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Posting Date: 06/09/2021
Expedited Requests
Expedited Requests The requester may submit for an expedited review of the PAR if it is determined that a delay could seriously jeopardize the beneficiary’s life, health, or ability to regain maximum function. If the medical documentation does [...]
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Posting Date: 03/14/2022
NGS Review of Prior Authorization Request
NGS Review of Prior Authorization Request Table of Contents NGS Review of Prior Authorization Request Number of Trips Extended Affirmation Periods for Beneficiaries with Chronic Conditions Decision Letters Resubmitting a Prior [...]
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Posting Date: 12/19/2024
Reminder for Correcting Hospice Edits for Certifying Physicians (17729, 17730)
Reminder for Correcting Hospice Edits for Certifying Physicians (17729, 17730) Reason Codes 17729 and 17730: Refer to specific hospice claim edits related to certifying physicians. Adjustments: Should be submitted for correcting input [...]
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Posting Date: 12/19/2024
MLN Connects® Newsletter: December 19, 2024
MLN Connects® Newsletter: December 19, 2024 News MBI Lookup Tools: CMS Seeks Input by February 17 CMS Roundup (December 13, 2024) Long-Term Care Hospital Provider Preview Reports: Review by January 15 Inpatient Rehabilitation Facility [...]
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Posting Date: 09/15/2022
Radiopharmaceutical Reimbursement
Radiopharmaceutical Reimbursement National Government Services has reviewed the radiopharmaceutical pricing methodology set forth in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Section 303(h) which states that [...]
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Posting Date: 12/19/2024
Preventive Services Overview
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 your patients from getting certain diseases. Register today for a [...]
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Posting Date: 12/19/2024
Using the Medicare Coverage Database: How to Find Important Medicare Coverage Information
Are you responsible for looking up whether a service is covered in the Medicare program at your facility but you're not sure where to look for the most relevant information? Have you received national coverage determination (NCD) or local [...]
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Posting Date: 02/26/2022
Initiate Eligibility Lookup
Initiate Eligibility Lookup Click the Eligibility Lookup button from the NGSConnex homepage. In the Select a Provider panel, click the Select button next to the applicable provider account. In the Select a [...]
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Posting Date: 12/17/2024
Provider Enrollment: Completing the CMS-855I Paper Application
During this webinar, we’ll provide an understanding of how to complete the CMS-855I provider enrollment paper application for a group member, sole proprietor or sole owner and we’ll also focus on reassigning Medicare benefits.
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Posting Date: 12/17/2024
PECOS: Manage Signatures and Additional Information Requests
During this webinar, we’ll give direction for the Provider Enrollment, Chain and Ownership System (PECOS) application on understanding how to manage signatures and respond to additional information request from submitted applications.
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Posting Date: 12/17/2024
Submitting Revalidation via PECOS
During this webinar, we’ll provide an understanding of how to utilize the Centers for Medicare & Medicaid Services (CMS) Internet-based Provider Enrollment Chain & Ownership System (PECOS) to be comfortable in navigating the system to submit a [...]
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Posting Date: 12/17/2024
Let's Chat About Provider Enrollment Revalidation
During this session, you’ll have the opportunity to ask questions about all accepts of provider enrollment. Answers will be provided by a panel of subject-matter experts. As this is a question-and-answer session, there is no presentation available.
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Posting Date: 12/17/2024
Medicare Secondary Payer: Preparing and Submitting Claims – Part 1
Join us for Part 1 of a two-part webinar. In Part 1, we will review Medicare Secondary Payer (MSP) claim coding and how to prepare/submit an MSP claim. This includes a review of the claim entry pages in the Fiscal Intermediary Standard System [...]
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Posting Date: 12/17/2024
Medicare Secondary Payer: Preparing and Submitting Claims (Examples) – Part 2
Join us for Part 2 of a two-part webinar. In Part 2, we will briefly recap the Medicare Secondary Payer (MSP). claim coding and billing instructions we reviewed in Part 1. We will then focus on reviewing examples of MSP claims. Be sure you [...]
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Posting Date: 12/17/2024
Method II CAH Claims Not Paying Professional Services with Revenue Codes 096x-098x
Certain CAH claims (TOB 85X) with professional service revenue codes 096x – 098X did not process for payment because the fee amount was not correctly retrieved during processing. The affected claims have receipt/processed dates in October 2024.
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Posting Date: 09/29/2022
Helpful Resources
Helpful Resources The absence of a local coverage determination (LCD) or Medical Policy Article does not indicate noncoverage, it means that currently, National Government Services (NGS) has not identified the service requires an associated [...]
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Posting Date: 12/16/2024
Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG)
Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG) L39189 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39189 A58921 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=58921 A59900 [...]
