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Posting Date: 10/27/2022
Documentation Required for Home Visits
Documentation Required for Home Visits CPT Codes 99341‒99350 As of 1/1/2019, CMS no longer requires providers to differentiate medical necessity for a home visit versus an office or outpatient visit. Providers no longer need to document [...]
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Posting Date: 10/27/2022
Referring, Monitoring and Certifying Home Health Services
Referring, Monitoring and Certifying Home Health Services Table of Contents Referring, Monitoring and Certifying Home Health Services Homebound Status Need for Skilled Services Under the Care of a Physician or Allowed Practitioner Plan [...]
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Posting Date: 10/27/2022
Scribing Medical Record Documentation
Scribing Medical Record Documentation National Government Services recognizes an increasing trend in providers’ use of scribes as assistants in medical record documentation. In these situations, a provider utilizes the services of staff to [...]
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Posting Date: 10/27/2022
Submit Medical Record Documentation Electronically
Submit Medical Record Documentation Electronically Table of Contents Submit Medical Record Documentation Electronically What do you need to get started? What are the Attachment Transactions? Who can use the Attachment Transactions? [...]
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Posting Date: 11/03/2022
Using the Medicare Part B PWK Fax-Mail-esMD Cover Sheet
Using the Medicare Part B PWK Fax-Mail-esMD Cover Sheet JK and J6 providers have the option of electronically submitting, mailing, or faxing documentation for electronically-submitted claims that require additional documentation for purposes [...]
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Posting Date: 10/10/2022
Anesthesia for Pain Management Procedures
Anesthesia for Pain Management Procedures The use of moderate or deep sedation, general anesthesia, and MAC is rarely indicated for pain management procedures and is not considered reasonable and necessary. The ASA provides guidelines for [...]
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Posting Date: 11/29/2021
Remittance Advice
Remittance Advice Table of Contents General Information Electronic Remittance Advice Remittance Message Codes Standard Paper Remittance General Information Once Medicare has processed a claim, the provider will receive a notice [...]
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Posting Date: 10/14/2021
Requesting an Exception to Timely Filing
Requesting an Exception to Timely Filing Table of Contents Requesting an Exception to Timely Filing No Appeal Rights for Claims Denied Based on Timely Filing Limit Provider Liability Exceptions that May Allow the Time Limit to be [...]
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Posting Date: 10/19/2022
Outpatient Services for Registered Inpatients
Outpatient Services for Registered Inpatients There are occasional circumstances in which a registered inpatient may require a service that is not available at the inpatient facility. These inpatient facilities include acute-care hospitals [...]
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Posting Date: 10/19/2022
Allergen Immunotherapy Preparation (95144-95165)
Allergen Immunotherapy Preparation (95144‑95165) National Government Services will allow the preparation and provision of antigen for allergen immunotherapy, codes 95144 through 95165 when performed incident to by auxiliary personnel. However, [...]
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Posting Date: 10/19/2022
CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy
CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy CMS created the Medicare Physician Fee Schedule Look-up Tool for MACs to follow when processing claims. CMS listed CPT code 15830 as a [...]
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Posting Date: 10/19/2022
Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid
Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid Table of Contents Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid Fee-For-Time Compensation Arrangements Reciprocal Billing Arrangements Related [...]
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Posting Date: 10/19/2022
Answers to Common Fee-for-Time Compensation Arrangements Questions
Answers to Common Fee-for-Time Compensation Arrangements Questions Does a fee-for-time compensation arrangement physician need to enroll with Medicare prior to acting as a physician? Answer: Currently, a fee-for-time compensation [...]
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Posting Date: 10/19/2022
Immunization Roster Billing
Immunization Roster Billing Table of Contents Immunization Roster Billing Claim Submission Options for Roster Billing Electronic Claim Submissions Paper Claim Submissions Vaccine Billing and Coding Resources [Return to Top] [...]
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Posting Date: 10/19/2022
Nonphysician Practitioners Billing for Surgical Procedures
Nonphysician Practitioners Billing for Surgical Procedures Several providers have asked about the Medicare guidance for NPPs include billing for surgical procedures. For the purpose of this education, NPPs include NPs, PA, and CNSs. State law [...]
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Posting Date: 10/20/2022
Professional Services During a Patient Hospice Election
Professional Services During a Patient Hospice Election Table of Contents Article Overview Hospice Election Medicare Payment During Hospice Election Determining the Correct Entity to Bill Separately Payable Part B Services Hospice and [...]
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Posting Date: 10/19/2022
Proper Billing for Finger and Toe Procedures
Proper Billing for Finger and Toe Procedures When billing for procedures that are performed on the fingers and/or toes, it’s essential to append the appropriate anatomical modifier for the service rendered. This allows the patient history to [...]
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Posting Date: 10/19/2022
Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements
Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements Table of Contents Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements Fee-For-Time Compensation [...]
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Posting Date: 09/08/2021
Proper Use of Taxonomy Codes
Proper Use of Taxonomy Codes A taxonomy code is a unique ten-character code that designates your classification and specialization and enables providers to identify their specialty at the claim level. CMS developed a crosswalk of [...]
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Posting Date: 10/19/2022
Common Reciprocal Billing Questions and Answers
Common Reciprocal Billing Questions and Answers If a practice, the same specialty as ours, wants us to take calls for them for two weeks, can we bill under their number as a reciprocal billing arrangement? Answer: No. In a reciprocal [...]
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Posting Date: 10/19/2022
Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans
Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans Background It has been noted that a high volume of PET scan claims falling between the CPT code range 78811–78816 are being denied upon original claim submission due [...]
