Skin Substitutes

Skin Substitutes CMS provides pricing for some wound care products; however, there are many that do not have established pricing. When a skin substitute/wound care product does not have established pricing, the pricing for the item will be [...]

NGSConnex

Section 4: Getting Ready to Bill Medicare NGSConnex NGSConnex is a self-service web application developed by National Government Services that offers providers and suppliers to access to information at their fingertips via the Internet. [...]

Common Working File

Section 4: Getting Ready to Bill Medicare Common Working File The CWF was developed in 1989 as a means to maintain all of the records for each Medicare beneficiary. These records are a detailed account of each Medicare beneficiary’s status [...]

Fiscal Intermediary Standard System

Section 4: Getting Ready to Bill Medicare Fiscal Intermediary Standard System National Government Services utilizes FISS to process claims and maintain Medicare beneficiary information. Providers have access to this information through a [...]

Advance Beneficiary Notice of Noncoverage

Section 4: Getting Ready to Bill Medicare Advance Beneficiary Notice of Noncoverage An ABN is a written notice a provider gives to a Medicare beneficiary before items or services are furnished, when the provider believes that Medicare [...]

Prepare and Submit a Medicare Tertiary Claim

Table of Contents Prepare and Submit a Medicare Tertiary Claim Step 1: Determine When a Claim(s) Must be Submitted to Medicare Step 2: Check for MSP Insurer Information in Medicare’s Records Step 3: Prepare and Submit Medicare Tertiary [...]

Using Medicare Resources

Did you know all providers who submit claims to the Medicare Program are required to be familiar and comply with the most current Medicare billing and coverage guidelines? Where do you turn to learn about Medicare? You can find a variety of [...]

Fast Track Access

Fast Track Access You will be prompted for the fast-track access when you use a feature that requires provider authentication (NPI, PTAN, TIN). Features: Claim Status, Checks, Offsets, Pricing, Appeals You can obtain a code after you [...]

Fast Track Access

Fast Track Access You will be prompted for the fast-track access when you use a feature that requires provider authentication (NPI, PTAN, TIN).  Features: Claim Status, Checks, Remittance Statements, Patient Status, Appeal Status You [...]

General Information <8>

General Information <8> When General Information is selected, the IVR will present the caller with a submenu. Voice Touch-Tone Entry IVR Supplies Phone Numbers 1 Commonly requested telephone numbers [...]

Understanding Medicare Fraud and Abuse

Join this session to learn about fraud and abuse affecting providers and your Medicare patients that will increase your awareness of integrity issues and prevent potential fraudulent and abusive practices against the Medicare Program.

Reopening versus Redetermination

Reopening versus Redetermination Table of contents Reopening versus Redetermination Reopening Telephone Reopening Unit Redeterminations [Return to Top] Reopening versus Redetermination Understanding your next steps are very [...]

Use National Government Services Self-Service Tools to Maximize your Workload

Use National Government Services Self-Service Tools to Maximize your Workload Our PCC telephone lines are busiest at the beginning and end of each month, and this creates long wait times for providers trying to resolve claim payments, denials, [...]

Common Denials Guide for Diabetes Self-Management Training and Medical Nutrition Therapy

Common Denials Guide for Diabetes Self-Management Training and Medical Nutrition Therapy National Government Services, MAC for Jurisdiction K and Jurisdiction 6, continues to provide you with resources to help reduce the burden of claim [...]

Non-Appealable Situations with Medicare Advantage Plans - Make Sure Your Staff is Aware

Non-Appealable Situations with Medicare Advantage Plans - Make Sure Your Staff is Aware When a Medicare Beneficiary enrolls in a MA Plan, that MA plan takes the place of Traditional Medicare benefits. National Government Services is [...]

Prepare and Submit an MSP Claim

Table of Contents Step 1: Determine if an MSP Claim Must be Submitted to Medicare Step 2: Check Medicare’s Eligibility Files via NGSConnex to Determine if There's Other Insurance Primary to Medicare Step 3: Prepare the MSP (Partial-Payment [...]

Determine if Medicare is Primary or Secondary for a Beneficiary's Services

Table of Contents Determine if Medicare is Primary or Secondary for a Beneficiary's Services Step 1: Collect MSP Information from the Beneficiary During an MSP Screening Process Step 2: Check for Open MSP Records for a Beneficiary in [...]

