MLN Connects® Newsletter: April 3, 2025

MLN Connects® Newsletter: April 3, 2025 News Home Infusion Therapy & Intravenous Immune Globulin Services: Get Monitoring Reports Medicare Providers & Suppliers: Report Managing Employees External User Services Help Desk: New [...]

MLN Connects® Newsletter: April 14, 2025

MLN Connects® Newsletter: April 14, 2025 FY 2026 Proposed Payment Rules CMS Seeks Public Input on Inpatient Hospital Whole-Person Care, Proposes Updates to Medicare Payments Inpatient Rehabilitation Facility Prospective Payment System [...]

Preventive Services: Initial Preventive Physical Examination and Annual Wellness Visit

Ensure that your patients obtain the wellness examinations they are eligible for by knowing the differences between the initial preventive physical examination and annual wellness visit. During this webinar, we'll review the coverage, [...]

Get Access to Keep Provider Enrollment Records Up To Date with Medicare

Get Access to Keep Provider Enrollment Records Up To Date with Medicare If you need to manage Medicare enrollment information for an individual provider or entity electronically through PECOS, you must have authorized access. This access will [...]

National A/B MAC Ambulance Provider/Supplier Coalition Meeting Invite

National A/B MAC Ambulance Provider/Supplier Coalition Meeting Invite Attention Ambulance Suppliers and Providers Join the first virtual National A/B MAC Ambulance Provider/Supplier Coalition meeting during EMS Week: Thursday, 5/22/2025 from [...]

Description of NPI and a Link to NPPES Registry

Description of NPI and a Link to NPPES Registry   As mandated by HIPAA, you should maintain (verify and update) your NPI data via NPPES on a regular basis. The NPI: is a ten-digit number and must be submitted on the enrollment form, [...]

Part B Spring 2025 Virtual Conference: Register Now

Register Now! Register now for the 2025 Spring Part B Virtual Conference: Understanding Medicare Compliance for Part B Providers happening on June 3–5,2025. This event will offer innovative ideas and broaden your expertise in Medicare [...]

Part A Summit- Skilled Nursing Facility: Coverage and Documentation

During this collaborative education session between Case Management and Medical Review, attendees will learn documentation requirements for skilled nursing facility (SNF) coverage, how to properly respond to Additional Documentation Requests [...]

Part A Summit Let’s Chat: Prior Authorization for Certain Hospital Outpatient Department Services

This Let’s Chat session focuses on Prior Authorization for certain hospital outpatient department (OPD) services and is an informal opportunity for you to chat with our staff about the selected topic. During the session, you may ask us [...]

Part A Summit -Need Answers? The Options to Consider Before Calling or Writing into Medicare

During this session, we will review top trends on why providers are reaching out to Medicare and the best options to resolve those inquires. Plus, valuable tips and resources to help get the most out of Medicare.

Part A Summit- Medicare Secondary Payer: Preventing Rejections of Your Medicare Primary Claims

Increase your cash flow by preventing rejections of your Medicare primary claims! In this webinar, we review why claims reject for Medicare Secondary Payer and explain how to prevent these rejections by reporting information on your claims that [...]

Part A Summit- Navigating Billing and Documentation for Behavioral Health Services in Federally Qualified Health Centers

Unlock the secrets to effective billing and documentation for behavioral health services within Federally Qualified Health Centers. This collaborative webinar will include insights from Medical Review and is designed to help healthcare [...]

Part A Summit - Exploring the NGS TPE Process

Join us to explore essential strategies for a successful Targeted Probe and Educate review. We'll cover the purpose of TPE and best practices, roles and responsibilities of National Government Service and providers under review. Gain [...]

Part A Summit – How to Submit an Appeal Request

Join us for a comprehensive session focused on understanding the appeal submission process within National Government Service. This presentation is designed to guide participants through each step of submitting an appeal, ensuring clarity and [...]

Part A Summit - NGSConnex: User Pain Points Examples/Solutions

Are you experiencing issues while utilizing NGSConnex? Join this informative session to learn what user pain points are and how to resolve these issues from an NGSConnex Agile Product Owner. This session will encompass issues with [...]

