MLN Connects® Newsletter: February 2, 2023

MLN Connects® Newsletter: February 2, 2023 News Aligning Quality Measures across CMS — The Universal Foundation Medicare Ground Ambulance Data Collection System: Portal to Report is Open Skilled Nursing Facilities: Care Compare January [...]

Let's Chat About Counseling to Prevent Tobacco Use

Let's Chat About Counseling to Prevent Tobacco Use Do you have questions on how to bill Medicare for tobacco counseling? Join us on 1/24/2023 for the opportunity to ask questions about coverage and billing for Medicare’s preventative service [...]

MLN Connects® Newsletter: January 5, 2023

MLN Connects® Newsletter: January 5, 2023 News COVID-19: Updated Vaccines for Children Ages Six Months – Five Years Advisory Panel on Hospital Outpatient Payment: Request for Nominations Certificates of Medical Necessity and DME [...]

MLN Connects® Newsletter: December 15, 2022

MLN Connects® Newsletter: December 15, 2022 News Opioid Treatment Programs: New Information for 2023 Part B Immunosuppressive Drug Benefit: Check Medicare Eligibility Home Health Quality Reporting Program: Get Final OASIS-E Instrument [...]

MLN Connects® Newsletter: December 1, 2022

MLN Connects® Newsletter: December 1, 2022 News CMS Urges Timely Patient Access to COVID-19 Vaccines, Therapeutics Quality Payment Program: Preview Your Performance Information by December 20 Clinical Laboratory Fee Schedule: CY 2023 [...]

MLN Connects® Newsletter: November 23, 2022

MLN Connects® Newsletter: November 23, 2022 News Colorectal Cancer Screening Test: Reduced Coinsurance for Related Procedures Begins January 1 Ambulance Fee Schedule: CY 2023 Inflation Factor & Productivity Adjustment Medicare [...]

Provider Enrollment: Reminder for Open Enrollment and Participation Agreement

Provider Enrollment: Reminder for Open Enrollment and Participation Agreement The 2023 Annual Participation Open Enrollment Period is approaching for another year. While this is an important time (from mid-November to December 31) for [...]

Billing New Monkeypox Vaccine and Laboratory Codes

Billing New Monkeypox Vaccine and Laboratory Codes On 7/23/2022, the WHO declared monkeypox a PHE. The HHS issued a statement regarding the Biden-Harris Administration’s actions to make vaccines, testing and treatments available. The AMA CPT [...]

The Medicare Essentials Virtual Conference

The Medicare Essentials Virtual Conference Are you new to working with Medicare or just need a refresher? The Medicare Essentials Virtual Conference, offers two pre-virtual sessions and eight sessions which provide a strong base for [...]

Home Health and Hospice Targeted Probe and Educate Resources

Home Health and Hospice Targeted Probe and Educate Resources It is imperative to keep up-to-date with all National Government Services JK and J6 HH+H TPE audit focus areas. This information can be located on the NGS website by first clicking [...]

National Government Services CAC Meeting Notice on Botulinum Toxins

National Government Services CAC Meeting Notice on Botulinum Toxins Information has been posted on our website in regards to the National Government Services l Contractor Advisory Committee Meeting regarding Botulinum Toxins to be [...]

MLN Connects® Newsletter: September 7, 2023

MLN Connects® Newsletter: September 7, 2023     News New Version of CMS.gov HHS Proposes Minimum Staffing Standards to Enhance Safety and Quality in Nursing Homes CMS Announces Resources and Flexibilities to Assist with [...]

5010 Bottom Page

Additional 5010 Resources Companion Document for 5010 Transactions: The standard companion guide trading partner information which provides instructions related to transactions based on ASC X12 Implementation Guides, version 005010. [...]

CMS Forms

DX Proc Codes ICD-10 (1B)

Chapter IV: Inquiries Submenu (01) DX Proc Codes ICD-10 (1B) Purpose The purpose of the DX/PROC CODES ICD-10 option is to provide a reference of ICD-10 code(s) used to identify a specific or various diagnosis codes or inpatient surgical [...]

Reporting Multiple Qualifying Visits on the Same Date of Service for FQHC Reimbursement

Reporting Multiple Qualifying Visits on the Same Date of Service for FQHC Reimbursement FQHC providers are reimbursed based on a PPS, which pays the facility for all services provided during a qualifying visit. In addition to reporting the [...]

Ambulance Rural ZIP Code Search

Ambulatory Surgical Center Approved HCPCS Codes and Payment Rates

Beneficiary Notices Initiatives

Medicare Monthly Review

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Helpful Contacts

Medicare Helpful Contacts and Partner Resources Medicare Helpful Contacts Medicare Partner Resources

Submit an Appeal Electronically via esMD

Submit an Appeal Electronically via esMD CMS developed a mechanism for contractors to receive first level appeals electronically from providers via a secure gateway known as Electronic Submission of Medical Documentation, or esMD. Some [...]

