HETS EDI Enrollment Form

HIPAA Eligibility Transaction System (HETS) allows users to exchange HIPAA compliant ANSI ASC X12 270/271 transactions for the purpose of checking Medicare eligibility.  The HETS EDI Enrollment Form allows providers to attest their [...]

Telehealth Place of Service 02 and 10 Clarification

Telehealth Place of Service 02 and 10 Clarification National Government Services has been receiving inquiries from providers in regard to POS 02 and POS 10 for telehealth service reporting. We’ve created this article to provide clarification. [...]

CLIA Number Processing Issue

CLIA Number Processing Issue National Government Services has been made aware of an issue with CLIA lab claims processing. CLIA numbers were not loaded through CWF, resulting in claim denials as CLIA did not match any file. We were informed [...]

Home Health Documentation Checklist

Home Health Documentation

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 rejected prior to the screening [...]

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 considered if it is received [...]

State License and Registrations for Certified Providers and Suppliers

State License and Registrations for Certified Providers and Suppliers Prior to submitting a provider enrollment application to Medicare, ensure that all applicable state requirements are met for your provider type. Each state has unique [...]

Eligible Method II Providers

Eligible Method II Providers If a CAH wants to become a Method II biller, email the request to A&R at ngsreimbursement@anthem.com.  Suppliers who can enroll as a Method II Biller Reassignment. Doctor of Medicine (MD) Doctor of [...]

Accreditation of Advanced Diagnostic Imaging and FDA Mammography Equipment

Reminder, if a hospital, clinic/group or Independent Diagnostic Treatment Facility has ADI screening equipment, certification from a designated ADI accrediting organization needs to be implemented or updated on the Medicare enrollment. The [...]

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, [...]

Eligible Institutional Providers

Eligible Institutional Providers Certified Providers and Certified Suppliers that Enroll via the Form CMS-855A. Unique statutory and regulatory requirements for these types of providers/suppliers are addressed in the CMS IOM Publication [...]

MLN Connects® Newsletter: August 15, 2024

MLN Connects® Newsletter: August 15, 2024 News Negotiating for Lower Drug Prices Works, Saves Billions Resources & Flexibilities to Assist with the Public Health Emergency in Florida, Georgia, and South Carolina Hospitals: New EMTALA [...]

Additional Development Requests for Part A Claims for CPT J9299

Additional Development Requests for Part A Claims for CPT J9299 A system error on 7/25/2024 caused ADR letters to be issued in error on Part A claims for CPT J9299 with DOS on or after 3/1/2024. The issue has been resolved and all impacted [...]

Proper Medicare Part B Claim Submissions

This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments, or denials. We will guide you through the CMS-1500 claim form and the electronic equivalent loops [...]

End-Stage Renal Disease: Medicare Part A Quick Reference Manual

End-Stage Renal Disease: Medicare Part A Quick Reference Manual Table of Contents ESRD Provider PTAN Number Range: Third through sixth digit FL 04 Type of Bill FL 6 Statement Covers Period FL 18-28 Condition Codes FL 18-28 Condition [...]

Claim Submission Guidelines

Claim Submission Guidelines CMS developed and transmitted HCPCS and PFS payment and coding files to include revisions to add other CDT codes and indicated parameters for payment to implement the finalized Medicare Parts A and B payment for [...]

Disproportionate Share Hospital

The Medicare DSH adjustment provision under Section 1886(d) (5) (F) of the Act was enacted by section 9105 of the COBRA of 1985 and became effective for discharges occurring on or after 5/1/1986. According to section 1886(d) (5) (F) of the Act, [...]

Electronically Submitted Claims that Exceed $99,999.99 Reminder

Electronically Submitted Claims that Exceed $99,999.99 Reminder Electronically submitted claims containing a dollar amount in excess of 99,999.99 will be rejected as a front-end EDI edit. The Standard Companion Guide for Health Care Claim: [...]

MLN Connects® Newsletter: August 22, 2024

MLN Connects® Newsletter: August 22, 2024 News Commemorating the 2nd Anniversary of the Lower Cost Prescription Drug Law MolDx Local Coverage Determination Statement Hospital Price Transparency: Get Resources to Help You Comply New [...]