Part A Summit - World of Medicare Contractors

Medicare Administrative Contractors are responsible for processing claims, managing policy and payment, and establishing regional policy guidelines. Centers for Medicare & Medicaid Services also uses several additional contractors to manage [...]

Part A Summit - Maintaining Your Provider Files

This virtual webinar will aid in maintaining accurate provider enrollment files for the internet-based Centers for Medicare & Medicaid Services systems: Identity & Access Management System, National Plan & Provider Enumeration [...]

Part A Summit- Navigating NGS and CMS Websites

Join us for this informative session where we will review how to find helpful Medicare references and resources on the National Government Services website (www.NGSMedicare.com) and the Centers for Medicare & Medicaid Services website [...]

Part A Summit - Provider Outreach and Education Roundtable

Join us for an interactive and insightful roundtable discussion with the Provider Outreach and Education Manager and team. This session is designed to offer a comprehensive look into the future of POE and explore innovative strategies for [...]

Medicare Part B Secondary Payer Post-Pay Overpayments

During this webinar, providers and office staff members will learn about the Medicare Part B overpayments and the appropriate steps for reporting Medicare Secondary Payer (MSP) overpayments. NGS MSP subject-matter experts will be on hand to [...]

How to Avoid Duplicate Claims

Duplicate denials continue to be one of the top billing errors. Unnecessary duplicate filing of Medicare claims cost the provider's office valuable time and resources, as well as Medicare's time and money to process them. Please join us [...]

Medicare Overpayment Process

Ensure that you are compliant and avoid financial penalties by understanding the Medicare overpayment regulations. This session will focus on identifying overpayments, using the proper forms and procedures, the timelines for repayment and the [...]

Understanding the Reopening and Appeal Process Open Forum

National Government Services is committed to reducing provider burden associated with Medicare claim denials, reopenings and appeals. Filing an inquiry on a Medicare claim can be frustrating and costly to your organization. This delay in [...]

55H2B

Avoiding/Correcting This Error Ensure the submitted documentation supports the beneficiary is confined to the home. An individual shall be considered “confined to the home” (homebound) if the following two criteria are met:   [...]

31287

Avoiding/Correcting This Error Hospice claims are required to be billed monthly. Verify the month beginning and ending date and the ‘From’ and ‘To’ dates on your claim. The claim must span the entire month for continuing care claims.

30993

Verify the MBI submitted on the claim matches the MBI in the Common Working File. If a new MBI has been assigned, follow the guidelines regarding the claim submission: For dates of service before the MBI change date use old or new MBI If [...]

37236

Avoiding/Correcting This Error Verify eligibility of the attending/ordering physicians in PECOS. Print that verification and make it part of the medical record. If applicable, submit a reopen request to the Appeals Department indicating error [...]

55HTP

Avoiding/Correcting This Error Verify that the initial certification is complete and includes all necessary elements, such as the patient’s homebound status, the need for skilled services, and a face-to-face encounter with a physician or [...]

55H1L

Avoiding/Correcting This Error Clinical progress notes should show evidence of a steady decline or downward trajectory in the beneficiary’s clinical status over time. Documentation should be objective, measurable and must support a life [...]

How to Avoid and Correct Duplicate Claim Denials

How to Avoid and Correct Duplicate Claim Denials A duplicate claim submission occurs when a physician or other qualified healthcare professional resubmits a claim either on paper or electronically for a single encounter and the service is [...]

Portable X-Ray Cost Analysis Survey

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.

Submitting Revalidation via PECOS

During this webinar, we’ll provide an understanding of how to utilize the Centers for Medicare & Medicaid Services (CMS) Internet-based Provider Enrollment Chain & Ownership System (PECOS) to be comfortable in navigating the system to [...]

Provider Enrollment: Completing the CMS-855B Paper Application

During this webinar, we'll provide an understanding of how to complete the CMS-855B provider enrollment paper application for a clinic, group or supplier.

Provider Enrollment: Completing the CMS-855A Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855A provider enrollment paper application.

Clinical Trials

Clinical Trials Clinical trials are interventional studies that assess treatments or diagnostics compromising experimental and control groups. Medicare coverage in these trials is guided by strict CMS rules and is limited to FDA-approved [...]

