Technical Guides and Information

Technical Guides and Information 5010 Process Flow Chart X12 Website: Technical Reports/Implementation Guides, Newsletters and X12 Transaction Sets

What is NGSConnex?

What is NGSConnex? NGSConnex  is a free, secure, web-based application developed by National Government Services just for you! NGSConnex provides access to a wide array of self-service functions that save you time and money, such as: [...]

Service Specific Post Payment Review of Darbepoetin Alfa Injection, 1 microgram (Non-ESRD Use)

National Government Services Part B MR Department analyzes national and local data to identify possible improper payment for Medicare services. In an effort to reduce the Part B CERT error rate, the MR Department will be conducting a service [...]

Announcing Service Specific Post-Payment Audits of Hyperbaric Oxygen (HBO) Services for J6 A Regions: IL, WI, and MN

Edit Reason Code: 5FPJP Bill Type = 13X CPT/HCPCS/Modifiers: G0277 Overview The Medical Review Department of National Government Services will be performing service specific post-payment reviews for claims submitted to Medicare Part A. When a [...]

Hospice Beneficiary Election Statement Addendum Frequently Asked Questions

Hospice Beneficiary Election Statement Addendum Frequently Asked Questions National Government Services, in collaboration with Palmetto GBA, CGS and CMS, developed these FAQs to assist providers in a better understand of the federal [...]

Multi-Jurisdictional Contractor Advisory Committee (CAC)/Subject Matter Expert Meeting

Multi-Jurisdictional Contractor Advisory Committee (CAC)/Subject Matter Expert Meeting March 10, 2022 Topic: SIJ Interventions and Procedures Questions for SIJ Interventions For all questions, answers must be based on clinical literature [...]

MLN Connects® Special Edition for Thursday, January 7, 2021

MLN Connects® Special Edition for Thursday, January 7, 2021 Physician Fee Schedule Update On December 27, the Consolidated Appropriations Act, 2021 modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS): Provided a [...]

MLN Connects® for Thursday, January 7, 2021

MLN Connects® for Thursday, January 7, 2021 COVID-19 Vaccines: CDC Long-Term Care Facility Toolkit View this edition as a: Webpage | PDF News COVID-19 Vaccines: CDC Long-Term Care Facility Toolkit MLN Web-Based Training: Complete [...]

Home Health Aide Services and the Intermittent or Part-Time Rule

Home Health Aide Services and the Intermittent or  Part-Time Rule Job Aid The CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 7, Section 50.2 states: The reason for the visits by the home health aide must [...]

PDGM Resources

PDGM Resources MLN Matters Article MM11081 – "Home Health Patient-Driven Groupings Model (PDGM) - Split Implementation" MLN Matters Article MM11395 – "Home Health Patient-Driven Groupings Model - Revised and Additional Manual Instructions" [...]

Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment

Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment This edit is applied to claims when a RAP and final episode claim are submitted at the same time or when a RAP is submitted when there is one for the same [...]

Revised Evaluation and Management Frequently Asked Question for Teaching Environment Services

Revised Evaluation and Management Frequently Asked Question for Teaching Environment Services We’ve revised an FAQ within the Teaching Environment section of our E/M FAQs to further define documentation requirements. Review the information at [...]

How to Get Started

How to Get Started Making the change is easy. If you use a clearinghouse to submit claims, contact your clearinghouse to ask how to enroll for the electronic remittance service. If you currently have a claim submission software program, [...]

Provider Contact Center

MLN Connects® Newsletter for Thursday, May 19, 2022

MLN Connects® Newsletter for Thursday, May 19, 2022 Biosimilars: Safe, Effective, & May Reduce Patient Costs News Biosimilars: Safe, Effective, & May Reduce Patient Costs PECOS Scroll Functionality Clinical Laboratory [...]

PA RSNAT Coversheet

Medicare Provider Enrollment Application Fee Decision Tree Tool

Remote Physiological Monitoring and Cardiovascular Monitoring Service and Billing Information

Billing and Coding and SAD Article Updates for May/June 2022

Billing and Coding and SAD Article Updates for May/June 2022 Billing and Coding: Denosumab (Prolia ™, Xgeva ™) (A52399) The article has been corrected to remove the following statement: (calcium 1000 mg daily and at least 400 IU vitamin D [...]

Modifier Usage

July 2022 Release "Dark Days" for the Common Working File Hosts

July 2022 Release "Dark Days" for the Common Working File Hosts For the upcoming July 2022 Release: For Production, CWF will be observing the Gray Day on Thursday, 6/30/2022 and Dark Days starting Friday, 7/1/2022 through Monday, 7/4/2022 [...]

Remote Monitoring Services

Remote Monitoring Services

Remote Monitoring Services In response to provider inquiries about the use of remote monitoring, National Government Services has developed a comprehensive summary of information for Remote Monitoring Services. NGS separately defined code [...]

