Tobacco Counseling via Telehealth

Tobacco Counseling via Telehealth Health equity in telehealth is the opportunity for everyone to receive the health care they need and deserve, regardless of social or economic status. Medicare Part B covers intermediate and intensive tobacco [...]

Announcing Service Specific Post-Payment Audits of Individual Psychotherapy Services for J6 A Regions: IL, WI and MN

Edit Reason Code: 5FSEP Bill Type = 13X, 85X CPT/HCPCS/Modifiers:90832- 90834 Overview The Medical Review Department of National Government Services will be performing service specific post-payment reviews for claims submitted to Medicare [...]

Tips for Documenting Homebound Status

Tips for Documenting Homebound Status Comprehensive and accurate documentation is crucial to providing safe and effective care to Medicare beneficiaries. National Government Services' medical review team reviews this documentation while making [...]

Physicians and Nonphysician Practitioners: Revised CMS-855I Medicare Enrollment Application Required November 1 (Combined CMS-855I and CMS-855R)

Physicians and Nonphysician Practitioners: Revised CMS-855I Medicare Enrollment Application Required November 1 (Combined CMS-855I and CMS-855R) If you don’t use PECOS, use the revised CMS-855I (Medicare Enrollment Application - Physicians and [...]

Update: End Stage Renal Disease Claim Adjustments Needed Due to CWF Error in Date of First Dialysis

Update: End Stage Renal Disease Claim Adjustments Needed Due to CWF Error in Date of First Dialysis As of 7/18/2023, CMS has identified that the CWF continues to have some inaccurate dates for the first date of dialysis. We will advise when [...]

I Am a Provider and “I Want to Complete an EDI Registration Form”

I Am a Provider and “I Want to Complete an EDI Registration Form” This selection will prompt you to complete the EDI Registration Form. This option is for providers who wish to submit claim files using a third party such as a billing service [...]

I Am a Provider and “I Want to Complete a Connex Registration Form”

I Am a Provider and “I Want to Complete a Connex Registration Form” This selection will prompt you to complete the Connex Registration Form. This option is for providers who wish to send claims or receive remits through the NGSConnex portal. [...]

Clearinghouse

Clearinghouse When Clearinghouse is selected as your submitter type the following objective will be displayed. Select the objective and then click Next. I am a Clearinghouse and “I want to complete an EDI Registration Form” This objective [...]

Common Questions

Common Questions What is the Entity Name? This is the EXACT provider’s name that was submitted in section 2 of the CMS-855/PECOS enrollment application when applying to participate with Medicare.   What information should be put in [...]

I Am a Provider and “I Want to Connect Directly to the Part A FISS/DDE System”

I Am a Provider and “I Want to Connect Directly to the Part A FISS/DDE System” This selection will prompt you to complete the Logon Request Form. This option is for providers who need to request, modify, reinstate, or add additional access to [...]

I Am a Provider and “I Want to Allow a 3rd Party Billing Service to Bill for Me Using the Part A FISS DDE System”

I Am a Provider and “I Want to Allow a 3rd Party Billing Service to Bill for Me Using the Part A FISS DDE System” This selection will prompt you to complete the Letter of Authorization Form. This option is for providers who wish to allow [...]

I Am a Billing Service and “I Want to Complete an EDI Registration Form”

I Am a Billing Service and “I Want to Complete an EDI Registration Form” This selection will prompt you to complete the EDI Registration Form. This objective is for billing services who need to obtain a new TPID or make a change to an [...]

Hierarchy of Medicare Regulations

Hierarchy of Medicare Regulations Have you wondered how Medicare determines what is covered? Below you will find the hierarchy of how Medicare regulations are created. Social Security Act Title XVIII of the Social Security Act is [...]

MLN Connects® Newsletter: October 19, 2023

MLN Connects® Newsletter: October 19, 2023     News 2024 Medicare Parts A & B Premiums and Deductibles Help CMS Improve Provider Resources — Respond by November 9 CMS Health Information Handler Helps You Submit [...]

PC-ACE Software Instructions, Resources and Guides

PC-ACE Software Instructions, Resources and Guides Creating a 276 Claim Status Request in PC-ACE and Importing and Reading the 277 Claim Status Report PC-ACE Software – For Professional Users: Importing and Reading the 999 & 277CA Files [...]

PC-ACE Software Instructions, Resources and Guides

PC-ACE Software Instructions, Resources and Guides Creating a 276 Claim Status Request in PC-ACE and Importing and Reading the 277 Claim Status Report PC-ACE - For Institutional Users: Importing and Reading the 999 and 277CA Files PC-ACE [...]

