Hospital Inpatient or Observation Evaluation and Management Add-On Code G0545 for Infectious Diseases

Hospital Inpatient or Observation Evaluation and Management Add-On Code G0545 for Infectious Diseases Effective 1/1/2025 Definition of G0545 Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or [...]

Log In

Log In Table of Contents Log In Log into NGSConnex Log In Issues [Return to Top] Log In In order to login to NGSConnex, go to our website landing page. Read the standard disclaimer and click Accept to continue. [Return to [...]

Account Suspensions

Account Suspensions Table of Contents Account Suspensions Unsuspend Your Account Invalid Login Attempts [Return to Top] Account Suspensions If an NGSConnex account has not been used within the last 30 days, the account will be [...]

Caregiver Training Services

Caregiver Training Services Effective 1/1/2024, payment will be made when practitioners train caregivers to support patients with certain diseases or illnesses (e.g., dementia) in carrying out a treatment plan. A caregiver is defined as a [...]

Safeguard Your Finances: Know Your Provider Enrollment Revalidation

Safeguard Your Finances: Know Your Provider Enrollment Revalidation Attention: Provider Enrollment and Credentialing Teams Ensure you revalidate before your deadline to prevent a "Stay of Enrollment" or claim rejections, which could result in [...]

Navigating Medicare Home Health & Hospice Insights for Providers Podcast

Navigating Medicare Home Health & Hospice Insights for Providers Podcast Listen to our podcast on Spotify and Apple Podcasts!   We invite you to join our thoughtful conversations and helpful insights into the Home Health & [...]

Navigating Medicare Part A Insights for Providers Podcast

Navigating Medicare Part A Insights for Providers Podcast Listen to our podcast on Spotify and Apple Podcasts! Listen to our podcast, Navigating Medicare Part A Insights for Providers, now available on Spotify and Apple Podcasts! We will be [...]

Common Tobacco Withdrawal Symptoms

Common Tobacco Withdrawal Symptoms Trying to quit tobacco use feels different for each person, but almost everyone will have some symptoms of nicotine withdrawal. When stopped, the body and brain must get used to not having nicotine. This can [...]

Reopening versus Redetermination

Reopening versus Redetermination Table of contents Reopening versus Redetermination Reopening Telephone Reopening Unit Redeterminations [Return to Top] Reopening versus Redetermination Understanding your next steps are very [...]

Medicare Diabetes Prevention Program 2025 Changes

Medicare Diabetes Prevention Program 2025 Changes The MDPP Expanded Model is intended to prevent Medicare beneficiaries with an indication of prediabetes from developing diabetes. Prevention of diabetes among this high-risk group of Medicare [...]

Home Health Claims Returning to Provider RC 19963

HH claims are returning to provider in error with RC 19963. This impacts HH claims with NOA/processed dates in January 2022. NOAs are being purged after 24 months. Please keep in mind there are claims that edit correctly for this reason code. [...]

NGS Office of Congressional Affairs Welcome Letter

Dear Members of Congress and Staff: As your work continues in the 119th Congress, National Government Services, Inc. maintains its dedicated role in serving your district/state as a Medicare contractor for Original Medicare. We are your [...]

Screening Mammography

Preventive Services Guide Screening Mammography A mammogram is an X-ray of the breast. Screening mammograms are routinely administered to detect breast cancer in women who have no apparent symptoms. Coverage Guidelines and Frequency Limits [...]

PC-ACE Software Instructions, Resources and Guides

PC-ACE Software Instructions, Resources and Guides Creating a 276 Claim Status Request in PC-ACE and Importing and Reading the 277 Claim Status Report PC-ACE Software – For Professional Users: Importing and Reading the 999 & 277CA Files [...]

APPEALS: How would one submit a paper appeal?

APPEALS: Where can I find the regulations on Medicare appeals?

APPEALS: I received a remittance advice with the message “this care may be covered by another payer per coordination of benefits.” Is this an appealable claim?

APPEALS: How can I get status of my redetermination or reopening request?

APPEALS: Is there a time limit for filing an appeal?

APPEALS: We are a large group with many physician and nonphysician practitioners. When we submit claims for nonphysician practitioners working in different sub-specialties, we receive denials that state: D984: Coverage/program guidelines not met, N20: Service not payable with other service rendered on the same day.

