GlobalPeriodCalculator Bottom

Please refer to the Physician Fee Schedule Look up on the CMS Web site to determine whether the procedure in question has a 90 day global period.

Hospital-Issued Notices of Noncoverage

Inhalation Treatment CPT 94640 – Billing Errors

Inhalation Treatment CPT 94640 – Billing Errors The National Government Services Appeals Department has identified billing errors relevant to CPT code 94640 for inhalation treatment. When you bill more than one unit per episode of care, the [...]

DME CERT Physician's Corner

DME CERT Physician’s Corner In an effort to reduce the CERT claims error rate, CGS Jurisdiction B DME MAC, has created a Physician’s Corner page which is specifically designed for physicians and practitioners to provide detailed information [...]

Download Medicare Remit Easy Print

Download Medicare Remit Easy Print To download MREP, please select the external link below to navigate to the MREP portion of the CMS Website. Download Medicare Remit Easy Print

Prolonged Services Timetable 2024

Prolonged Services Timetable 2024 CPT Code HCPCS Code for Prolonged Service CPT and CMS Base Time CMS-Extra Minutes Needed CMS Time Requirement for Prolonged Services Date Span 99205 G2212 60 15 [...]

Hospice PIP Rate Review Form

Part A Ambulance Claims Not Retaining Fractional Units

Fractional Units are not being retained on ambulance mileage HCPCS entered via DDE. This results in reason code 32226 (Units required but not present).  

ESRD Claims Are Paying Incorrectly

National Government Services has been made aware of ESRD claims with HCPCS code 90999 processing at rates that are cents instead of hundreds of dollars. This is causing the claims to pay incorrectly. This issue appears to have started mid-July, 2023.

Home Health 32G Adjustment Issue for Separation Periods of < 60 Days

A segment of home health claims with 32G type of bills are incorrectly being re-coded to earlier periods during processing, instead of the correct later periods. This error is occurring when the separation between the two periods is 60 days or [...]

Hospice Informational Unsolicited Response Adjustments - Type of Bill 8XG

Due to original informational unsolicited responses (IURs) processing not occurring between the timeframe of 8/1/2017 and 4/1/2021, a significant volume of hospice IUR adjustments have been initiated by the common working file (CWF) to [...]

Optical Character Recognition Misreading Referring Provider Names

OCR software is misreading the referring/ ordering provider name (item 17) on some Part B claims.

Letter of Authorization for EDI

Letter of Authorization for EDI We’ve extended our Letter of Authorization PIN expiration period based on user feedback. Letter of Authorization PINs are now valid for 30 days and there is no limit on the number of times a PIN can be used. [...]

Interim Rate Review Documentation Request Form for Hospitals

Billing Overlap/Dispute Resolution Process Effective 3/1/2023

Billing Overlap/Dispute Resolution Process Effective 3/1/2023 An overlapping situation may occur between hospitals for inpatient stays, home health agencies, outpatient services and hospice agencies. Overlapping situations may also occur due [...]

Hospice Claims Edit Issue RC W7048

National Government Services has noted an increase in hospice claims editing incorrectly for RC W7048 following the July 2023 system release. This is occurring for revenue codes 0250 (non-injectable prescription drugs), 0290 and/or 0294 [...]

Guidelines for Submitting Prior Authorization Certain Hospital Outpatient Department

General PAR Documentation Requesters must include the following data elements in all PARs to avoid potential delays in processing. Your MAC may request additional, optional elements for submission of the PAR. Initial Submission Documentation: [...]

Dispute Request for Assistance (RFA) Form

CMS Links

  Administrative Simplification Overview Ambulatory Surgical Centers (ASC) Center  Clinical Laboratory Improvement Amendments (CLIA)  Beneficiary Notices Initiative (BNI)  CMS.gov Email Updates CMS.gov Open [...]

Proper Medicare Part B Claim Submissions Due to the Change Healthcare Security Incident

Proper Medicare Part B Claim Submissions Due to the Change Healthcare Security Incident With many providers submitting paper claims due to the Change Healthcare security incident, it is important to submit your claims correctly. Failure to do [...]

MLN Connects® Newsletter: April 11, 2024

MLN Connects® Newsletter: April 11, 2024 Proposed Payment Rules CMS Proposes New Policies to Support Underserved Communities, Ease Drug Shortages, and Promote Patient Safety News CMS Roundup (Apr. 5, 2024) Medicare Shared Savings [...]

NGSConnex Medicare Part B Remittances

NGSConnex Medicare Part B Remittances We’ve added an enhancement that offers providers the option to view/print remittance advices in NGSConnex for up to 24 months from the date of search. You are required to complete the EDI enrollment to [...]

