Billing and Coding Article Update for August 2023

Billing and Coding Article Update for August 2023 Billing and Coding: Non-Invasive Vascular Studies (A56758) Effective 8/31/2023, the following ICD-10-CM codes were added to the "ICD-10-CM Codes That Support Medical Necessity" section (Group [...]

MLN Connects® Newsletter: August 24, 2023

MLN Connects® Newsletter: August 24, 2023 News Seasonal Flu Vaccine Pricing for 2023–2024 Season Expanded Home Health Value-Based Purchasing Model: July 2023 Interim Performance Reports, Post-Event Materials, & Comment on CY 2024 [...]

Unprocessable Claim Rejections and Corrections

Unprocessable Claim Rejections and Corrections Assigned and nonassigned services are considered unprocessable when incomplete or invalid information is detected in our claims processing system. Unprocessable claim is described in the CMS IOM [...]

Medicare Beneficiary Eligibility Checklist

Tip Sheet #1

National Government Services Office of Congressional Affairs Protocol: Tip Sheet #1 Medicare is changing and we live in a MAC world and this protocol explains the process to help you submit your Medicare constituent inquiries. Today, [...]

MLN Connects® Newsletter: September 21, 2023

MLN Connects® Newsletter: September 21, 2023     News CMS Announces Resources and Flexibilities to Assist with the Public Health Emergency in the State of Georgia Organ Transplantation Affinity Group: Strengthening [...]

Telehealth Services

Answers to Common Fee-For-Time Compensation Arrangements Questions

Save the Dates! National Government Services Fall 2023 Virtual Conference for Medicare Part A Providers

Save the Dates! National Government Services Fall 2023 Virtual Conference for Medicare Part A Providers Ending 2023 on a Strong Medicare Note 11/1/2023-11/2/2023 The National Government Services POE Team will be holding our bi-annual virtual [...]

Join Us for the A/B DME Collaborative Surgical Dressings Webinar

Join Us for the A/B DME Collaborative Surgical Dressings Webinar Representatives from all four DME MAC jurisdictions and the A/B MACs will explain medical record requirements for surgical dressings. We hope you’ll join the MACs for this [...]

October 2023

In This Issue National Government Services Articles for Part A and Part B Providers Dental Services: Billing and Coding Article A59543 is Available EDI Spotlight: Strengthening Security Local Coverage Determination Open Meeting [...]

Don't Miss Out - Register Today! National Government Services: Medicare Part B Care Management Tuesdays

Don't Miss Out - Register Today! National Government Services: Medicare Part B Care Management Tuesdays According to the CDC, six in ten adults in the U.S. have a chronic disease and four in ten adults have two or more. As your Medicare [...]

LCD and Billing and Coding Article Update for October 2023

LCD and Billing and Coding Article Update for October 2023 Billing and Coding: Autonomic Function Testing (A57024) Due to the annual ICD-10 Code updates, ICD-10 code G20 has been deleted and the following ICD-10 codes have been added: G20.A1, [...]

Provider Outreach and Education Reminders

Decrease Burden and Combine Multiple PDFs into One Before Responding to Additional Documentation Requests Using NGSConnex

Decrease Burden and Combine Multiple PDFs into One Before Responding to Additional Documentation Requests Using NGSConnex Recently, National Government Services has seen an increase in providers submitting multiple PDF attachments for the same [...]

MLN Connects® Newsletter: September 28, 2023

MLN Connects® Newsletter: September 28, 2023     News CMS Statement on Current Status of Blood Tests for Organ Transplant Rejection CMS Roundup (Sept 22, 2023) Cardiovascular Disease: Talk with Your Patients about [...]

Medicare Part B CMS-1500 Crosswalk for 5010 Electronic Claims

Collaborative A/B/DME Therapeutic Shoes for Persons with Diabetes Webinar

Collaborative A/B/DME Therapeutic Shoes for Persons with Diabetes Webinar Providers – Do you need assistance in understanding what is needed when ordering diabetic shoes? This collaborative webinar on Therapeutic Shoes for Persons with [...]

Billing for Services Not Included in the FQHC Benefit

Billing for Services Not Included in the FQHC Benefit Table of Contents Billing for Services Not Included in the FQHC Benefit Ambulance Services Body Braces Durable Medical Equipment Laboratory Services Medicare-Excluded [...]

Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims

Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims Table of Contents Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims Repetitive Services Repetitive Services [...]

What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy

What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy Table of Contents What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy [...]

Hospitals Must Correctly Assign Severe Malnutrition Diagnosis Codes to Inpatient Claims

Hospitals Must Correctly Assign Severe Malnutrition Diagnosis Codes to Inpatient Claims Table of Contents Hospitals Must Correctly Assign Severe Malnutrition Diagnosis Codes to Inpatient Claims Hospital Action(s) Related Content [...]