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Posting Date: 10/19/2022
Unlisted and Not Otherwise Classified Procedure Codes
Unlisted and Not Otherwise Classified Procedure Codes Table of Contents Unlisted and Not Otherwise Classified Procedure Codes Proper Billing for NOC Procedures Electronic Claims Paper Claims The following tips will help you bill [...]
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Posting Date: 03/17/2023
Fiscal Year/Calendar Year Claim Split
Fiscal Year/Calendar Year Claim Split Part A/B Type of Bill Fiscal Year Split Calendar Year Splint Part A – 11X, 21X prospective payment system (PPS*) No No Part A – 11X, 18X, 21X, non-PPS Yes [...]
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Posting Date: 12/16/2020
The Medicare Home Infusion Therapy Benefit and Home Health Agencies
The Medicare Home Infusion Therapy Benefit and Home Health Agencies If you are a HHA that wants to provide and bill Medicare HIT professional services starting in CY 2021, you are required to enroll with the Part B Medicare Administrative [...]
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Posting Date: 09/13/2022
Medicare Coverage for Living Organ Transplant Donors
Medicare Coverage for Living Organ Transplant Donors Table of Contents Coverage Hospital Guidelines Physician Guidelines Billing Guidelines Transplant Centers Physicians and Surgeons Related Content [Return to Top] Coverage [...]
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Posting Date: 11/26/2018
Kidney Transplant Services
Kidney Transplant Services Table of Contents Kidney Transplant Services Physician Services Pretransplant Services Immunosuppressive Drugs Cadaver Donor Updated CMS-1500 Claim Form Guidelines [Return to Top] Kidney Transplant [...]
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Posting Date: 09/03/2024
September 2024
In This Issue National Government Services Articles for Part A and Part B Providers Introducing the All-New Medicare University! Removal of Facet HCPCS Codes National Government Services Articles for Part A Providers [...]
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Posting Date: 08/29/2024
MLN Connects® Newsletter: August 29, 2024
MLN Connects® Newsletter: August 29, 2024 News CMS Roundup (August 23, 2024) Physicians, Teaching Hospitals, & Non-Physician Practitioners: Review Your Open Payment Data by December 31 Claims, Pricers, & Codes Home Health [...]
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Posting Date: 08/21/2018
Eligible Part B Physicians and Nonphysicians to Enroll as Ordering and Referring Only
Eligible Part B Physicians and Nonphysicians to Enroll as Ordering and Referring Only Physician and nonphysician practitioners who can enroll in Medicare solely to order or refer: Doctors of medicine or osteopathy Doctors of dental surgery [...]
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Posting Date: 07/06/2018
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 in as a Method II Biller Reassignment. Doctor of Medicine (MD) Doctor of [...]
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Posting Date: 02/04/2021
CMS-20134 Completion Tips for Medicare Diabetes Prevention Program Suppliers
CMS-20134 Completion Tips for Medicare Diabetes Prevention Program Suppliers Review the standards on page 2 and follow the instructions printed on the CMS-20134 application Section General Guidelines Section 1: Basic [...]
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Posting Date: 04/29/2021
Physicians and Nonphysician Practitioners in Private Practice (Sole Owner or Sole Proprietor) With or Without any Reassigned Benefits
Physicians and Nonphysician Practitioners in Private Practice (Sole Owner or Sole Proprietor) With or Without any Reassigned Benefits Revalidation instructions for sole proprietor using SSN or EIN: Download CMS-855I. Complete Sections 1, [...]
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Posting Date: 08/21/2018
Approved Pending Regional Office Review
Approved Pending Regional Office Review For ambulatory surgical centers (ASCs) and portable x-ray suppliers (PXRS): When credentialing, you will receive an approved pending regional office review status in PECOS. National Government [...]
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Posting Date: 09/03/2024
Physical/Occupational Therapy Billing
Join us as we review billing guidelines for physical and occupational therapy. We'll review when to apply the KX modifier and the importance of appropriate medical documentation. National Government Services has a Local Coverage Determination [...]
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Posting Date: 09/03/2024
PECOS: Manage Signatures and Additional Information Requests
During this webinar, we’ll give direction for the Provider Enrollment, Chain and Ownership System (PECOS) application on understanding how to manage signatures and respond to additional information request from submitted applications.
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Posting Date: 10/12/2022
Medicare Coverage for Zika Virus Testing
Medicare Coverage for Zika Virus Testing In February, 2016 the Zika virus was declared a PHE by the WHO. In the United States, the CDC considers the Zika virus disease to be a nationally notifiable condition. The Zika virus is primarily [...]
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Posting Date: 10/12/2022
Molecular Pathology: Claims Review and Supporting Information to Submit on the Claim
Molecular Pathology: Claims Review and Supporting Information to Submit on the Claim Table of Contents Molecular Pathology: Claims Review and Supporting Information to Submit on the Claim Prepayment and/or Post Payment Review Tier 2 Codes [...]
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Posting Date: 10/12/2022
Surgical Pathology Billing Tips
Surgical Pathology Billing Tips CPT Codes: 88300-88399 Surgical pathology is the study of tissues removed from living patients during surgery to help diagnose a disease and determine a treatment plan. Surgical pathology involves gross and [...]
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Posting Date: 10/13/2022
Pathology Interpretation Services
Pathology Interpretation Services National Government Services has noted that there is some confusion and questions regarding the billing of professional components on some laboratory services. There is a certain subset of CPT codes for which [...]
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Posting Date: 10/12/2022
Clarification on the Proper Reporting of Radiation Treatment CPT Code 77427
Clarification on the Proper Reporting of Radiation Treatment CPT Code 77427 National Government Services would like to advise providers that bill CPT code 77427, Radiation treatment management, five treatments, of the proper way to report this [...]
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