Submit an Appeal Electronically via esMD

Submit an Appeal Electronically via esMD CMS developed a mechanism for contractors to receive first level appeals electronically from providers via a secure gateway known as Electronic Submission of Medical Documentation, or esMD. Some [...]

Submit an Appeal Electronically via esMD

Submit an Appeal Electronically via esMD CMS developed a mechanism for contractors to receive first level appeals electronically from providers via a secure gateway known as Electronic Submission of Medical Documentation, or esMD. Some [...]

September 2023

In This Issue National Government Services Articles for Part A and Part B Providers Introducing PECOS 2.0 Duplicate Claim Editing Information Two Interactive Voice Response System Features Ending 9/30/2023 October 2023 Release "Dark [...]

August 2023

In This Issue National Government Services Articles for Part A and Part B Providers CR13220 - Technical Revisions Only to the National Coverage Determination (NCD) Manual, Publication (Pub) 100-03 Tip Sheet for Medicare Providers on [...]

July 2023

In This Issue National Government Services Articles for Part A and Part B Providers Billing and Coding Article Updates for July 2023 National Government Services Proposed LCDs for Comment (6/22/2023-8/5/2023) End of the Public Health [...]

June 2023

In This Issue National Government Services Articles for Part A and Part B Providers Tobacco Cessation Counseling Doesn’t Have To Be Lengthy or Intimidating EDI Enrollment Spotlights Packet Completion Times Upcoming Change to the [...]

April 2023

In This Issue National Government Services Articles for Part A and Part B Providers Appealing a Denied Claim New Version of PC-ACE: April 2023 Type of Bill Code is a Requirement for All Prior Authorization Requests Change in Pricing [...]

March 2023

In This Issue National Government Services Articles for Part A and Part B Providers LCD, Billing and Coding Article Updates for March 2023 Chimeric Antigen Receptor (CAR) T-cell Therapy Billing Instructions April 2023 Release "Dark [...]

Outpatient Department Prior Authorization UTN Alert

Each UTN is Valid for One-Time Use The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient department procedures: Panniculectomy, Rhinoplasty, Vein Ablation, Blepharoplasty [...]

Outpatient Department Prior Authorization Type of Bill Alert

Providers Who Submit a Type of Bill 13X Are Required to Submit a Prior Authorization Request for the OPD PA Services The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient [...]

UTN Alert: Implanted Spinal Neurostimulator Trial and Permanent UTN

UTN Alert: Implanted Spinal Neurostimulator Trial and Permanent UTN The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient department procedures: Panniculectomy, [...]

Type of Bill Code is a Requirement for All Prior Authorization Requests

Type of Bill Code is a Requirement for All Prior Authorization Requests The National Government Services PA Department has seen an increase in cases that are submitted without a TOB code. PA staff conducts outreach to obtain this code; [...]

Outpatient Department Prior Authorization Implanted Spinal Neurostimulators Alert

Outpatient Department Prior Authorization Implanted Spinal Neurostimulators Alert Implanted Spinal Neurostimulator Prior Authorization National Government Services Medical Review initiated a prior authorization review outpatient department [...]

MLN Connects® Newsletter: September 14, 2023

MLN Connects® Newsletter: September 14, 2023     News Inflation Reduction Act Continues to Lower Out-of-Pocket Prescription Drug Costs for Drugs with Price Increases Above Inflation CMS Roundup (Sept 8, 2023) New Provider [...]

Billing for Originating Site

Billing for Originating Site Originating Site An originating site is the location of an eligible Medicare beneficiary at the time the telehealth services is being furnished via a telecommunications system. Medicare beneficiaries are eligible [...]

Distant Site

Distant Site The term “distant site” means the site where the physician or practitioner providing the professional service is located at the time the service is provided via a telecommunications system. Medicare distant site practitioners who [...]

General Information

General InformationTelehealth services require use of an interactive audio and video telecommunications system that permits real-time communication between the provider at the distant site and the Medicare beneficiary at the originating [...]

Originating Site

Originating Site An originating site is the location of an eligible Medicare beneficiary at the time the telehealth services is being furnished via a telecommunications system. Medicare beneficiaries are eligible for telehealth services only [...]

Facility Fee for Originating Site

Facility Fee for Originating Site The originating site facility fee is a separately billable Part B payment. The payment amount to the originating site is the lesser of 80 percent of the actual charge or 80 percent of the originating site [...]

Billing and Payment for Distant Site Professional Fee

Billing and Payment for Distant Site Professional Fee Claims for distant site telehealth services are submitted to the Part B MAC that processes claims for the performing physician/practitioner’s service area. Physicians/practitioners submit [...]

List of Covered Medicare Telehealth Services

List of Covered Medicare Telehealth Services Several conditions must be met for Medicare to make payments for telehealth services under the Physician Fee Schedule. The service must be on the list of Medicare telehealth services and meet [...]

