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Posting Date: 02/26/2022
Beneficiary Eligibility Information Panel
Beneficiary Eligibility Information Panel Table of Contents Beneficiary Eligibility Information Panel Printable View Initiate a New Search [Return to Top] Beneficiary Eligibility Information Panel The Beneficiary Eligibility [...]
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Posting Date: 02/26/2022
Flu Vaccine
Flu Vaccine Select Flu Vaccine from the left-side navigation. You will find the patient's flu vaccination history in this section. The Medicare beneficiary must have active Part B coverage and must not have a date of death on file at the [...]
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Posting Date: 09/27/2023
Hepatitis Screening
Hepatitis Screening Select Hepatitis Screening from the left-side navigation. The Hepatitis Screening panel provides information for the following HCPCS codes. 86704 ‒ Hepatitis B core antibody (HBcAb); total 86706 ‒ Hepatitis B surface [...]
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Posting Date: 11/05/2021
Hospice Payment Rates
Hospice Payment Rates National Government Services publishes hospice rate sheets you can use to validate hospice payments based on your service location. Although FISS is the official payment made by the Medicare Program, you can use the rates [...]
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Posting Date: 10/17/2024
Accelerated and Advanced Payment Program
COVID-19 Accelerated/Advanced Payment Revised Repayment Terms On 3/28/2020, CMS expanded the existing CAAP to a broader group of Medicare Part B Providers. The CMS CAAP Program was established to increase case flow to Medicare providers and [...]
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Posting Date: 10/17/2024
Bankruptcy Notifications
Notify us if you file bankruptcy. If you have filed a bankruptcy petition or are involved in a bankruptcy proceeding, National Government Services requests that you notify us immediately so that we can properly coordinate with the CMS and the [...]
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Posting Date: 10/17/2024
Complete a Voluntary Refund
Table of Contents Forms Used for Providers NOT on Automatic Immediate Recoupments and Check(s) Are Attached to This Form(s) Option 1: Completing the Voluntary Refund Form High Volume Spreadsheet Instructions Option 2: Large [...]
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Posting Date: 10/17/2024
How Should I Respond?
An overpayment may be identified and self-reported by a provider via clerfical error reopening or an overpayment, may be discovered by Medicare contractors as part of the claim and reimbursement review process. The key to reporting and repaying [...]
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Posting Date: 10/17/2024
Nettings/Offsets Across Organization Affiliations
Effective 1/4/2016, CMS implemented a change to begin netting/offsetting provider money across affiliated providers within the same and also across workloads within a single organization. This CMS change brings consistency to all Part B [...]
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Posting Date: 10/17/2024
Overpayment Rebuttal Process
You’ll need to know what the rebuttal process is before initiating and know that the outcome of the rebuttal may not change the National Government Services recoupment process. The overpayment rebuttal process is a protocol used when an [...]
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Posting Date: 10/17/2024
Overpayment Request
Table of Contents Forms You'll Need Large Scale Overpayments Overpayment Notification Process Timeline for Processing a Demand Letter [Return to Top] Forms You'll Need Forms for non MSP-related are generally done via NGSConnex, but [...]
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Posting Date: 10/17/2024
Respond to a Demand Letter
Table of Contents Form(s) you’ll need Timeline for Processing a Demand Letter [Return to Top] Form(s) you’ll need Providers on Automatic immediate Recoupments Do nothing as this automation process will automatically be done and [...]
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Posting Date: 10/17/2024
Request an Immediate Recoupment
Forms You’ll Need These forms apply to providers that are NOT on Automatic Immediate Recoupments. Electronic Submissions JK or J6 Immediate Recoupment Request Form - Electronic/E-mail Paper Submissions Jurisdiction K [...]
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Posting Date: 10/17/2024
Set Up an Extended Repayment Schedule
Forms you’ll need J6 Applying for an Extended Repayment Schedule JK Applying for an Extended Repayment Schedule If repaying an overpayment would constitute a “hardship” on the provider, a request for an ERS should be submitted [...]
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Posting Date: 10/10/2024
Navigating Medicare Part B Insights for Providers Podcast
Navigating Medicare Part B Insights for Providers Podcast Listen to our podcast, Navigating Medicare Part B Insights for Providers, on Spotify and Apple Podcasts! We will be posting a new episode on the 2nd and 4th Wednesday of each [...]
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Posting Date: 10/21/2024
Initiate a Prior Authorization Request for OPD Services for Part A Facility
Initiate a Prior Authorization Request for OPD Services for Part A Facility Table of Contents Initiate a Prior Authorization Request Request Details Requestor’s Information Rendering Physician Information Attachments [...]
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Posting Date: 10/17/2024
MLN Connects® Newsletter: October 17, 2024
MLN Connects® Newsletter: October 17, 2024 News Inpatient Psychiatric Facilities: Guidance on All-Inclusive Cost Reporting No-Pay Medicare Summary Notice Mailing Frequency Changed to Every 120 Days Health Literacy: Help Your Patients Get [...]
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Posting Date: 11/12/2021
Interactive Voice Response System
Interactive Voice Response System CMS requires that Medicare contractors offer self-service options to their providers for general inquiries. CMS also requires providers to utilize those self-service options, such as the IVR. National [...]
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Posting Date: 11/16/2021
Skilled Nursing Facility Consolidated Billing
Skilled Nursing Facility Consolidated Billing Back in 1997 as part of the Balanced Budget Act, Congress mandated that payment for the majority of services provided to beneficiaries in a Medicare-covered SNF stay be included in a bundled [...]
