17730 Hospice Claim Edits for Certifying Physicians

17729 and 17730 Hospice Claim Edits for Certifying Physicians Effective for hospice claims with claim ‘From’ dates on or after 6/3/2024, new claim edits have been implemented per CR 13342 to enforce CMS’ rule to deny hospice claims if the name [...]

How to Determine if the Provider is Active and Get the Provider Enrolled in Medicare Part B

How to Determine if the Provider is Active and Get the Provider Enrolled in Medicare Part B Table of Contents Determine if the Provider Has an Active Enrollment How to Enroll the Provider in Medicare Part B [Return to Top] Determine [...]

Get Help Completing My Enrollment Application

Since your organization can apply for Medicare enrollment in two ways, online through the PECOS system and on paper, it is important to know where to go to learn about the expected processes and guidelines. There are two main areas where you [...]

MLN Connects® Newsletter: November 27, 2024

MLN Connects® Newsletter: November 27, 2024 News Opioid Treatment Programs: CY 2025 Updates HIV Screening & Prevention Claims, Pricers, & Codes Home Health Prospective Payment System Grouper: January Update Clotting Factor: [...]

How to Determine if the Provider is Active and Get the Provider Enrolled in Medicare Part B

Table of Contents Determine If the Provider Has an Active Enrollment How to Enroll the Provider in Medicare Part B Determine If the Provider Has an Active Enrollment Navigate to the Medicare Fee-For-Service Public Provider Enrollment [...]

Flu, COVID-19 and PPV Vaccines

During this webinar, we'll review the coverage, coding and billing guidelines for influenza, pneumococcal and COVID-19 vaccine administration and billing.

The Utilization of the KX Modifier on Dental Claims

The Utilization of the KX Modifier on Dental Claims National Government Services wants to bring to your attention the usage of the KX modifier for the submission of Medicare claims for dental services that are inextricably linked to covered [...]

Rural Tobacco Disparity

Rural Tobacco Disparity Tobacco use and exposure to SHS are major causes of preventable disease, disability and mortality in the United States and are responsible for approximately 480,000 deaths annually; another 16 million people are living [...]

Behavioral Health Telehealth In-Person Requirements

Behavioral Health Telehealth In-Person Requirements National Government Services has been receiving questions regarding the behavioral health telehealth requirement that the initial telehealth service include an in person visit within the [...]

Report a Change of Ownership, Acquisition/Merger or Consolidation

Table of Contents Step 1: Determine You Are in the Right Place Step 2: Understand Type of CHOW Change of Ownership Acquisition/Merger Consolidation CHOW Reminders Step 3: Make Changes via Enrollment Application Change of [...]

Screening for Cardiovascular Disease and Abdominal Aortic Aneurysm

During this webinar, we'll review the coverage, coding, and billing guidelines for cardiovascular disease (CVD) screening blood tests, intensive behavioral therapy for CVD, and ultrasound screening for abdominal aortic aneurysm preventive services.

December 2024

In This Issue National Government Services Articles for Part A and Part B Providers Two Weeks to Prepare to Use NGSConnex for Beneficiary Eligibility Information A/B DME MAC Collaborative Lower Limb Orthoses Webinar November is Lung [...]

Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)

Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q) This stringent claim editing process helps ensure that Medicare does not make payments for services rendered to beneficiaries who are not eligible due to being [...]

Termination of the Hospice Benefit Component of the VBID Model on 12/31/2024

Termination of the Hospice Benefit Component of the VBID Model on 12/31/2024 After carefully considering recent feedback about the increasing operational challenges of the Hospice Benefit Component and limited and decreasing participation [...]

Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2025

Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2025 Table of Contents Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2025 Advantages of Being a Medicare-Participating [...]

Medicare Participating Physician or Supplier Agreement Form (CMS-460)

Introduction

Medicare Part B 101 Manual: Introduction Medicare Program for Part B Providers Table of Contents Introduction Medicare Administrative Contractors Medicare Contracting Reform Providers Responsible for Knowing Guidelines Medicare Part A [...]

Get Help with Rejected/Denied Enrollment Application

Table of Contents Get Help with Rejected/Denied Enrollment Application Determine the Application Status Understand Rejection or Denial Related Content [Return to Top] Get Help with Rejected/Denied Enrollment Application The CMS IOM [...]

Get Help with Rejected/Denied Enrollment Application

Table of  Contents   Get Help with Rejected/Denied Enrollment Application Determine the Application Status Understand Rejection or Denial Related Content Get Help with Rejected/Denied Enrollment Application The CMS IOM [...]

Get Help with Rejected/Denied Enrollment Application

Table of Contents Get Help with Rejected/Denied Enrollment Application Determine the Application Status Understand Rejection or Denial Related Content  Get Help with Rejected/Denied Enrollment Application The CMS IOM Publication [...]

Requests for Additional Information

Table of Contents Requests for Additional Information Paper Application Submissions PECOS Application Submissions [Return to Top] Requests for Additional Information While processing the application(s), National Government [...]

Provider Contact Center

Provider Contact Center Table of Contents Want to talk to us? Make the Most of Your Call Customer Care Representative Assistance Interactive Voice Response System NGSConnex Online Inquiry System Written Correspondence and Inquiries [...]

Interactive Voice Response System

Interactive Voice Response System State IVR Number Hours Available* Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont 877-567-7205 Monday–Friday: 6:00 a.m.–7:00 p.m. ET [...]