Browser Compatibility

Browser Compatibility Access NGSConnex using one of the supported browsers below. Microsoft Edge version 88.0 and above Google Chrome version 45.0 and above  Mozilla Firefox version 31.0 and above Apple Safari version 9 and [...]

Mental Health Services

Mental Health Services Medicare Part B provides benefits for psychiatric services, which are medically necessary for the diagnosis or treatment of diagnostic and/or behavioral health treatment. Medicare recognizes the following Part B [...]

Register Today! National Government Services Fall 2023 Medicare Virtual Conference: Understanding Medicare Compliance for Part B Providers

Register Today! National Government Services Fall 2023 Medicare Virtual Conference: Understanding Medicare Compliance for Part B Providers This three full-day virtual conference will offer a variety of Part B sessions geared toward Medicare [...]

Medicare Billing Fact Sheet for Electronic (837P) and Paper (Form CMS-1500) Claims

Credit Balance Report Reminder

Credit Balance Report Reminder CBRs for the quarter ending 9/30/2023 are now due. CBRs must be submitted within 30 days of the end of the quarter to be considered timely. FISS DDE users who submit the 838 detail page directly over the [...]

Medicare Overpayments Are Not Redeterminations

Medicare Overpayments Are Not Redeterminations Our records indicate some providers are incorrectly submitting redetermination request forms for MSP overpayment issues. Please use this notification as educational instruction from National [...]

MLN Connects® Newsletter: October 26, 2023

MLN Connects® Newsletter: October 26, 2023 News Help CMS Improve Provider Resources — Respond by November 9 CMS Roundup (Oct 20, 2023) Nursing Facility Evaluation and Management Visits: Comparative Billing Report in October Claims, [...]

Part B Top Claim Errors Are Updated

Part B Top Claim Errors Are 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 error reason code, a [...]

Prior Authorization Outpatient Department Exemption Additional Documentation Requests

Prior Authorization Outpatient Department Exemption Additional Documentation Requests National Government Services Prior Authorization initiated the process of issuing ADRs to exempt providers. Please monitor your facility’s ADR location [...]

Navigating Medicare Home Health & Hospice Insights for Providers Podcast

Navigating Medicare Home Health & Hospice Insights for Providers Podcast Listen to our new podcast on Spotify and Apple Podcasts!   We invite you to join our thoughtful conversations and helpful insights into the Home Health & [...]

Coming Soon ‒ The CY 2024 Medicare Physician Fee Schedule

Coming Soon - The CY 2024 Medicare Physician Fee Schedule The CY 2024 MPFS will soon be available on the Fee Schedule Lookup tool located on NGSMedicare.com, after the CY 2024 physician fee schedule regulation is put on display. Once the Fee [...]

Electronic Cost Report Exhibit Templates

Micro-invasive Glaucoma Surgery Update

Micro-invasive Glaucoma Surgery Update The MIGS LCD, L37244, and Billing and Coding Article, A56588, will not become final and therefore have been removed from the Medicare Coverage Database. Accordingly, at this time there will be no change [...]

January 2024 Billing and Coding Articles Updates

January 2024 Billing and Coding Articles Updates Billing and Coding: Denosumab (Prolia ™, Xgeva ™) (A52399) Coding Information #2 has been removed based on Transmittal 12397 (CR 13468), Payment of Codes for Chemotherapy Administration and [...]

January Code Set Update for PC Print: January 2024

January Code Set Update for PC-Print: January 2024 The PC-Print January code set update will be available on our website 1/3/2024. The update contains the following enhancements: CR13303 Implement Operating Rules - Phase III Electronic [...]

Improving Customer Experience

Improving Customer Experience We are committed to improving your experience. Please watch this two-minute video that explains how each day we review comments from providers who submit surveys to let us know what is working well and how we can [...]

New Version of PC-ACE: January 2024

New Version of PC-ACE: January 2024 PC-ACE Version 6.1 contains several CMS mandates and product enhancements including but not limited to the items listed below. MLN Matters® MM13248 Revised: Processing Services During Disenrollment from [...]

Medicare Part B Final Rule

New Medicare Topic – Medicare Part B Final Rule 2024

New Medicare Topic – Medicare Part B Final Rule 2024 CMS issued the final rule on 11/2/2023, which announces finalized policy changes for Medicare payments under the PFS and other Medicare Part B issues, effective on or after 1/1/2024. There [...]

CMS Region 2 Office Hours

CMS Region 2 Office Hours The CMS Region 2 Office recently began conducting a series of “Office Hours” calls. The purpose of these sessions is to provide brief updates on Medicare topics of current interest to Part A facilities, physicians and [...]