Comprehensive Error Rate Testing Program Report: Sample Reduced for Reporting Year 2023

Comprehensive Error Rate Testing Program Report: Sample Reduced for Reporting Year 2023 CMS reduced the number of claims in the Comprehensive Error Rate Testing program report for reporting year 2023. We’ll send you a letter if your claims are [...]

New Version of PC-ACE: July 2021

New Version of PC-ACE: July 2021 PC-ACE Version 5.1 contains several CMS mandates and product enhancements including but not limited to the items listed below. 12206 – FFS Coverage of Costs for Kidney Acquisitions in MW Hospitals for [...]

Medicare University Scheduled Maintenance

Medicare University Scheduled Maintenance Due to scheduled maintenance, Medicare University will be unavailable beginning Tuesday, 6/15/2021 from 8:00 p.m–11:00 p.m. ET. As a result, the Medicare University will not be accessible. We [...]

Billing and Coding for Tempus Next Generation Sequencing Panel

Billing and Coding for Tempus Next Generation Sequencing Panel The Tempus Next Generation Sequencing Panel must be submitted with CPT code 81479. CPT 81479 (unlisted molecular pathology procedure) will be individually reviewed. Posted [...]

COVID-19 Accelerated and Advanced Payment YouTube Video

COVID-19 Accelerated and Advanced Payment YouTube Video National Government Services developed the Part B COVID-19 Accelerated and Advanced Payment, Repayment and Recoupment Process YouTube Video to address common questions we are receiving. [...]

Proper Billing Units for HCPCS Code J7320

Proper Billing Units for HCPCS Code J7320 National Government Services has noticed improper billing units used for HCPCS code J7320, Hyaluronan or derivative, GenVisc 850, for intra-articular injection, 1 mg. GenVisc 850 is indicated for the [...]

Oxygen Coverage and Documentation Requirements

Oxygen Coverage and Documentation Requirements Please review this YouTube video that was developed from the A/B and DME MAC’s collaborative webinar titled ‘Oxygen Coverage and Documentation Requirements’. This video is a collaborative [...]

New NGSMedicare.com is Coming Soon

New NGSMedicare.com is Coming Soon We continue to listen and gain invaluable insight from you on our provider content website, NGSMedicare.com. Coming mid-Summer 2021, you will be able to see your feedback put into action. Posted 6/8/2021

NGSConnex Now Offers One Stop Electronic Appeals Solution

NGSConnex Now Offers One Stop Electronic Appeals Solution Medicare Part A providers and HH+H providers who are located in Jurisdiction 6 and submit fee-for-service claims to National Government Services now have the ability to submit [...]

MLN Connects® for Thursday, January 28, 2021

MLN Connects® for Thursday, January 28, 2021 Medicare Wellness Visits: Get Your Patients Off to a Heathy Start View this edition as a: Webpage | PDF News Care Compare: 2019 Preview Period Open through March 25 Open Payments Data [...]

MACs will host a Multi-Jurisdictional CAC Meeting Regarding Epidural Interventions for Chronic Pain Management

Medicare Administrative Contractors will Host a Multi-Jurisdictional Contractor Advisory Committee Meeting Regarding Epidural Interventions for Chronic Pain Management Due to the public health crisis, this meeting will be held via [...]

MLN Connects® for Thursday, February 4, 2021

MLN Connects® for Thursday, February 4, 2021 Improving Accuracy of Medicare Payments View this edition as a: Webpage | PDF News Improving Accuracy of Medicare Payments Cardiovascular Health: Medicare Covers Screening & Therapy [...]

MLN Connects® for Thursday, February 18, 2021

MLN Connects® for Thursday, February 18, 2021 COVID-19: EUA for Antibody Treatment View this edition as a: Webpage | PDF News CMS Takes Further Steps to Ensure Medicare Beneficiaries Have Wide Access to COVID-19 Antibody Treatment [...]

MLN Connects® for Thursday, February 25, 2021

MLN Connects® for Thursday, February 25, 2021 Medicare Secondary Payer: Billing for Services View this edition as a: Webpage | PDF News CMS Offers Comprehensive Support to the State of Texas to Combat Winter Storm Compliance [...]

MLN Connects® for Thursday, March 4, 2021

MLN Connects® for Thursday, March 4, 2021 COVID-19 Vaccine Codes: EUA for Janssen Biotech View this edition as a: Webpage | PDF News COVID-19 Vaccine Codes: EUA Effective Date for Janssen Biotech Inc. COVID-19 Vaccine [...]

MLN Connects® for Thursday, March 11, 2021

MLN Connects® for Thursday, March 11, 2021 Hospitals: Are You Using Your PEPPER Data?  View this edition as a: Webpage | PDF News PEPPERs for Short-term Acute Care Hospitals Colorectal Cancer: Medicare Covers Screening [...]

MLN Connects® for Thursday, March 25, 2021

MLN Connects® for Thursday, March 25, 2021 Home Health Payment Corrections View this edition as a: Webpage | PDF News Medicare Shared Savings Program: Application Deadlines for January 1, 2022, Start Date Repetitive, Scheduled [...]