New Medical Review Frequently Asked Questions

New Medical Review Frequently Asked Questions We’ve added Medical Review Frequently Asked Questions to our website. Visit our Help and FAQs web page for common questions and answers related to Medical Review and other topics including: EDI, [...]

Medical Review

Registration is Open for the National Government Services Medicare Fall 2021 Virtual Conference!

Registration is Open for the National Government Services Medicare Fall 2021 Virtual Conference! The National Government Services POE Team is holding our latest bi-annual virtual conference on Tuesday, 11/9/2021 and Wednesday, 11/10/2021. This [...]

National Government Services Medicare Fall 2021 Virtual Conference

National Government Services Medicare Fall 2021 Virtual Conference The National Government Services POE Team's biannual virtual conference is scheduled for Tuesday, 11/9/2021 and Wednesday, 11/10/2021. This two full-day virtual conference [...]

Save Time and Money by Submitting your Appeals (Reopenings & Redeterminations) Electronically

Save Time and Money by Submitting your Appeals (Reopenings & Redeterminations) Electronically Two easy ways to submit. National Government Services will now allow Medicare Part A and Part B providers to submit claim appeal requests, [...]

Improving Customer Experience in 2021

Improving Customer Experience in 2021 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 [...]

Provider Action To Be Taken Following the Provider-Based Mid-Build Audit

Provider Action To Be Taken Following the Provider-Based Mid-Build Audit The off-campus PBDs that were “mid-build” prior to 11/2/2015 received mid-build determination letters in January 2021 from the CMS mid-build audit contractor, Cahaba [...]

National Influenza Vaccination Week

National Influenza Vaccination Week National Influenza Vaccination Week is Observed 12/5/2021–12/11/2021 Influenza (flu) is a contagious respiratory illness caused by the influenza virus and causes mild to severe illness. Millions of people [...]

Proper Claim Submission for Repetitive, Scheduled, Non-Emergent Ambulance Transports

Proper Claim Submission for Repetitive, Scheduled, Non-Emergent Ambulance Transports The CMS implemented the prior authorization of RSNAT. NGS J6 states Illinois, Minnesota, and Wisconsin were added to the RSNAT Model effective with dates [...]

July and August 2022 Billing and Coding Article Updates

July/August 2022 Billing and Coding Article Updates Billing and Coding Articles Billing and Coding: Botulinum Toxins (A52848) Based on comments received, ICD-10-CM codes N39.41 and N39.46 have been added to the Group 4 ICD-10 code list [...]

Change Request 10484, Pub.100-20, Rev2357: Additional Instructions to Hospitals on the Election of a Medicare SSI Component of the DSH Payment Adjustment for Cost Reports FY 2004 and Earlier

Change Request 10484, Pub.100-20, Rev2357: Additional Instructions to Hospitals on the Election of a Medicare SSI Component of the DSH Payment Adjustment for Cost Reports FY 2004 and Earlier Please click on the following link to read the [...]

Appeal Submission Process for Claims with Multiple Line Items

Appeal Submission Process for Claims with Multiple Line Items We have identified instances where providers are submitting several appeals for one claim internal control number. If you need to appeal (redetermination) a claim with multiple [...]

MLN Connects® for Thursday, January 16, 2020

MLN Connects® for Thursday, January 16, 2020 Quality Payment Program: Learn About the MIPS 2020 Performance Period MLN Connects® for Thursday, January 16, 2020 View this edition as a PDF News CMS Reduces Psychiatric Hospital Burden [...]

MLN Connects® for Thursday, January 9, 2020

MLN Connects® for Thursday, January 9, 2020 Read the Latest Quality Payment Program Updates MLN Connects® for Thursday, January 9, 2020 View this edition as a PDF News Quality Payment Program: 2018 Performance Data Quality [...]

Notification to Providers: Preventive and Screening Services

Notification to Providers: Preventive and Screening Services Centralized billing is a process in which a provider, who provides mass immunization services for influenza virus and pneumococcal pneumonia virus (PPV) immunizations, can send all [...]

MLN Connects® for Thursday, February 27, 2020

MLN Connects® for Thursday, February 27, 2020 COVID-19 Coding Guidance MLN Connects® for Thursday, February 27, 2020 View this edition as a PDF News Quality Payment Program: MIPS 2019 Data Submission Period Open through March 31 [...]