APPEALS: What are the top appeals submitted to NGS?

APPEALS: Can one appeal a claim that rejected with MA130?

APPEALS: Is there a reference sheet to determine what constitutes an appeal?

APPEALS: What is a Medicare appeal?

APPEALS: What is the solution to avoiding claim denials?

APPEALS: What is the appeal process?

APPEALS: What is the best way to get duplicate denials paid on appeal?

MLN Connects® Newsletter: March 25, 2025

MLN Connects® Newsletter: March 25, 2025 News ESRD: Payment for Phosphate Binders Effective January 1, 2025 Hospitals: Apply for Additional Residency Positions by March 31 Skilled Nursing Facilities: Revalidation Deadline is May 1 [...]

APPEALS: Is documentation required for an appeal?

APPEALS: Another denial we see is “This service has been provided at a frequency that is more than the medically appropriate indication by policy or regulation.” How can we avoid these denials?

APPEALS: We are a large group with many physicians and nonphysician practitioners. When we submit claims for nonphysician practitioners working in different sub-specialties, we get claim denials that state: “D463: New patient qualifications were not met or M13: Only one initial visit is covered per specialty per medical group.” How can we avoid these?

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction K Part A Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Debridement, subcutaneous tissue (includes epidermis and dermis, if performed) 11042, 11045 [...]

Radiopharmaceutical Reimbursement

Radiopharmaceutical Reimbursement National Government Services has reviewed the radiopharmaceutical pricing methodology set forth in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Section 303(h) which states that [...]

Hospital-Based Ambulance Basic Billing Guidelines

Hospital-Based Ambulance Basic Billing Guidelines For hospital-based ambulance billing under Medicare, services should be billed on the UB-04 form using the ambulance service-specific NPI, not the acute hospital NPI, and claims for inpatient [...]

About Appeals

About Appeals Table of Contents About Appeals Reopening vs. Redetermination Reopening Redetermination [Return to Top] About Appeals Providers and beneficiaries have the right to appeal claim determinations made by National [...]

Understanding the Approval Recommendation Process for Certified Providers

Understanding the Approval Recommendation Process for Certified Providers The certified provider completes and submits a CMS-855 enrollment application and all supporting documentation to its MAC, including any state require documentation [...]

About Us

National Government Services, Inc., a subsidiary of Elevance Health, Inc., has a long history of supporting federal health agencies, including CMS. Throughout the country, NGS has served as a Medicare contractor since the inception of the [...]

REMITTANCE: What do the two-letter codes on my remittance advice mean?

REMITTANCE: Can I post the electronic remittance advice information into my accounts receivable system?

REMITTANCE: Do I need special computer software to use the electronic remittance advice?

REMITTANCE: How long will I receive paper remittances once I sign up for the electronic remittance advice?

REMITTANCE: If I have a computer problem while trying to download my electronic remittance advice, can I have it reposted to download again?

PC-ACE: Where can I find out more about the PC-ACE free billing software?

PC-ACE: Why did my PC-ACE software expire?

PC-ACE: Why am I receiving security rights error/issue when installing PC-ACE?

PC-ACE: How often is the PC-ACE software upgraded?

PC-ACE: How do I determine the version of PC-ACE I am using?

LCD NCD: What are the differences between LCDs and NCDs?

PC-ACE: Where can I find out more about the PC-ACE free billing software?

PC-ACE: How do I correct a web browser error when downloading or making changes to the software?

PC-ACE: Is there a resource I can use to assist me with Medicare Secondary Payer (MSP) claims when using PC-ACE?

CAR-T: Will the Part A claim for CAR-T deny if it is submitted with the KX modifier?

CAR-T: Is the KX modifier required for Part A and Part B claims?

CAR-T: Is Risk Evaluation and Mitigation Strategy (REMS) verified by the facility’s site name or address?

CAR-T: What is the effective date for the requirement of the KX modifier for administration of CAR-T?

EDI: I heard that 5010 requires a physical address in box 33 and P.O. boxes are no longer accepted. Is this true?

EDI: How long are Electronic Remittance Advices (ERAs) available in my mailbox?

EDI: Is the 277CA returned for each test submission?

EDI: I am receiving the following CSC and EIC code on my 277CA. How do I make the correction?

EDI: How do I restore a remit file?