34538

Avoiding/Correcting This Error To avoid this error: When submitting your Medicare primary claim, report the reason Medicare is primary using claim coding in Prevent an MSP Rejection on a Medicare Primary Claim. To correct this [...]

Proper Part B Claim Submissions

This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments or denials. We will guide you through the CMS-1500 claim form and the electronic equivalent loops [...]

Proper Part B Claim Submissions

This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments or denials. We will guide you through the CMS-1500 claim form and the electronic equivalent loops [...]

Private Practice Physical/Occupational Therapy Billing

We invite you to join our informative webinar focused on billing guidelines for physical and occupational therapy in private practice. During this webinar, we'll review important topics such as the appropriate use of the KX modifier and the [...]

Steps to Claim Corrections

This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

Steps to Claim Corrections

This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

MSP Right Hand

Helpful Resources Verification of Medicare Secondary Payer Data  

DDE: Can a provider view additional development requests (ADRs) via the FISS/DDE?

CLAIMS: How do I indicate on a Medicare claim that the services are NOT related to a liability, no fault (including medical payment) or Workers’ Compensation accident, injury or illness MSP record in the CWF?

Provider Enrollment: Completing the CMS-855B Paper Application

During this webinar, we'll provide an understanding of how to complete the CMS-855B provider enrollment paper application for a clinic, group or supplier.

Provider Enrollment: Completing the CMS-855A Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855A provider enrollment paper application.

Provider Enrollment: Completing the CMS-855I Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855I provider enrollment paper application for a group member, sole proprietor or sole owner and we’ll also focus on reassigning Medicare benefits.

Critical Access Hospitals, FQHC and RHC Quarterly Top Claim Errors

Do you struggle with your claim denials, rejections and return to provider (RTP) claims? Do you want to be proactive in preventing unnecessary errors? Join us for a review of top claim errors for your provider type based on recent data [...]

Four Reasons Patients Fear Quitting Tobacco

Four Reasons Patients Fear Quitting Tobacco Stress: If you rely on cigarettes to loosen up during your day, you might worry about losing this release valve. It’s essential to remember that using nicotine to relax is only a temporary fix and [...]

IDTF Procedure Codes (65 KB)

Prior Authorization CPT/HCPCS Code Inquiry Tool

The Annual Wellness Visit: Promoting Good Health Through Disease Prevention and Detection

Medicare covers many preventive services to keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep your patients from getting certain diseases. Register today for an [...]

Prior Authorization CPT/HCPCS Code Inquiry Tool

Prior Authorization CPT/HCPCS Code Inquiry Tool This is a self-service tool to allow ambulance service providers, hospital, or physician office staff responsible for submitting prior authorization requests (PARs), to determine if the [...]

Skilled Nursing Facility and Swing Bed Quarterly Top Claim Errors

Do you struggle with your claim denials, rejections and return to provider (RTP) claims? Do you want to be proactive in preventing unnecessary errors? Join us in a review of top claim errors for your provider type based on recent data analysis. [...]

Hospital, CMHC, CORF/ORF and ESRD Facilities Quarterly Top Claim Errors

Do you struggle with your claim denials, rejections and return to provider (RTP) claims? Do you want to be proactive in preventing unnecessary errors? Join us in a review of top claim errors for your provider type based on recent data analysis. [...]

How to Avoid Duplicate Claims

Duplicate denials continue to be one of the top billing errors. Unnecessary duplicate filing of Medicare claims cost the provider's office valuable time and resources, as well as Medicare's time and money to process them. Please join us [...]

Private Practice Physical/Occupational Therapy Billing

We invite you to join our informative webinar focused on billing guidelines for physical and occupational therapy in private practice. During this webinar, we'll review important topics such as the appropriate use of the KX modifier and the [...]

Let's Chat About Provider Enrollment

During this session, you’ll have the opportunity to ask questions about all aspects of provider enrollment. Answers will be provided by a panel of subject-matter experts. As this is a question-and-answer session, there is no presentation available.

Provider Enrollment: Completing the CMS-855I Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855I provider enrollment paper application for a group member, sole proprietor or sole owner and we’ll also focus on reassigning Medicare benefits.