Make Today the Day - Sign Up for Medicare Diabetic and Prevention Program Email Updates

Make Today the Day ‒ Sign Up for Medicare Diabetic and Prevention Program Email Updates The MDPP supplier Email Updates are the mechanism by which MDPP suppliers will receive important information and reminders, such as upcoming due [...]

Amending Medical Records

Amending Medical Records Amendments, Corrections and Delayed Entries in Medical Documentation    All services provided to beneficiaries are expected to be documented in the medical record at the time they are rendered. [...]

Did You Know that the Medicare Part B Overpayment Form Has Been Retired?

Did You Know that the Medicare Part B Overpayment Form Has Been Retired? Our records indicate some providers are still using the retired Medicare Part B Overpayment Form. The new process for provider-initiated non MSP overpayments is as [...]

Article Revisions: February 2020

Article Revisions: February 2020 The medical policies and related articles can be found in our Medical Policy Center. Billing and Coding: Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy (A57826) The [...]

MLN Connects® for Thursday, February 20, 2020

MLN Connects® for Thursday, February 20, 2020 Bill Correctly for Medicare Telehealth Services MLN Connects® for Thursday, February 20, 2020 View this edition as a PDF   News CMS Develops New Code for Coronavirus Lab Test [...]

MLN Connects® for Thursday, February 13, 2020

MLN Connects® for Thursday, February 13, 2020 Protect Your Patients from Influenza MLN Connects® for Thursday, February 13, 2020 View this edition as a PDF News DMEPOS Items Subject to Prior Authorization Influenza Activity [...]

Reassignment of Medicare Benefits: Revised CMS-855R Required May 1

Reassignment of Medicare Benefits: Revised CMS-855R Required May 1 Physicians and non-physician practitioners: Use the revised CMS-855R (Reassignment of Benefits) application once it is posted on the CMS Forms List (go.usa.gov/cuu5Y) in early [...]

MLN Connects® for Thursday, February 6, 2020

MLN Connects® for Thursday, February 6, 2020 New Medicare Provider Enrollment Educational Tool MLN Connects® for Thursday, February 6, 2020 View this edition as a PDF News Open Payments Registration Promoting Interoperability [...]

MLN Connects® for Thursday, January 30, 2020

MLN Connects® for Thursday, January 30, 2020 Genetic Testing and Innovative Antibiotics MLN Connects® for Thursday, January 30, 2020 View this edition as a PDF News CMS Expands Coverage of NGS as Diagnostic Tool for Patients with [...]

Calendar Year 2019 1099 Form Information

Calendar Year 2019 1099 Form Information National Government Services will mail all 1099 Forms for CY 2019 by 1/31/2020. Medicare providers and beneficiaries who are serviced by NGS, regardless of their location, will receive a single Part A [...]

LCD and Article Revisions: January–February 2020

LCD and Article Revisions: January–February 2020 The medical policies and related articles can be found in our Medical Policy Center LCD Revisions Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture [...]

MLN Connects® for Thursday, January 23, 2020

MLN Connects® for Thursday, January 23, 2020 Medicare Learning Network Celebrates 20 Years MLN Connects® for Thursday, January 23, 2020 View this edition as a PDF News Medicare Learning Network Celebrates 20 Years CMS Updates [...]

MLN Connects® Special Edition for Monday, March 23, 2020

MLN Connects® Special Edition for Monday, March 23, 2020 COVID-19: Relief for Quality Reporting Programs and Provider Enrollment Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in [...]

Provider Enrollment Hot Line for Matters Related to COVID-19

Provider Enrollment Hot Line for Matters Related to COVID-19 As a result of the effects of 2019 Novel Coronavirus (COVID-19), a national emergency exists nationwide. On 3/13/2020, the Administrator of CMS authorized nationwide waivers under [...]

National Government Services LCD Open Meeting

National Government Services LCD Open Meeting The transcript and recording of the 2/26/2020 LCD Open Meeting are now available on our website at Open Meeting Records. Posted 3/20/2020

Matching Assessments to Home Health Claims

Matching Assessments to Home Health Claims   CMS has recently published instructions on validating the OASIS and claim match for home health claims. SE20010 titled “Ensure Required Patient Assessment Information for Home Health Claims” [...]