Social Security Income Ratios

Social Security Income Ratios The federal fiscal year 2022 SSI ratios for IPPS hospitals, IRFs and LTCHs were posted on the CMS website. IPPS IRF LTCH We will update the latest published 2022 SSI ratios in the Provider Specific File of [...]

Reimbursing Place of Service 10 at the Nonfacility Rate for Medicare Telehealth Services

In CY 2024, CMS issued a change to processing for telehealth services billed with POS 10. As of 1/1/2024, these claims are to be paid at the nonfacility PFS rate. A system processing issue resulted in incorrect payments at the facility rate and [...]

Submit Supporting Documentation

Submit Supporting Documentation We encourage you to submit cost reports and supporting documentation electronically whenever possible. In addition to the environmental benefits of this approach, it is also more time and cost efficient. The [...]

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 [...]

Hospice Pricer Tool

Hospice Pricer Tool The CMS Web Pricer will assist in evaluating your hospice claim reimbursement. Revised 4/18/2024

MLN Connects® Newsletter: April 18, 2024

MLN Connects® Newsletter: April 18, 2024 News PrEP for HIV: Prepare for Potential Medicare Part B Coverage Events Clinical Laboratory Fee Schedule Upcoming Meetings: Register to Present, Speak, or Attend in Person by June 1 [...]

3/13/2024 Part B POE Advisory Group Meeting

3/13/2024 Part B POE Advisory Group Meeting Meeting Minutes Meeting Time: 10:00 a.m.‒12:00 p.m. ET Member Attendees: Doris Barnes, Aurelio Barraco, Madelon Berger, Ilka Collier, Eileen Conlan, Renay Coonan, Tracy Essling, Stephanie [...]

Helpful Reminders on Advance Care Planning

Helpful Reminders on Advance Care Planning ACP billing codes: 99497: Advance care planning, including the first 30 minutes of face-to-face explanation and discussion (when performed) of advance directives such as standard forms. 99498: [...]

Reminders for the New Hospice Certifying Physician Claim Edit Effective 5/1/2024

Reminders for the New Hospice Certifying Physician Claim Edit Effective 5/1/2024 Effective for hospice claim "From" dates on or after 5/1/2024, CMS implemented edits to enforce a new rule that would deny hospice claims if the certifying [...]

Top Claim Errors Have Been Reviewed and Updated

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 under Resources > Claims and Appeals to learn what you can do to avoid claim [...]

Receive and Respond to Audit and Reimbursement Correspondence via NGSConnex

Table of Contents Receive and Respond to Audit and Reimbursement Correspondence via NGSConnex What are the benefits? [Return to Top] Receive and Respond to Audit and Reimbursement Correspondence via NGSConnex National Government [...]

Home Office Cost Statements

A home office of a chain organization is a related organization to its participating providers. Home offices usually furnish central management and administrative services, e.g., centralized accounting, purchasing, personnel services, [...]

Who May File an Appeal

Who May File an Appeal Table of Contents Who May File an Appeal Appointment of Representative When Is an Appointment Not Necessary? Who May Be a Representative How to Make and Revoke an Appointment Required Elements When to Submit the [...]

Submit an Appeal Electronically with NGSConnex

Submit an Appeal Electronically with NGSConnex Table of Contents Submit an Appeal Electronically with NGSConnex Step 1: Access NGSConnex Step 2: Submit an Electronic Appeal and Attach Documentation Step 3: Attach Documentation [...]

Get Help Submitting an Appeal Hard Copy

Get Help Submitting an Appeal Hard Copy Table of Contents Get Help Submitting an Appeal Hard Copy Step 1: Complete the Appeals Request Form Helpful Tips: [Return to Top] Get Help Submitting an Appeal Hard Copy All levels of appeals [...]

Reopenings for Minor Errors and Omissions

Reopenings for Minor Errors and Omissions Table of Contents Reopenings for Minor Errors and Omissions Reopening Facts What is a Clerical Error? Clerical Error and Omission Reopening Request Request a Reopening - NGSConnex Request a Reopening - [...]

Overpayment: How Should I Respond?

Table of Contents Overpayment: How Should I Respond? What Action Should I Take? Complete a Voluntary Refund Where Should I Send my Forms and Payments? [Return to Top] Overpayment: How Should I Respond? An overpayment may be [...]

What Documents are Needed

What Documents are Needed Table of Contents What Documents are Needed Supporting Medical Records Ambulance Ambulatory Surgery, Operating Room, Lithotripsy and Preadmission Testing Cardiac Rehabilitation Clinic and Therapeutic [...]