Facet Joint Interventions

Facet Joint Interventions National Government Services will begin accepting PARs for Facet Joint Intervention codes on 6/15/2023 for services provided beginning on or after 7/1/2023.   To meet coverage criteria, the patient’s medical [...]

Part B

Part B  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us EDI Enrollment EDI Solutions Forms [...]

FQHC

FQHC and RHC  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us Cost Reports EDI Enrollment EDI [...]

Part A

Part A  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us Cost Reports EDI Enrollment EDI [...]

Home Health and Hospice

Home Health and Hospice  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us Cost Reports EDI [...]

Direct Graduate Medical Education/Indirect Medical Education

Direct Graduate Medical Education Table of Contents Direct Graduate Medical Education Indirect Medical Education [Return to Top] Direct Graduate Medical Education Section 1886(h) of the Act as added by section 9202 of the COBRA of [...]

Reducing Unprocessable Claim Rejections

When claims are submitted with invalid, incomplete or incorrect information, our claims processing system will detect these errors and will reject claims as unprocessable. Our goal is to assist our providers in submitting claims correctly the [...]

Preventive Services: Flu and PPV Vaccines

During this webinar, we will review the coverage, coding and billing guidelines under Medicare Part B for Influenza and Pneumococcal Pneumonia Virus vaccinations.

Original Medicare Coverage Costs

Original Medicare Coverage Costs Important Links Medicare News Fact Sheet Your Medicare Costs Your Medicare Benefits Your Medicare Coverage Your Medicare Coverage for Home Health Services Your Medicare Coverage for Hospice Care [...]

Physician Fee Schedule Look-Up

Part B Medicare Administrative Contractor Overview for Dental Providers

The purpose of this webinar is to introduce dental providers to National Government Services and explain our role as the Medicare Administrative Contractor for Jurisdictions 6 and K. We’ll also share helpful resources related to coverage, [...]

Clinical Trial Services and Modifiers Q0 and Q1

Clinical Trial Services and Modifiers Q0 and Q1 Table of Contents Clinical Trial Services and Modifiers Q0 and Q1 Q0 and Q1 Modifiers Use in Approved Clinical Trials Modifier Q0 Modifier Q1 Clinical Service Billing May Include [...]

National Coverage Determination 190.3 - Cytogenetic Testing: Discretionary Diagnoses

National Coverage Determination 190.3 – Cytogenetic Testing: Discretionary Diagnoses Under NCD 190.3, Cytogenetic Testing, CMS allows contractors discretion in coverage of specific Indications. “As this policy indicates, individual A/B MACs [...]

"What If" and Scenario Questions

"What If" and Scenario Questions Physician offices often contact us with different scenarios and "what if?" questions regarding coding and documentation for a particular service(s). Providers ask the contractors for a definitive response on [...]

Medically Unlikely Edits Billing and Processing

Medically Unlikely Edits Billing and Processing Table of Contents Medically Unlikely Edits Billing and Processing Notes on MUE Processing Instructions MUE Program Inquires Related Content [Return to Top] Medically Unlikely Edits [...]

Avoid Processing Delays by Following Proper Submission Guidelines

Avoid Processing Delays by Following Proper Submission Guidelines Table of Contents Avoid Processing Delays by Following Proper Submission Guidelines Claims Appeals Responding to an ADR Consider Submission via NGSConnex or Electronic [...]

Acceptable Electronic Signatures Reminder

Acceptable Electronic Signatures Reminder Table of Contents Acceptable Electronic Signatures Reminder Examples of Acceptable Electronic Signature Examples [Return to Top] Acceptable Electronic Signatures Reminder CMS issued [...]

Primary Care Exception Guidelines

Primary Care Exception Guidelines Services performed by attending physicians at teaching hospitals, in collaboration with house staff in an approved GME program, generally require evidence of direct care by the attending physician in order to [...]

Cloned Documentation Could Result in Medicare Denials for Payment

Cloned Documentation Could Result in Medicare Denials for Payment Medicare providers today are faced with the challenges of providing quality healthcare while meeting ever increasing regulatory and compliance regulations. Many providers are [...]