Do Not Forward “DNF”

Do Not Forward “DNF” With implementation of the DNF initiative, contractors were required to use “return service requested” envelopes for hard copy RAs, hard-copy checks and returned EFT payments. If you are a provider that receives hard [...]

Reactivation of Billing Privileges

Reactivation of Billing Privileges To reactivate your individual and/or group billing privileges, please follow instructions within the deactivation letter. Assisting with Reactivation Instructions for Accessing PECOS For first-time user, [...]

Failure to Complete Revalidation

Failure to Complete Revalidation Avoid claims being rejected or termination of Medicare billing privileges by responding: by the revalidation due date timely to additional information requested Related Content Medicare Revalidation [...]

Failure to Report a Critical Change

Failure to Report a Critical Change Providers and suppliers enrolled in Medicare are required to ensure strict compliance with Medicare regulations by submitting updates and changes to enrollment information in accordance with specified [...]

Site Visit Failure

Site Visit Failure CMS reserves the right, when deemed necessary, to perform onsite review of a provider or supplier to verify that the enrollment information submitted to CMS or its agents is accurate and to determine compliance with Medicare [...]

MLN Connects® Newsletter: July 3, 2024

MLN Connects Newsletter: July 3, 2024 News ESRD Prospective Payment System CY 2025 Proposed Rule — Submit Comments by August 26 CMS Roundup (June 28, 2024) Improve Your Search Results for CMS Content Claims, Pricers, & Codes [...]

PECOS Enrollment Process and Advantages

PECOS Enrollment Process and Advantages The Internet-based PECOS can be used in lieu of the paper enrollment application. Submitting the application via PECOS is the preferred method. Advantages of Online Enrollment: Lets you submit [...]

Enrollment Application Forms

Enrollment Application Forms You have two options for submitting your Part B Enrollment application to Medicare. You can choose to submit: Electronic application through PECOS, or CMS paper application forms Also view Understanding [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Business Function State Mailing Address Additional Documentation Requests CT, MA, ME, NH, NY, RI, VT National Government Services, Inc. P.O. Box 7108 Indianapolis, IN [...]

PECOS Enrollment Process and Advantages

Skilled Services

Skilled Services Table of Contents Skilled Services Skilled Nursing Examples of skilled nursing Skilled Therapy Skilled Respiratory Nonskilled Service Examples Examples of personal care services General Skilled [...]

Education Partnership Request Form

Chimeric Antigen Receptor (CAR) T-cell Therapy

MLN Connects® Newsletter: January 11, 2024

MLN Connects® Newsletter: January 11, 2024 News Marriage and Family Therapist & Mental Health Counselor Services: Overpayments to Critical Access Hospitals Billing under Method II Medicare Part A Cost Report Exhibits: New Electronic [...]

MLN Matters® MM13331: Incorporation of Recent Provider Enrollment Regulatory Changes into Chapter 10 of CMS Publication (Pub.) 100-08 - Physician Fee Schedule (PFS) Final Rule

MLN Matters® MM13331 - Incorporation of Recent Provider Enrollment Regulatory Changes into Chapter 10 of CMS Publication (Pub.) 100-08 - Physician Fee Schedule (PFS) Final Rule Revised 1/12/2024

Provider Compliance Tips for Home Health Services (Part A Non DRG)

Eligibility Criteria for Face-to-Face Encounters

Eligibility Criteria for Face-to-Face Encounters National Government Services is reminding home health providers that a face-to-face encounter form is not adequate documentation to support that a face-to-face encounter occurred. [...]

Home Health Plans of Care: NPs, CNSs and PAs Allowed to Certify

Home Health Plans of Care: Nurse Practitioners, Clinical Nurse Specialists and Physician Assistants Allowed to Certify Section 3708 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. No. 116-136) amended sections [...]

Home Health: The Definition of an Allowed Practitioner

Home Health:  The Definition of an Allowed Practitioner As per MM12615 the “Definition of an Allowed Practitioner” has been revised to read as follows (CR 12615): Medicare Benefit Policy Manual Chapter 7 Section 30.2.1 – Definition of an [...]

Medicare Home Health Benefit

Low and No Medicare Utilization Cost Report

Low and No Medicare Utilization Cost Report No Utilization Cost Reports To comply with program cost reporting requirements, a provider that has not furnished any covered Medicare services during a cost reporting period must only complete the [...]

MLN Connects® Newsletter: January 18, 2024

MLN Connects® Newsletter: January 18, 2024 News CMS Finalizes Rule to Expand Access to Health Information and Improve the Prior Authorization Process Acute Hospital Care at Home Data Release CMS Roundup (Jan 12, 2024) Medicare Part B [...]

Medicare Requirements for Marriage and Family Therapists and Mental Health Counselors

Medicare Requirements for Marriage and Family Therapists and Mental Health Counselors Effective 1/1/2024, Medicare added two new nonphysician specialties. To enroll with Medicare, all the requirements for the specialty must be met. [...]