COVID-19 Part A Frequently Asked Questions

COVID-19 Part A Frequently Asked Questions Table of Contents COVID-19 Part A Frequently Asked Questions Section B. Diagnostic Laboratory Services Section LL. Hospital Billing for Remote Services Section MM. Outpatient Therapy Services [...]

Fiscal Intermediary Standard System Direct Data Entry Screen Changes – October 2023

Fiscal Intermediary Standard System Direct Data Entry Screen Changes – October 2023 The October 2023 quarterly system release was implemented on 10/2/2023 and includes the FISS DDE screen changes identified below. CMS issued CR 13138 which [...]

Tip Sheet: Proper Use of Modifier 25

Tip Sheet: Proper Use of Modifier 25 A review of top claim reason codes indicate a steady reoccurrence of claims being returned to provider (RTP) for reason code W7021, when there was a medical visit on same day as a type 'T' or 'S' procedure [...]

Three-Day Qualifying Hospital Stay Required for Medicare-Covered SNF Stay

Three-Day Qualifying Hospital Stay Required for Medicare-Covered SNF Stay Table of Contents Three-Day Qualifying Hospital Stay Required for Medicare-Covered SNF Stay Additional Information Billing Reminders Related Content [Return to [...]

MLN Connects® Newsletter: October 5, 2023

MLN Connects® Newsletter: October 5, 2023     News Administration Moves Forward with Medicare Drug Price Negotiations to Lower Prescription Drug Costs for People with Medicare CMS Requests Public Input on Coverage of [...]

Update on proposed LCD for Transesophageal Echocardiography

Update on proposed LCD for Transesophageal Echocardiography The LCD for Transesophageal Echocardiography (TEE) was published for comment and presented at an Open Meeting in July 2023. NGS is continuing to assess the provisions in this LCD and [...]

MLN Connects® Newsletter: October 6, 2023

MLN Connects® Newsletter: October 6, 2023     News COVID-19: Updated Novavax COVID-19 Vaccine, Adjuvanted for Patients 12 & Older Posted 10/6/2023

Cognitive Assessment and Care Plan Services CPT Code 99483

Cognitive Assessment and Care Plan Services CPT Code 99483 Effective 1/1/2021, Medicare increased payment for these services to $282 (may be geographically adjusted) when provided in an office setting, added these services to the definition of [...]

Mental Health Crisis Help

Mental Health Crisis Help Anyone experiencing a mental health crisis, including substance use crisis or thoughts of suicide, can get confidential support 24/7 by calling 988 or visiting the 988 Suicide & Crisis Lifeline website. View the [...]

Notification of the 2024 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review

Notification of the 2024 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review The amount that must remain in controversy for ALJ hearing requests filed on or [...]

MLN Connects® Newsletter: October 12, 2023

MLN Connects® Newsletter: October 12, 2023     News CMS Roundup (Oct 6, 2023) Protect Your Patients: Give Them a Flu Shot Publications Direct Data Entry: 10-Digit Screen Expansion Medicare Preventive Services — [...]

Let’s Get Ready for The Great American Smokeout on 11/16/2023!

Let’s Get Ready for The Great American Smokeout on 11/16/2023! For more than 40 years, the American Cancer Society has hosted the Great American Smokeout on the third Thursday of November. This yearly event is a call for action, not just for [...]

Multi-Factor Authentication

Multi-Factor Authentication Multi-factor authentication (MFA) is a second layer of security required by CMS to have online access to protected health information. The MFA screen will display every time you log in to NGSConnex. Each day [...]

View Remittance

View Remittance If you receive SPRs you will not be able to view remittance statements in NGSConnex. If you are signed up to receive an 835 ERAs or you have elected to view remittance statements through NGSConnex, you may view and print or [...]

Change Your Password

Change Your Password Select the Manage Account button on the NGSConnex home page. Select User Profile. You must change your NGSConnex password at least once every 60 days. This is a CMS security requirement to have online access to [...]

Processing Drivers and System Claim Paths

Chapter I: Online System Terminology   Processing Drivers and System Claim Paths Purpose Claims that are filed through the FISS DDE Provider Online System follow a prescribed route referred to as a system claim path. Claim paths [...]

Claim Status and Location Codes

Chapter I: Online System Terminology Claim Status and Location Codes Purpose The purpose of the status and location is to route claims through FISS. The status describes the general condition of the claim (i.e., whether paid, denied, [...]

Main Menu

Chapter II: Online Menu Functions Overview FISS/DDE Main Menu Purpose The FISS/DDE MAIN MENU offers the following four submenu options: 01 – Inquiries 02 – Claims/Attachments 03 – Claims Correction 04 – Online Reports View [...]