Steps for Success in a Targeted Probe and Educate Review

Steps for Success in a Targeted Probe and Educate Review We’ve provided tips and tricks to assist you with succeeding in a TPE review and the post-probe educational process. Content presented includes: Getting started with TPE Updating the [...]

End of Public Health Emergency Brings Change

End of Public Health Emergency Brings Change The end of the PHE is near and you may have questions. CMS and National Government Services want to ensure a seamless transition from the flexibilities enacted as a result of the COVID-19 [...]

Hospice Cap Self-Reporting Reminder for the 2022 Cap Year

Hospice Cap Self-Reporting Reminder for the 2022 Cap Year The hospice cap self-reporting for the 2022 cap year (10/1/2021-9/30/2022) is due no later than 2/28/2023. Hospice providers should submit the pro-forma calculation along with [...]

CMS Updates to Clinical Lab Fee Schedule for 2023 Reminder

CMS Updates to Clinical Lab Fee Schedule for 2023 Reminder National Government Services has received many calls in relation to the CMS updates to the Clinical Laboratory Fee Schedule for 2023. Providers have identified instances of not [...]

MLN Connects® Newsletter: Prescription Drug Inflation Rebate Program Guidance – Feb 9, 2023

MLN Connects® Newsletter: Prescription Drug Inflation Rebate Program Guidance – Feb 9, 2023     News Medicare Part B Drug Inflation Rebates HHS Releases Initial Guidance for Medicare Prescription Drug Inflation Rebate [...]

2023 Evaluation and Management Services – Prolonged Services

2023 Evaluation and Management Services – Prolonged Services Based on recent CMS clarifications for 2023 Evaluation and Management Services, particularly for prolonged services, National Government Services is now revising some previously [...]

Home Health Claims Incorrectly Receiving Reason Code U538E

HH final and adjusted claims with 2022 dates of service are receiving U538E incorrectly, when there is an older period on file. This prevents providers from being able to adjust these claims and update patient status from “06” to any other [...]

MLN Connects® Newsletter: February 16, 2023

MLN Connects® Newsletter: February 16, 2023     News Billing Medicare Part B for Insulin with New Limits on Patient Monthly Coinsurance Unprecedented Efforts to Increase Transparency of Nursing Home Ownership CMS Proposes [...]

New Service Added to the Hospital Outpatient Department Prior Authorization Program

New Service Added to the Hospital Outpatient Department Prior Authorization Program Effective for dates of service rendered on or after 7/1/2023, facet joint interventions are added to the HOPD services requiring prior authorization as a [...]

Chimeric Antigen Receptor (CAR) T-cell Therapy Billing Instructions

Chimeric Antigen Receptor (CAR) T-cell Therapy Billing Instructions Effective for dates of service on or after 8/7/2019, Medicare will pay claims from approved providers for administration of autologous T-cells expressing at least one CAR for [...]

LCD, Billing and Coding Article Updates for March 2023

LCD, Billing and Coding Article Updates for March 2023 Billing and Coding: Billing and Coding: Implantable Automatic Defibrillators (A56326) Based on Transmittal 11832 (CR13070) ICD-10-CM and Other Coding Revisions to NCDs - July 2023 Update, [...]

April 2023 Release "Dark Days" for the Common Working File Hosts

April 2023 Release "Dark Days" for the Common Working File Hosts For the upcoming April 2023 Release: For Production, CWF will be observing the Gray Day on Thursday, 3/30/2023 and Dark Days starting Friday, 3/31/2023 through Sunday, 4/2/2023 [...]

Credit Balance Report Reminder for Jurisdiction 6 Part A Providers

Credit Balance Report Reminder for Jurisdiction 6 Part A Providers For the quarter ending 12/31/2022, CBR must be submitted and received by the ORU by 3/1/2023 to be considered timely. Failure to submit the CBR will result in the provider [...]

MLN Connects® Newsletter: COVID-19 Public Health Emergency (PHE) New Overview Fact Sheet — Feb 27, 2023

MLN Connects® Newsletter: COVID-19 Public Health Emergency (PHE) New Overview Fact Sheet — Feb 27, 2023     News COVID-19 Public Health Emergency (PHE) New Overview Fact Sheet​​​​​​​ Posted 2/28/2023

MLN Connects® Newsletter: March 2, 2023

MLN Connects® Newsletter: March 2, 2023 News The Future of Medicare Enrollment: Save Time with PECOS's Consolidated Application Voluntary Prior Authorization Process for Certain Power Mobility Device Accessory Items Expanded Home [...]

LCD Archived Open Meeting Records

Open Meeting Records Jurisdiction 6 Open Meeting Records Meeting Date Audio Transcript 10/15/2020 ‒  J6/JK Open Meeting Recording Transcript 6/24/2020 ‒  J6/JK Open Meeting [...]

Audiology Services

Audiology Services CMS finalized an exception to the physician order requirement for certain diagnostic testing services to broaden patient access to services furnished by audiologists in the CY 2023 Physician Fee Schedule Final Rule. Visit [...]