APPEALS: I received a remittance advice with the message “this care may be covered by another payer per coordination of benefits.” Is this an appealable claim?

CO-109

Avoiding/Correcting This Error This denial is received when your Medicare patient is enrolled in a MA plan, instead of “traditional fee-for-service” Medicare. MA plans are health plans offered by private companies approved by Medicare that [...]

CO-22

Avoiding/Correcting This Error During patient registration, it’s important for office staff to identify whether a beneficiary’s claims should be covered by other insurance before, or in addition to, Medicare. Providers shall [...]

CO-109

Avoiding/Correcting This Error This denial is received when your Medicare patient is enrolled in a MA plan, instead of “traditional fee-for-service” Medicare. MA plans are health plans offered by private companies approved by Medicare that [...]

CO-22

Avoiding/Correcting This Error During patient registration it’s important for office staff to identify whether a beneficiary’s claims should be covered by other insurance before, or in addition to, Medicare. Providers shall use [...]

PR-31

Avoiding/Correcting This Error Services were denied for one or more of the following reasons: The name or Medicare number was incorrect or missing. The date of death precedes the date of service. Expenses were incurred prior to coverage. [...]

PR-31

Avoiding/Correcting This Error Services were denied for one or more of the following reasons: The name or Medicare number was incorrect or missing. The date of death precedes the date of service. Expenses were incurred prior to coverage. [...]

Fundamentals of Medicare

Track the Status of Your Application

How to Search You may track the status of your provider enrollment application (PECOS or paper) submissions via the: Check Provider Enrollment Application Status tool by: Case number/web tracker id or NPI and TIN combination [...]

Provider Enrollment Application Process Timeline

All MACs, including National Governments Services, have a goal to finalize an Internet-based PECOS application within 15 days and a CMS-855 paper application within 30 days, if all required information is available. About the Application [...]

PECOS Application Status Tool

The status of your application is indicated by the step that is highlighted. If an application fee is required, an additional step will be added and the system will generate five steps. Your application was successfully [...]

Getting Access to PECOS

During this webinar, we’ll discuss how to obtain access to the Internet-based Provider Enrollment Chain & Ownership System (PECOS) and gain connection to provider enrollment record as well as understand other Centers for Mediacre & Medicaid [...]

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.

Provider Enrollment: Completing the CMS-855A Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855A provider enrollment paper application.

Identify the Proper Order of Payers for a Beneficiary's Services

Table of Contents Background Step 1: Check for Open Medicare Secondary Payer Records for the Beneficiary in the Common Working File Step 2: Collect MSP Information from the Beneficiary  Step 3: Compare the MSP Information you [...]

Checking Eligibility and Knowing Your Point of Contact

Checking Eligibility and Knowing your Point of Contact Table of Contents Checking Eligibility and Knowing your Point of Contact How to Verify Patient Eligibility Related Content Listed below are the different patient eligibility and [...]

Go Paperless Today - Protect Your Bottom Line

Go Paperless Today ‒ Protect Your Bottom Line Every day is a great day to choose electronic solutions rather than paper. Make today the day you go electronic. If you are sending paper to National Government Services, change that now. You can [...]

Medicare Home Health Collaboration with Other Provider Types

Medicare Home Health Collaboration with Other Provider Types Table of Contents The Medicare Home Health Benefit Therapy Providers and the Home Health Benefit Durable Medical Equipment Suppliers and the Home Health Benefit Hospice and the [...]

One Week Until Beneficiary Eligibility Information Leaves the IVR

One Week Until Beneficiary Eligibility Information Leaves the IVR  As we’ve communicated, beginning 11/18/2024, beneficiary eligibility information will not be offered on the IVR. This includes all beneficiary eligibility information that [...]

U5200

Avoiding/Correcting This Error Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS/DDE Provider Online System, HETS or NGSConnex to verify [...]

U5200

Avoiding/Correcting This Error Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS Provider Online System, HETS or NGSConnex to verify beneficiary [...]

U5210

Avoiding/Correcting This Error Each beneficiary should be screened for eligibility. Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS Provider [...]

C7010

Avoiding/Correcting This Error If services are unrelated to hospice stay, resubmit with condition code 07 (treatment of nonterminal illness for hospice patient). Verify hospice enrollment prior to claim submission by reviewing the CWF, HETS [...]