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 [...]

Clinics/Group Practices and Other Suppliers

Clinics/Group Practices and Other Suppliers Download CMS-855B. Complete Sections: 1, 2, 3, 4, 5, 6, 8, 12, 13, 15B and D (if applicable) Attachment 1 for Ambulance Suppliers Attachment 2 for IDTFs Attachment 3 for OTP Notes [...]

Introducing PECOS 2.0 

Introducing PECOS 2.0 PECOS 2.0 will make the Medicare enrollment and revalidation processes faster and more efficient. For more information, visit Introducing PECOS 2.0. Revised 7/31/2024

Reviewing the PECOS Enrollment Practice Location Area for OPPS Providers Claim Submission

Reviewing the PECOS Enrollment Practice Location Area for OPPS Providers Claim Submission All off-campus OPPS locations must be identified on the enrollment record. If a hospital OPPS claim is submitted with a practice service location that [...]

Part A Content

Cost Report Contacts: CT, ME, MA, NH, NY, RI, VT: Bobbi Jo Luciano, Manager Office: South Portland, ME Sharon Townsend Office: South Portland, ME JK_Cost_Report_Filing@anthem.com Mailing Address for USPS: National Government Services Attn: [...]

Part A Content

Cost Report Contacts: IL, MN, WI, All FQHC: Bobbi Jo Luciano, Manager Office: South Portland, ME Sharon Townsend Office: South Portland, ME J6_Cost_Report_Filing@anthem.com Mailing Address for USPS: National Government Services Attn: Cost [...]

Transitional Care Management

Transitional Care Management Table of Contents Billing Codes Billing Information Documentation Related Content [Return to Top] Billing Codes 99495: Moderate complexity F2F 7 to 14 days 99496: High complexity F2F 7 days [...]

Advanced Care Planning

Advanced Care Planning Table of Contents Billing Codes Billing Information Documentation Related Content [Return to Top] Billing Codes 99497: 30 minutes 99498: each additional 30 minutes [Return to Top] Billing Information [...]

Behavioral Health Integration

Behavioral Health Integration Table of Contents BHI Overview Eligible Conditions Part B Billing/Coding BHI Services New Coding and Payment for BHI Conditions Billed by Clinical Psychologists and Clinical Social Workers Initiating [...]

Chronic Care Management

Chronic Care Management Table of Contents Billing Codes Billing and Documentation Care management for chronic conditions Related Content [Return to Top] Billing Codes 99490: Provide at least 20 minutes of clinical staff time [...]

Principal Care Management

Principal Care Management Table of Contents Billing Codes Documentation Related Content [Return to Top] Billing Codes 99424: PCM services for a single high-risk disease first 30 minutes provided personally by a physician or [...]

Psychiatric Collaborative Care Model

Psychiatric Collaborative Care Model The psychiatric CoCM was introduced in 2018 and Medicare began making separate payments using CPT codes 99492, 99493 and 99494. Effective 1/1/2021, G2214 was added to Psychiatric CoCM to cover shorter [...]

Hospice Notice of Election Termination/Revocation (Type of Bill 8xB)

Hospice Notice of Election Termination/Revocation (Type of Bill 8xB) Table of Contents Hospice Notice of Election Termination/Revocation Examples of NOTR Time Frames Reminders/Notes on the NOTR Correcting a Discharge Date on an [...]

Medicare University Right Content

Helpful Resources Log into MU Sign up for Email Updates

Procedure Code 99211 Job Aid

Procedure Code 99211 Job Aid Table of Contents Definition for 99211 Definition for Established Patient Face-to-Face Encounter Requirements Presence of Physician Requirements Evaluation and Management Services Provider-Patient [...]

Resources for Medicare Providers of Service

Resources for Medicare Providers of Service Access to all resources and tools offered to our Medicare provider and supplier communities  

Hospice Documentation Checklist

Hospice Documentation Tips

Hospice Documentation Tips Medicare coverage of hospice depends on a physician’s certification that an individual’s prognosis is a life expectancy of six months or less if the terminal illness runs its normal course. It is important that the [...]

Implementation of the Election Statement Addendum

Implementation of the Election Statement Addendum Hospice Election Statement Addendum Hospice care is a benefit under the hospital insurance program. To be eligible to elect hospice care under Medicare, the beneficiary must be entitled to [...]

Tips for Responding to a Hospice ADR

Tips for Responding to a Hospice ADR National Government Services performs medical review audits of services billed to Medicare to validate that the documentation supports coverage and level of services billed. If one of your claims is [...]

General Inpatient Check Off List

Documentation Requirements for the Medicare Hospice Election Statement

Documentation Requirements for the Medicare Hospice Election Statement Election of Hospice Hospice care is a benefit under the hospital insurance program. To be eligible to elect hospice care under Medicare, the beneficiary must be entitled [...]

Incident to Office Guidelines

“Incident to” Office Guidelines The CMS rules for billing office services as “incident to” a physician’s services are summarized within this document. Of note, the concept does not apply to services performed in the hospital environment, which [...]

Description of NPI and a Link to NPPES Registry

Description of NPI and a Link to NPPES Registry   As mandated by HIPAA, you should maintain (verify and update) your NPI data via NPPES on a regular basis. The NPI: is a ten-digit number and must be submitted on the enrollment form, [...]

August 2024

In This Issue National Government Services Articles for Part A and Part B Providers LCD and Article Updates for June/July 2024 [Cancelled] Multijurisdictional Contractor Advisory Committee Meeting Notice on Superficial Radiation Therapy [...]

Part B Top Claim Errors Updated

Part B Top Claim Errors Updated Using data analysis, we update the Top Claim Errors on a quarterly basis and provide: the error reason code; a description of the error; the error type; details that include steps you can take to [...]

Introducing the All-New Medicare University!

  Introducing the All-New Medicare University! We encourage you to visit the new Medicare University and explore these exciting enhancements. Simply follow the directions below to check it out. Logging in for the First Time Medicare [...]

MLN Connects® Newsletter: August 1, 2024

MLN Connects® Newsletter: August 1, 2024 Final Payment Rules Skilled Nursing Facility FY 2025 Final Rule Inpatient Rehabilitation Facility FY 2025 Final Rule Inpatient Psychiatric Facility FY 2025 Final Rule Hospice FY 2025 Final Rule [...]

Description of NPI and a Link to NPPES Registry

Description of NPI and a Link to NPPES Registry As mandated by HIPAA, you should maintain (verify and update) your NPI data via NPPES on a regular basis. The NPI: is a ten-digit number and must be submitted on the enrollment form, will [...]

Description of NPI and a Link to NPPES Registry

Description of NPI and a Link to NPPES Registry   As mandated by HIPAA, you should maintain (verify and update) your NPI data via NPPES on a regular basis. The NPI: is a ten-digit number and must be submitted on the enrollment form, [...]

State License and Registrations for Individuals and Organizations

State License and Registrations for Individuals and Organizations Prior to submitting a provider enrollment application to Medicare, ensure that all applicable state licensing and/or specialty certification requirements are current. Each state [...]

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 [...]

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 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 a site visit [...]

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 [...]

Acknowledgement Email

Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: NGS-PE-Communications@elevancehealth.com containing the NGS case number for tracking [...]

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

Request 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 [...]