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Posting Date: 12/18/2024
Provider Enrollment Application Fee Amount for CY 2025
Provider Enrollment Application Fee Amount for CY 2025 The provider enrollment application fee for CY 2025 is $730. For more information, view MLN Connects® Newsletter: December 12, 2024. Posted 12/18/2024
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Posting Date: 03/21/2024
Medicare Part B Drug Coverage
Medicare Part B Drug Coverage Medicare Part B may provide coverage for medically necessary drugs/biologicals that are furnished “incident to” a physician’s service. This coverage does not apply to drugs that are usually [...]
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Posting Date: 03/21/2024
Allergen Immunotherapy: Coding and Billing CPT 95165
Allergen Immunotherapy: Coding and Billing CPT 95165 CPT 95165 is defined as “Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of [...]
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Posting Date: 12/18/2024
[REVISED UPDATE] Hospice Claims Rejected with Reason Code 17729
Claim rejections for TOB 081X and 082X with RC 17729 have occurred due to a file error. These claims did comply with CMS-required entry of the correct certifying physician in the “Attending” field, which did match the PECOS Enrolled [...]
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Posting Date: 06/14/2022
Documentation Information
Documentation Information It is recommended that PARs are submitted at least ten business days prior to the expected date of service to allow National Government Services the full standard timeframe to receive and review requests. Effective [...]
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Posting Date: 06/09/2021
About Hospital OPD PA Model
About Hospital OPD PA Model Table of Contents About Hospital OPD PA Model General Information Related Content [Return to Top] About the Hospital OPD PA Model CMS implemented a PA program for certain hospital OPD services for DOS on [...]
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Posting Date: 12/18/2024
Inpatient Psychiatric Facilities: Three-Day or Less Interruptions
To prevent return to provider (RTP) claims, join us for this webinar in which we will review “three-day or less interruptions” in a beneficiary’s inpatient psychiatric facility (IPF) stay, how to count the interruption days, how to report [...]
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Posting Date: 12/18/2024
Home Health Claims Returning to Provider RC 19963
HH claims are returning to provider in error with RC 19963. This impacts HH claims with NOA/processed dates in January 2022. NOAs are being purged after 24 months. Please keep in mind there are claims that edit correctly for this reason code. [...]
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Posting Date: 12/31/2024
Virtual Multi-Jurisdictional Town Hall Meeting To Be Held 12/10/2024
Virtual Multi-Jurisdictional Town Hall Meeting To Be Held 12/10/2024 National Government Services, along with Novitas Solutions and First Coast Service Options, CGS Administrators, Noridian Healthcare Solutions, Palmetto GBA and WPS Government [...]
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Posting Date: 09/30/2024
Code Set Update for PC Print: January 2025
Code Set Update for PC Print: January 2025 The PC Print January code set update will be available on our website 1/8/2025. The update contains the following enhancements: CR13792 Implement Operating Rules - Phase III Electronic [...]
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Posting Date: 12/26/2024
Call Center Planned Outage Status
Call Center Planned Outage Offline Friday, 1/20/2025
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Posting Date: 01/02/2025
The Medicare Appeals Process: What You Need to Know
This informative session will help you navigate Medicare’s appeals process by providing information on what an appeal is, how to determine if a claim can be appealed, who may file an appeal, the appeal levels, timeframes and documentation [...]
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Posting Date: 01/02/2025
Who is My LSO?
Who is My LSO? Select the Manage Account button on the NGSConnex home page. Select User Profile and scroll down to the ‘System Access’ section. Select the Checkbox next to the provider record you want to determine the LSO for. [...]
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Posting Date: 01/02/2025
Magnetic Resonance Angiography (MRA)
Magnetic Resonance Angiography (MRA) gadolinium, contrast, imaging L33633 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33633 A56747 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56747 70544, [...]
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Posting Date: 01/02/2025
LCD/Billing and Coding Article Updates – December 2024–January 2025
LCD/Billing and Coding Article Updates – December 2024–January 2025 Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG) (L39189) – Effective 12/15/2024 Under the Indications of Coverage, added the following language: "The use of [...]
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Posting Date: 01/02/2025
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 [...]
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Posting Date: 01/02/2025
Provider Enrollment Revalidation Overview
During this webinar, learn about important changes in the revalidation process, how to determine Medicare enrollment revalidation due date and information to avoid disruption in Medicare billing.
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Posting Date: 01/02/2025
Proper Part B Claim Submissions
This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments or denials. We will guide you through the CMS-1500 claim form and the electronic equivalent loops [...]
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Posting Date: 01/02/2025
Reducing Unprocessable Claims
When claims are submitted with invalid, incomplete or incorrect information, our claims processing system will detect these errors and will reject claims as unprocessable. Our goal is to assist our providers in submitting claims correctly the [...]
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