G0 Modifier Required for Telehealth for Individuals with Acute Stroke

G0 Modifier Required for Telehealth for Individuals with Acute Stroke Effective for claims with dates of service on and after 1/1/2019, Medicare will accept HCPCS modifier G0 to identify telehealth services furnished for purposes of diagnosis, [...]

GT Modifier

GT Modifier Effective 10/01/2018, the GT modifier (via interactive audio and video telecommunications systems) is only required on institutional claims for distant site services billed under CAH Method II (claim type 085X). The GT modifier is [...]

Clarification of Telehealth for DSMT

Clarification of Telehealth for DSMT Individual and group DSMT services may be paid as a Medicare telehealth service. Effective for claims with dates of service on and after 1/1/2019, Medicare allows all ten hours of the initial DSMT training [...]

ESRD-Related Services as a Telehealth Service

ESRD-Related Services as a Telehealth Service Effective for DOS on/after 1/1/2019, renal dialysis facilities and the homes of ESRD beneficiaries receiving home dialysis may be originating sites and will not apply originating site geographic [...]

Ambulatory Surgical Center Pass-Through Devices

Ambulatory Surgical Center Pass-Through Devices What is a Pass-Through Device? Pass-through status is determined for newly FDA-approved drug and device products on an individual basis. Drugs and devices qualifying for pass-through status [...]

MLN Connects® Newsletter: COVID-19: Updated mRNA Vaccines for Patients 6 Months & Older – September 14, 2023

MLN Connects® Newsletter: COVID-19: Updated mRNA Vaccines for Patients 6 Months & Older – September 14, 2023     News COVID-19: Updated mRNA Vaccines for Patients 6 Months & Older Posted 9/14/2023

New YouTube Video: Surgical Dressings and Supplies: Part A/B and DME Collaborative Presentation

New YouTube Video: Surgical Dressings and Supplies: Part A/B and DME Collaborative Presentation The Part A/B and DME MACs are offering a YouTube video on Surgical Dressings and Supplies. This video offers information on the coverage criteria [...]

Interested in Becoming a Home Health or Hospice Provider Outreach and Education Advisory Group Member?

Interested in Becoming a Home Health or Hospice Provider Outreach and Education Advisory Group Member? Are you someone who would be interested in helping shape the education provided by your MAC? We want to hear from you! Join us to [...]

Don’t Let Your Flu Vaccination Claims Deny!

Don’t Let Your Flu Vaccination Claims Deny! The 2023-2024 flu vaccine season has begun. At the beginning of each flu season, National Government Services sees an increase in claim denial volume for flu vaccinations. This notice is being [...]

Save the Dates! National Government Services Fall 2023 Virtual Conference for Part B Providers

Save the Dates! National Government Services Fall 2023 Virtual Conference for Part B Providers Understanding Medicare Compliance 11/6/2023-11/8/2023 We’re excited to announce our Medicare Part B 2023 Fall Virtual Conference! This three-day [...]

Attention all OPPS Providers: Provider-Based Department Edits Being Implemented on/after 8/1/2023

Attention All OPPS Providers: Provider-Based Department Table of Contents Edits Being Implemented on/after 8/1/2023 Reason Code 34977: Practice address issue Reason Code 34978: PO and/or PN modifier missing Reason Code 34984: ER [...]

URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations

URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations Table of Contents Urgent: Provider Compliance Required Effective 8/1/2023 Requirements Claim Filing Requirements Final Reminders Related Content [Return to [...]

ESRD Facilities: Clarification for Providing Dialysis Services to Patients Acute Kidney Injury

ESRD Facilities: Clarifications for Providing Dialysis Services to Patients Acute Kidney Injury Effective 1/1/2017. ESRD facilities (hospital-based and freestanding) may furnish renal dialysis services to beneficiaries with AKI (both adult and [...]

Professional Services During a Patient Hospice Election

Professional Services during a Patient Hospice Election Table of Contents Article Overview Hospice Election Medicare Payment During Hospice Election Determining the Correct Entity to Bill Separately Payable Part B Services Hospice and [...]

Direct Data Entry Users May Need to Adjust Screen Size

Direct Data Entry Users May Need to Adjust Screen Size CMS recently issued Change Request 13138 “Implementation to Expand Monetary Amount Fields Related to Billing and Payment to Accommodate 10-Digits in Length ($99,999,999.99) - Phase 1”. [...]

Drugs and Biologicals - Coverage and Billing

Drugs and Biologicals – Coverage and Billing Medicare Part B will provide coverage for drugs that are furnished “incident to” a physician’s service. Coverage applies to drugs are not usually self-administered by the patients who take them. In [...]

Outpatient Therapy Functional Reporting

Outpatient Therapy Functional Reporting Table of Contents Outpatient Therapy Functional Reporting Reporting Episode - similar to the therapy episode of care Required Functional Reporting Discharge Reporting Unique Functional Reporting [...]