Modifier CS and COVID-19 Billing

Modifier CS and COVID-19 Billing How should the CS modifier, which removes application of beneficiary cost-sharing (deductible and co-payment), be applied to telehealth services and/or E/M visits? The CS modifier should be applied for certain [...]

MLN Connects® Newsletter: September 21, 2023

MLN Connects® Newsletter: September 21, 2023     News CMS Announces Resources and Flexibilities to Assist with the Public Health Emergency in the State of Georgia Organ Transplantation Affinity Group: Strengthening [...]

Telehealth Services

Answers to Common Fee-For-Time Compensation Arrangements Questions

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

Save the Dates! National Government Services Fall 2023 Virtual Conference for Medicare Part A Providers Ending 2023 on a Strong Medicare Note 11/1/2023-11/2/2023 The National Government Services POE Team will be holding our bi-annual virtual [...]

Join Us for the A/B DME Collaborative Surgical Dressings Webinar

Join Us for the A/B DME Collaborative Surgical Dressings Webinar Representatives from all four DME MAC jurisdictions and the A/B MACs will explain medical record requirements for surgical dressings. We hope you’ll join the MACs for this [...]

October 2023

In This Issue National Government Services Articles for Part A and Part B Providers Dental Services: Billing and Coding Article A59543 is Available EDI Spotlight: Strengthening Security Local Coverage Determination Open Meeting [...]

LCD and Billing and Coding Article Update for October 2023

LCD and Billing and Coding Article Update for October 2023 Billing and Coding: Autonomic Function Testing (A57024) Due to the annual ICD-10 Code updates, ICD-10 code G20 has been deleted and the following ICD-10 codes have been added: G20.A1, [...]

Provider Outreach and Education Reminders

Decrease Burden and Combine Multiple PDFs into One Before Responding to Additional Documentation Requests Using NGSConnex

Decrease Burden and Combine Multiple PDFs into One Before Responding to Additional Documentation Requests Using NGSConnex Recently, National Government Services has seen an increase in providers submitting multiple PDF attachments for the same [...]

MLN Connects® Newsletter: September 28, 2023

MLN Connects® Newsletter: September 28, 2023     News CMS Statement on Current Status of Blood Tests for Organ Transplant Rejection CMS Roundup (Sept 22, 2023) Cardiovascular Disease: Talk with Your Patients about [...]

Medicare Part B CMS-1500 Crosswalk for 5010 Electronic Claims

Collaborative A/B/DME Therapeutic Shoes for Persons with Diabetes Webinar

Collaborative A/B/DME Therapeutic Shoes for Persons with Diabetes Webinar Providers – Do you need assistance in understanding what is needed when ordering diabetic shoes? This collaborative webinar on Therapeutic Shoes for Persons with [...]

Billing for Services Not Included in the FQHC Benefit

Billing for Services Not Included in the FQHC Benefit Table of Contents Billing for Services Not Included in the FQHC Benefit Ambulance Services Body Braces Durable Medical Equipment Laboratory Services Medicare-Excluded [...]

Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims

Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims Table of Contents Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims Repetitive Services Repetitive Services [...]

What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy

What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy Table of Contents What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy [...]

COVID-19 Part A Frequently Asked Questions

COVID-19 Part A Frequently Asked Questions Table of Contents COVID-19 Part A Frequently Asked Questions Section B. Diagnostic Laboratory Services Section LL. Hospital Billing for Remote Services Section MM. Outpatient Therapy Services [...]

Fiscal Intermediary Standard System Direct Data Entry Screen Changes – October 2023

Fiscal Intermediary Standard System Direct Data Entry Screen Changes – October 2023 The October 2023 quarterly system release was implemented on 10/2/2023 and includes the FISS DDE screen changes identified below. CMS issued CR 13138 which [...]

Tip Sheet: Proper Use of Modifier 25

Tip Sheet: Proper Use of Modifier 25 A review of top claim reason codes indicate a steady reoccurrence of claims being returned to provider (RTP) for reason code W7021, when there was a medical visit on same day as a type 'T' or 'S' procedure [...]

Three-Day Qualifying Hospital Stay Required for Medicare-Covered SNF Stay

Three-Day Qualifying Hospital Stay Required for Medicare-Covered SNF Stay Table of Contents Three-Day Qualifying Hospital Stay Required for Medicare-Covered SNF Stay Additional Information Billing Reminders Related Content [Return to [...]

MLN Connects® Newsletter: October 5, 2023

MLN Connects® Newsletter: October 5, 2023     News Administration Moves Forward with Medicare Drug Price Negotiations to Lower Prescription Drug Costs for People with Medicare CMS Requests Public Input on Coverage of [...]

Update on proposed LCD for Transesophageal Echocardiography

Update on proposed LCD for Transesophageal Echocardiography The LCD for Transesophageal Echocardiography (TEE) was published for comment and presented at an Open Meeting in July 2023. NGS is continuing to assess the provisions in this LCD and [...]

MLN Connects® Newsletter: October 6, 2023

MLN Connects® Newsletter: October 6, 2023     News COVID-19: Updated Novavax COVID-19 Vaccine, Adjuvanted for Patients 12 & Older Posted 10/6/2023

Cognitive Assessment and Care Plan Services CPT Code 99483

Cognitive Assessment and Care Plan Services CPT Code 99483 Effective 1/1/2021, Medicare increased payment for these services to $282 (may be geographically adjusted) when provided in an office setting, added these services to the definition of [...]