Audiology

Resolving PECOS Common Errors and Warnings

Medicare Provider/Supplier Specialty Codes

Medicare Provider/Supplier Provider Type Codes

MLN Connects® Newsletter: March 9, 2023

MLN Connects® Newsletter: March 9, 2023 News Nutrition-Related Health Conditions: Recommend Medicare Preventive Services Compliance Advance Care Planning: Bill Correctly for Services Claims, Pricers and Codes Medicare [...]

2023 Evaluation and Management Services – New Frequently Asked Questions

2023 Evaluation and Management Services – New Frequently Asked Questions Based on recent CMS clarifications for 2023 evaluation and management services, we’ve added new frequently asked questions for the following evaluation and management [...]

Tip Sheet #3

Tip Sheet #3 Below are the most common issues handled by the SSA. These Medicare-related issues should be handled by your local SSA office: Change of address requests Medicare beneficiary eligibility status for Medicare Effective dates of [...]

Sacroiliac Joint Injections and Procedures Frequently Asked Questions

Sacroiliac Joint Injections and Procedures Frequently Asked Questions  We’ve added frequently asked questions related to New Local Coverage Determination for Sacroiliac Joint Injections and Procedures. We encourage our providers to view [...]

DDE Logon ID and Password Reminders

DDE Logon ID and Password Reminders CMS’ information security policy strictly prohibits the sharing or loaning of Medicare assigned IDs and passwords. Users should take appropriate measures to prevent unauthorized disclosure or modification of [...]

Knee Orthosis: A/B and DME Collaborative Presentation

Knee Orthosis: A/B and DME Collaborative Presentation View the A/B and DME Knee Orthosis YouTube video for information on knee orthosis. Posted 3/23/2023

The Medicare Home Infusion Therapy Benefit and Home Health Agencies

Resolved: Home Health Claims Editing for Reason Codes U5210/U5220

Resolved: Home Health Claims Editing for Reason Codes U5210/U5220 Some home health NOAs and claims were incorrectly hitting reason codes U5210 and U5220. These reason codes state there is no Medicare entitlement for the dates of service when [...]

Change in Pricing for Electroencephalogram Long-Term Monitoring Effective 4/1/2023

Change in Pricing for Electroencephalogram Long-Term Monitoring Effective 4/1/2023 After reviewing Medicare claims data for EEG continuous recording (CPT codes 95700 through 95718) as well as seeking input from providers, industry, [...]

(SE20024) FAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as Inpatients

MLN Matters®: SE20024 FAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as Inpatients

MLN Connects® Newsletter: March 30, 2023

MLN Connects® Newsletter: March 30, 2023 News COVID-19: Booster Dose for Children 6 months – 4 years Identity & Access Management System: Easier for Surrogates Medicare Advantage Value-Based Insurance Design Model Extended [...]

CR12669 - Instructions Relating to the Evaluation of Section 1115 Waiver Days in the Calculation of Disproportionate Share Hospital Reimbursement

CR12669 - Instructions Relating to the Evaluation of Section 1115 Waiver Days in the Calculation of Disproportionate Share Hospital Reimbursement​​​​​​​

Bill Correctly: Power Mobility Device Repairs

Bill Correctly: Power Mobility Device Repairs An Office of Inspector General report stated that Medicare improperly paid claims for PMD repairs when suppliers didn’t provide sufficient documentation to support billing charges. The Power [...]

Clinical Trials

Improving Customer Experience

Improving Customer Experience 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 we [...]

MLN Connects® Newsletter: April 6, 2023

MLN Connects® Newsletter:  April 6, 2023 News Resources & Flexibilities to Assist with Public Health Emergency in Mississippi Due to Recent Storms Program for Evaluating Payment Patterns Electronic Reports Advance Beneficiary [...]

MSP Payment and Savings Calculator Top

Medicare Secondary Payer Payment Calculator The MSP payment calculator is intended to provide an approximation of what an MSP payment may be for assigned claims. This calculator does not reflect applicable coinsurance, deductible, or other [...]

Reminder: Maintaining Ownership Consistency of Multiple Medicare Enrollments with same Tax Identification Number

Reminder: Maintaining Ownership Consistency of Multiple Medicare Enrollments with same Tax Identification Number View CMS’ “Medicare Enrollment: Maintain the Same Owners in All Enrollment Records” article within MLN Connects® Newsletter: [...]

Modifiers Used During the COVID-19 Public Health Emergency

Modifiers Used During the COVID-19 Public Health Emergency Modifier Part A Billed on UB04? Part B Billed on 1500? Details References Exceptions/Special Usage CS Exception Yes Waives [...]

Clarification on the Proper Use of the CS Modifier

Clarification on the Proper Use of the CS Modifier Per MLN Matters® article SE20011, the CS modifier (cost-sharing waiver for COVID-19 testing) is applicable to certain services furnished beginning on 3/18/2020 through the end of the PHE, [...]