April 2020 Fiscal Intermediary Standard System Direct Data Entry Screen Changes

April 2020 Fiscal Intermediary Standard System Direct Data Entry Screen Changes The purpose of the new HCPCS screen (1E) is to provide information related to HCPCS pricing and allowable revenue codes related to HCPCS. To access the new HCPCS [...]

Incorrect Provider Types Billing Care Plan Oversight Services for Patients Receiving Care

Incorrect Provider Types Billing Care Plan Oversight Services for Patients Receiving Care CPO is physician supervision of patients under the home health or hospice benefit where the patient requires complex or multi-disciplinary care requiring [...]

MLN Connects® for Thursday, March 19, 2020

MLN Connects® for Thursday, March 19, 2020 Interoperability and Patient Access MLN Connects® for Thursday, March 19, 2020 View this edition as a PDF News Quality Payment Program: 2020 Facility-Based Status Lower Extremity Joint [...]

MLN Connects® Special Edition for Tuesday, March 17, 2020

MLN Connects® Special Edition for Tuesday, March 17, 2020 President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak CMS Outlines New Flexibilities Available to People with Medicare The Trump [...]

MLN Connects® Special Edition for Friday, March 13, 2020

MLN Connects® Special Edition for Friday, March 13, 2020 COVID-19: Test Pricing, Diagnostic Lab Tests, Pricing & Codes, and EHB Coverage COVID-19: Test Pricing; Diagnostic Lab Tests, Pricing & Codes; and EHB Coverage Quarterly [...]

MLN Connects® Special Edition for Monday, March 16, 2020

MLN Connects® Special Edition for Monday, March 16, 2020 COVID-19: FFS Response and Nursing Home Visitor Guidance Medicare FFS Response to COVID-19 The HHS Secretary declared a public health emergency, which allows for CMS programmatic [...]

MLN Connects® for Thursday, March 12, 2020

MLN Connects® for Thursday, March 12, 2020 2019 Novel Coronavirus Guidance MLN Connects® for Thursday, March 12, 2020 View this edition as a PDF News CMS Sends More Detailed Guidance to Providers about COVID-19 HHS Finalizes [...]

MLN Connects® Special Edition for Friday, March 6, 2020

MLN Connects® Special Edition for Friday, March 6, 2020 CMS Develops Additional Code for Coronavirus Lab Tests Agency Issues Fact Sheets Detailing Coverage under Programs On March 6, CMS took additional actions to ensure America’s patients, [...]

MLN Connects® Special Edition for Monday, March 9, 2020

MLN Connects® Special Edition for Monday, March 9, 2020 COVID-19 Response: CMS Issues FAQs to Assist Medicare Providers On March 6, CMS issued frequently asked questions and answers (FAQs) for health care providers regarding Medicare payment [...]

MLN Connects® for Thursday, March 5, 2020

MLN Connects® for Thursday, March 5, 2020 Ambulance Fee Schedule, Transports & Data Collection MLN Connects® for Thursday, March 5, 2020 View this edition as a PDF News DMEPOS Suppliers: HCPCS Codes Affected by Further [...]

MLN Connects® Special Edition for Wednesday, March 4, 2020

MLN Connects® Special Edition for Wednesday, March 4, 2020 CMS Announces Actions to Address Spread of Coronavirus CMS calls on all health care providers to activate infection control practices and issues guidance to inspectors as they inspect [...]

MLN Connects® Special Edition for Tuesday, April 7, 2020

MLN Connects® Special Edition for Tuesday, April 7, 2020 COVID-19: Telehealth Video, Coinsurance and Deductible Waived, ASC Attestations, Ambulance Modifiers, Lessons From Front Lines, MLN Call Today New Video Available on Medicare Coverage [...]

Pricing of HCPCS G2066 - Update

Pricing of HCPCS G2066 — Update On 3/12/2020 NGS posted an article on our website regarding a fee adjustment for HCPCS G2066 (Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, [...]

MLN Connects® Special Edition for Friday, April 3, 2020

MLN Connects® Special Edition for Friday, April 3, 2020 COVID-19: Telehealth Billing Correction, Nursing Home Recommendations, Billing for Multi-Function Ventilators, New ICD-10-CM Diagnosis Code Billing for Professional Telehealth [...]