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Posting Date: 11/12/2021
Local Coverage Determination
Local Coverage Determination LCDs are developed by the local Medicare contractor in the absence of a national Medicare payment policy. These policies describe specific criteria which determine whether an item or service is covered by Medicare [...]
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Posting Date: 11/12/2021
ABN Modifiers
ABN Modifiers Modifier Description GA Waiver of liability statement issued, as required by payer policy, individual case GX Notice of liability issued, voluntary under payer policy GY Item [...]
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Posting Date: 11/12/2021
American Medical Association and Current Procedural Terminology
American Medical Association and Current Procedural Terminology The AMA is your trusted source for official CPT. The most widely accepted medical nomenclature used to report medical procedures and services under public and private health [...]
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Posting Date: 11/12/2021
CMS Forms and Publications
CMS Forms and Publications CMS publishes and maintains numerous Medicare forms that are used daily by the provider community. Some commonly used forms are: Provider Enrollment CMS-855 forms (CMS-855B, CMS-855I and CMS-855O) Medicare [...]
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Posting Date: 11/12/2021
CMS Regional Offices
CMS Regional Offices CMS has ten RO reorganized in a Consortia structure based on the agency’s key lines of business: Medicare Health Plans Operations Financial Management and Fee-for-Service Operations Medicaid and Children’s Health [...]
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Posting Date: 11/12/2021
Clinical Lab Improvement Amendment
Clinical Lab Improvement Amendment CMS regulates all laboratory testing (except research) performed on humans in the U.S. through the CLIA. The objective of the CLIA program is to ensure quality laboratory testing. Although all [...]
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Posting Date: 11/11/2021
Comprehensive Error Rate Testing
Comprehensive Error Rate Testing The CERT program was established by CMS to monitor the accuracy of claim payment in the Medicare FFS Program. The intent of the CERT program is to protect the Medicare Trust Fund by identifying errors and [...]
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Posting Date: 11/12/2021
Electronic Health Records
Electronic Health Records Eligible professionals under the Medicare EHR Incentive Program include: Doctor of medicine or osteopathy Doctor of dental surgery or dental medicine Doctor of podiatry Doctor of optometry Chiropractor If [...]
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Posting Date: 11/12/2021
Electronic Prescribing
Electronic Prescribing In 2013, the eRx Incentive Program for participating and reporting in the Medicare Electronic Prescribing (eRx) Incentive Program ended. The six-month 2014, eRx payment adjustment reporting period began on 1/1/2013 and [...]
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Posting Date: 11/12/2021
Evaluation and Management Documentation Guidelines
Evaluation and Management Documentation Guidelines Health care professionals may use the most current documentation guidelines for the date of service performed. Refer to these resources for guidance: CMS Evaluation and Management AMA [...]
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Posting Date: 11/12/2021
Federal Register
Federal Register The OFR provides access to the official text of: Federal laws Presidential documents Administrative regulations and notices The ACFR oversees the functions of the Federal Register publications system. For more [...]
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Posting Date: 11/12/2021
Health Insurance Portability and Accountability Act of 1996
Health Insurance Portability and Accountability Act of 1996 The HIPAA was signed in to law to improve and simplify the administration of the Medicare Program under title XVIII of the Social Security Act, the Medicaid program under title XIX [...]
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Posting Date: 11/12/2021
Limitation of Liability (Advance Beneficiary Notice of Noncoverage)
Limitation of Liability (Advance Beneficiary Notice of Noncoverage) Services denied as not reasonable and medically necessary, under section 1862(a) (1) of the Social Security Act, are subject to the Limitation of Liability (ABN) provision. [...]
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Posting Date: 11/12/2021
Medically Unlikely Edits
Medically Unlikely Edits In January 2007, CMS developed MUEs to reduce the paid claims error rate for Part B claims. An MUE for a HCPCS /CPT code is the maximum units of service that a provider would report under most circumstances for a [...]
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Posting Date: 11/12/2021
Medicare Coverage Database
Medicare Coverage Database The Medicare Coverage Database is an administrative and educational tool to assist providers, physicians and suppliers in submitting correct claims for payment. The Medicare Coverage Database features LCDs developed [...]
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Posting Date: 11/12/2021
Medicare Electronic Data Interchange
Medicare Electronic Data Interchange Information about how providers can communicate electronically with the Medicare Program can be found on the CMS website at Medicare Electronic Billing & EDI Transactions. This web page contains EDI [...]
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Posting Date: 11/12/2021
Medicare Fraud and Abuse
Medicare Fraud and Abuse As the CMS MAC for J6 and JK, National Government Services fully supports the CMS initiative for program safeguards and shares the following information for your use: Fraud is the intentional deception or [...]
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Posting Date: 11/12/2021
Medicare Learning Network®
Medicare Learning Network® You will see the MLN logo on our website. The MLN is a registered trademark of the CMS and the brand name for official information health care professionals can trust. CMS’ Catalog of products is available on the [...]
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Posting Date: 11/12/2021
Medicare Provider-Supplier Enrollment with NGS
Medicare Provider-Supplier Enrollment with NGS A Medicare enrollment application would follow the NPI application. CMS is responsible for NPI application processes and NGS is responsible for processing enrollment applications for [...]
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Posting Date: 11/12/2021
NGS Internet Resources
NGS Internet Resources The NGSMedicare.com website was established by National Government Services in response to the increased usage of the internet as a learning resource for health care professionals. This website is designed to provide [...]
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