CR13105 - Technical Revisions Only to the National Coverage Determination (NCD) Manual

CR13105 - Technical Revisions Only to the National Coverage Determination (NCD) Manual

Medicare Part A CMS Data Center Migration – Rescheduled May 2023 Dark Days for Data Center Migration

May 2023 Dark Days for CMS Data Center Migration – Rescheduled May 2023 Dark Days for Data Center Migration As we previously communicated, the Medicare Part A CMS Data Center Migration was postponed. The new date for the migration is [...]

MLN Connects® Newsletter: May 11, 2023

MLN Connects® Newsletter:  May 11, 2023 News CMS Roundup (May 5, 2023) Medicare Ground Ambulance Data Collection System: Report Information Compliance Bill Correctly: Power Mobility Devices Repairs MLN Matters® [...]

MLN Connects® Newsletter: May 18, 2023

MLN Connects® Newsletter:  May 18, 2023 News COVID-19: Public Health Emergency Ended May 11 End of COVID-19 Public Health Emergency FAQs Advancing Health Equity Through The CMS Innovation Center: First Year Progress And What’s To [...]

Medical Review: Targeted Probe and Educate Review Topics Updated

Medical Review: Targeted Probe and Educate Review Topics Updated The Medical Review: TPE Review Topics page on our website has been updated. This page lists the topics and CPT codes under review by the National Government Services MR [...]

Jurisdiction K MAC Fact Sheet

Jurisdiction K Medicare Administrative Contractor Fact Sheet National Government Services, Inc. has a long history of supporting federal health agencies such as CMS. Throughout the country, NGS has efficient operation, financial and human [...]

Jurisdiction 6 MAC Fact Sheet

Jurisdiction 6 Medicare Administrative Contractor Fact Sheet National Government Services, Inc. has a long history of supporting federal health agencies such as CMS. Throughout the country, NGS has efficient operation, financial and human [...]

MLN Connects® Newsletter: CMS Proposes Policies to Improve Patient Safety and Promote Health Equity — April 10, 2023

MLN Connects® Newsletter: CMS Proposes Policies to Improve Patient Safety and Promote Health Equity — April 10, 2023 Proposed Rule CMS Proposes Policies to Improve Patient Safety and Promote Health Equity Posted 4/11/2023

NGS Telehealth Billing FAQs for COVID-19

NGS Telehealth Billing FAQs for COVID-19 Changes What has changed in Medicare coverage for telehealth services? Answer: There are 85 new codes added to the list of services that can be delivered via telehealth. List of Telehealth [...]

Attention Home Health and Hospice Providers Using NGSConnex to Submit Level One Appeals Redetermination Requests

Attention Home Health and Hospice Providers Using NGSConnex to Submit Level One Appeals Redetermination Requests National Government Services strongly recommends that all providers, including home health and hospice agencies, utilize NGSConnex [...]

Billing and Coding Article Updates for May and June 2023

Billing and Coding Article Updates for May and June 2023 Self-Administered Drug Exclusion List: Medical Policy Article A53021 (JK) and A53022 (J6) The article has been updated to add: Adalimumab-aacf (Idacio®), Adalimumab-afzb (Abrilada™), [...]

MLN Connects® Newsletter: May 25, 2023

MLN Connects® Newsletter:  May 25, 2023 News DMEPOS Competitive Bidding Program: Temporary Gap Period Starts January 1 CMS Roundup (May 19, 2023) Medicare Providers: Deadlines for Joining an Accountable Care Organization [...]

Billing and Reimbursement for Penile Pressure Cuff

Billing and Reimbursement for Penile Pressure Cuff Effective 6/1/2023, when billing for penile pressure cuff used for the provision of a voiding pressure study, please submit using CPT code 55899 (unlisted procedure, male genital [...]

Part A Claims for High Cost Items and Certain Drugs Requiring Additional Information

Part A Claims for High Cost Items and Certain Drugs Requiring Additional Information National Government Services has noticed that when a claim RTPs for additional information to be added to the Remarks Field (FL 80, or electronic [...]

Claims for Drugs Without a Product-Specific Code Assigned

Claims for Drugs Without a Product-Specific Code Assigned National Government Services has noticed that when a claim RTPs for additional information to be added to the Remarks field concerning certain drugs, some providers attempt to provide [...]

July 2023 Release "Dark Days" for the Common Working File Hosts

July 2023 Release "Dark Days" for the Common Working File Hosts For the upcoming July 2023 Release: For Production, CWF will be observing the Gray Day on Thursday, 6/29/2023 and Dark Days starting Friday, 6/30/2023 through Sunday, 7/2/2023 to [...]

Enter E-mail Step 1 Description

Step 1:  Please Enter Your E-mail Address

Overpayment Recovery Tool Page Bottom

Locating Your DCN SEQ The DCN SEQ number can be located on the first page of the overpayment demand letter. Below are two examples of the first page from the two types of demand letters you may receive. Most Common Letter The most common [...]

Top Customer Care Telephone Inquiries - CT, NY

Top Customer Care Telephone Inquiries Connecticut and New York The following chart provides a listing of the top provider customer care telephone inquiries and suggestions for locating this information. Please use the following [...]