MLN Connects® for Thursday, April 2, 2020

MLN Connects® for Thursday, April 2, 2020 Interoperability and Patient Access Final Rule Call — April 7 MLN Connects® for Thursday, April 2, 2020 View this edition as a PDF News IRF Provider Preview Reports: Review Your Data by [...]

COVID-19 Cost Report Due Date Extensions

COVID-19 Cost Report Due Date Extensions Due to instructions received from CMS relative to the COVID-19 pandemic, and in accordance with 42CFR§413.24(f)(2)(ii), the due date for submission of any Medicare cost report with an original due date [...]

MLN Connects® Special Edition for Tuesday, March 31, 2020

MLN Connects® Special Edition for Tuesday, March 31, 2020 COVID-19: Regulatory Changes, Telehealth Billing, and Specimen Collection Codes Trump Administration Makes Sweeping Regulatory Changes to Help U.S. Health Care System Address [...]

MLN Connects® Special Edition for Monday, March 30, 2020

MLN Connects® Special Edition for Monday, March 30, 2020 COVID-19: Financial Relief, Nursing Home Telehealth, Quality Reporting, Clinical Laboratories, Hospital Data Sharing  Trump Administration Provides Financial Relief for [...]

MLN Connects® Special Edition for Thursday, March 26, 2020

MLN Connects® Special Edition for Thursday, March 26, 2020 COVID-19: Enrollment Relief, Open Payments, Beneficiary Notices 2019-Novel Coronavirus (COVID-19) Medicare Provider Enrollment Relief Frequently Asked Questions (FAQs) Frequently [...]

[Update] President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak; CMS Outlines New Flexibilities Available to People with Medicare

[Update] President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak; CMS Outlines New Flexibilities Available to People with Medicare On 3/17/2020, CMS announced that FFS Medicare is expanding coverage for [...]

MLN Connects® Special Edition for Friday, March 20, 2020

MLN Connects® Special Edition for Friday, March 20, 2020 COVID-19: Telehealth and Non-Essential Procedures Medicare FFS Response to the Public Health Emergency on the Coronavirus (COVID-19) — Revised COVID-19 Elective Surgeries and [...]

MLN Connects® for Thursday, May 7, 2020

MLN Connects® for Thursday, May 7, 2020 More COVID-19 Updates MLN Connects® for Thursday, May 7, 2020 View this edition as a PDF News CMS Announces Independent Commission to Address Safety and Quality in Nursing Homes Home [...]

MLN Connects® Special Edition for Thursday, April 30, 2020

MLN Connects® Special Edition for Thursday, April 30, 2020 COVID-19: Second Round of Sweeping Changes, RHC & FQHC Flexibilities, EMTALA New and Expanded Flexibilities for Rural Health Clinics (RHCs) and Federally Qualified Health [...]

HCPCS Codes U0003 and U0004 for COVID Testing

HCPCS Codes U0003 and U0004 for COVID Testing In the 4/15/2020 press release, CMS Increases Medicare Payment for High-Production Coronavirus Lab Tests, CMS announced a higher payment for certain laboratory tests where the technology used for [...]

MLN Connects® Special Edition for Monday, April 20, 2020

MLN Connects® Special Edition for Monday, April 20, 2020 COVID-19: Nursing Home Transparency, Recommendations for Areas with Low Incidence of Disease   Trump Administration Announces New Nursing Homes COVID-19 Transparency Effort CMS [...]

MLN Connects® Special Edition for Friday, April 17, 2020

MLN Connects® Special Edition for Friday, April 17, 2020 COVID-19: RHC & FQHC Flexibilities, Increased Payment for Lab Tests, Hospital Waivers, Call Audio and Transcript RHC & FQHC Flexibilities During COVID-19 Public Health [...]

MLN Connects® for Thursday, April 16, 2020

MLN Connects® for Thursday, April 16, 2020 3 Proposed Payment Rules MLN Connects® for Thursday, April 16, 2020 View this edition as a PDF News Hospice Payment Rate Update Proposed Rule for FY 2021 IPF Prospective [...]

MLN Connects® Special Edition for Wednesday, April 15, 2020

MLN Connects® for Wednesday, April 15, 2020 COVID-19: Reprocessing Hospital Claims, Essential Diagnostic Services, Non-Invasive Ventilators IPPS Hospitals, LTCHs: Reprocessing Claims for CARES Act Trump Administration Announces Expanded [...]