Teaching Physician Virtual Supervision in 2024 Clarification

Teaching Physician Virtual Supervision in 2024 Clarification This article is to clarify virtual supervision provided by the teaching physician for the key portions of the service of a resident. There has been some confusion on the setting in [...]

Revised: Interactive Voice Response System Feature Ending Soon

Revised: Interactive Voice Response System Feature Ending Soon It was announced on 1/10/2024 that the following function will no longer be available on our IVR System as of 2/16/2024. This change is currently delayed. Once a new date is [...]

Membership Rosters

Membership Rosters Jurisdiction 6 and Jurisdiction K Home Health POE Advisory Group Roster Member Provider/Institution State Anderson, Jade Promedica Senior Care (Heartland Home Health) Multi [...]

Telehealth Changes for 2024 – Modifier 95 and Place of Service Codes

Telehealth Changes for 2024 – Modifier 95 and Place of Service Codes National Government Services has received many questions regarding the use of modifier 95 going forward. CMS implemented the usage of modifier 95 during the COVID-19 PHE as a [...]

2024 Annual Update to the Therapy Code List: Caregiver Training Codes

2024 Annual Update to the Therapy Code List: Caregiver Training Codes The CMS annual update to the therapy code list includes three new caregiver training “sometimes therapy” codes to include caregiver training when the patient is not [...]

2024 Annual Update to the Therapy Code List: Remote Therapeutic Monitoring

2024 Annual Update to the Therapy Code List: Remote Therapeutic Monitoring CMS is updating Disposition 10, in addition to other modifications, to clarify that, for RTM services, physical and occupational therapists in private practice may [...]

The Part B Top Claim Errors Have Been Reviewed and Updated

The Part B Top Claim Errors Have Been Reviewed and Updated Our top claim errors are updated on a quarterly basis to reflect current information. Visit Top Claim Errors to learn what you can do to avoid claim processing delays. We’ve listed the [...]

Frequently Asked Questions Have Been Reviewed and Updated

Frequently Asked Questions Have Been Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Topics available are: ASCA Appeals CAR T-cell [...]

Submit a Quarterly Credit Balance Report

Table of Contents Submit a Quarterly Credit Balance Report How to Submit a Quarterly Credit Balance Report Credit Balance Submission Timeline Failure to Submit/Late Filings Additional Tips for a Successful Credit Balance Report [...]

Credit Balance Report Reminder: Due Date Approaching

Credit Balance Report Reminder: Due Date Approaching For the quarter ending 12/31/2023, CBRs can be submitted starting 1/1/2024 and must be submitted within 30 days to be considered timely. The easiest and fastest way to submit your CBR is [...]

EDI Solutions J6

Helpful Resources EDI Front End Rejection Code Lookup Tool Reset My EDI Password Contact the EDI Help Desk 877-273-4334 Available by phone or email Monday–Friday* 8:00 a.m.–5:00 p.m. ET 8:00 a.m.–4:00 p.m. CT * Closed for training on the [...]

EDI Solutions JK

Helpful Resources EDI Front End Rejection Code Lookup Tool Reset My EDI Password Contact the EDI Help Desk 888-379-9132 Available by phone or email Monday–Friday* 8:00 a.m.–5:00 p.m. ET 8:00 a.m.–4:00 p.m. CT * Closed for training on the [...]

View Medicare Accountable Care Organization

View Medicare Accountable Care Organization ACOs are groups of doctors, hospitals and other health care providers, who come together voluntarily to give coordinated high quality care to Medicare patients they serve.  Coordinated care [...]

Targeted Probe HHH Right Hand

Helpful Resources Targeted Probe and Educate Manual NGSConnex Log Into NGSConnex NGSConnex User Guide USPS National Government Services, Inc. P.O. Box 7108 Indianapolis, IN 46207-7108 UPS/FedEx National Government Services, Inc. 220 [...]

Targeted Probe Part A Right Hand

Helpful Resources Targeted Probe and Educate Manual NGSConnex Log Into NGSConnex NGSConnex User Guide USPS National Government Services, Inc. P.O. Box 7108 Indianapolis, IN 46207-7108 UPS/FedEx National Government Services, Inc. 220 [...]

Targeted Probe HHH Right Hand

Helpful Resources Targeted Probe and Educate Manual NGSConnex Log Into NGSConnex NGSConnex User Guide USPS National Government Services, Inc. P.O. Box 6474 Indianapolis, IN 46206-6474 UPS/FedEx National Government Services, Inc. 220 [...]

J6 Part B Targeted Probe Right Hand

Helpful Resources Targeted Probe and Educate Manual NGSConnex Log Into NGSConnex NGSConnex User Guide USPS National Government Services, Inc. P.O. Box 6475 Indianapolis, IN 46206-6475 UPS/FedEx National Government Services, Inc. 220 [...]