Mental Health Crisis Help

Mental Health Crisis Help Anyone experiencing a mental health crisis, including substance use crisis or thoughts of suicide, can get confidential support 24/7 by calling 988 or visiting the 988 Suicide & Crisis Lifeline website. View the [...]

Notification of the 2024 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review

Notification of the 2024 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review The amount that must remain in controversy for ALJ hearing requests filed on or [...]

MLN Connects® Newsletter: October 12, 2023

MLN Connects® Newsletter: October 12, 2023     News CMS Roundup (Oct 6, 2023) Protect Your Patients: Give Them a Flu Shot Publications Direct Data Entry: 10-Digit Screen Expansion Medicare Preventive Services — [...]

Let’s Get Ready for The Great American Smokeout on 11/16/2023!

Let’s Get Ready for The Great American Smokeout on 11/16/2023! For more than 40 years, the American Cancer Society has hosted the Great American Smokeout on the third Thursday of November. This yearly event is a call for action, not just for [...]

Ambulance

National Government Services Medicare Part B Preventive Services Week

National Government Services Medicare Part B Preventive Services Week 12/6/2022 – 12/8/2022 Medicare offers many preventive service benefits that can help detect health problems early and keep your patients from getting certain diseases. [...]

OIG Guidance for COVID-19 Vaccination

OIG Guidance for COVID-19 Vaccination On 4/15/2021, the HHS-OIG issued Message from HHS-OIG Leadership on the COVID-19 Vaccination Program and Provider Compliance that states: As COVID-19 vaccinations continue to be administered nationwide, [...]

Confirming Eligibility to Enroll

Confirming Eligibility to Enroll  We’ve expanded our list of Eligible Nonphysicians who can enroll in Medicare to include the definition, qualifications and supporting documentation for each specialty.  Posted 12/15/2022

MLN Connects® Newsletter: CMS Awards 200 New Medicare-Funded Residency Slots to Hospitals Serving Underserved Communities– Jan 9, 2023

MLN Connects® Newsletter: CMS Awards 200 New Medicare-Funded Residency Slots to Hospitals Serving Underserved Communities– Jan 9, 2023​​     News CMS Awards 200 New Medicare-Funded Residency Slots to Hospitals Serving [...]

Over-the-Counter COVID-19 Test Benefits

Over-the-Counter COVID-19 Test Benefits Beginning 4/4/2022, and through the end of the COVID-19 PHE, Medicare started paying for U.S. FDA-approved, authorized, or cleared OTC COVID-19 tests at no cost to Medicare beneficiaries with Medicare [...]

MLN Connects® Newsletter: January 12, 2023

MLN Connects® Newsletter: January 12, 2023     News Key Dates for First Year of Inflation Reduction Act’s Medicare Drug Price Negotiation Program Cognitive Assessment: CY 2023 Updates Care Compare: Telehealth Indicator [...]

The Revised CY 2023 Medicare Physician Fee Schedule Is Now Available

The Revised CY 2023 Medicare Physician Fee Schedule Is Now Available The revised CY 2023 MPFS is now available. You can view these Part B Physician Fee Schedule by accessing Resources > Tools & Calculators > Fee Schedule Lookup. [...]

Documentation for Hospice Transfers

Documentation for Hospice Transfers The purpose of a hospice transfer is to allow the beneficiary the opportunity to switch agencies without affecting their benefit period in an effort to provide continuity of care. Instead of the beneficiary [...]

Entry Process Questions

Entry Process Questions I need to complete a Logon Request Form This option is used for a provider/facility to request/modify access to the Part A FISS/DDE system. (EDI Enrollment Agreement is included within this packet if needed.) [...]

Oxygen: A/B and DME Collaborative Presentation

Oxygen: A/B and DME Collaborative Presentation View the A/B and DME Oxygen YouTube Video for information on oxygen. Posted 1/18/2023

MLN Connects® Newsletter: January 19, 2023

MLN Connects® Newsletter: January 19, 2023     News Additional Steps to Strengthen Nursing Home Safety and Transparency Increase in 2023 in Organizations and Beneficiaries Benefiting from Coordinated Care in Accountable [...]

Billing and Coding Article Updates for January 2023

Billing and Coding Article Updates for January 2023 Billing and Coding: Bevacizumab and biosimilars (A52370) The reference for Bevacizumab-adcd (Vegzelma®) listed under the Ophthalmologic Guidelines section of the article has been removed. [...]

Bibliography for Hyaluronans CAC Meeting on 3/16/2023

Bibliography for Hyaluronans CAC Meeting on 3/16/2023 George E. Intra-articular hyaluronan treatment for osteoarthritis. Ann Rheum Dis. Nov 1998;57(11):637-40. doi:10.1136/ard.57.11.637. https://ard.bmj.com/content/57/11/637.  [...]

Important Steps When Responding to Additional Development Response Letters

Important Steps When Responding to Additional Development Response Letters When National Government Services requests documentation, you must send us only what has been requested. We are receiving numerous unnecessary documents from providers [...]

View 1099s

View 1099s The Internal Revenue Service 1099 form is a collection of tax forms documenting different types of payments made by an individual or a business that typically isn't your employer. The 1099 portal forms are a courtesy copy and are [...]

MLN Connects® Newsletter: Public Health Emergency 1135 Waivers: Updated Guidance for Providers - February 23, 2023

MLN Connects®Newsletter: Public Health Emergency 1135 Waivers: Updated Guidance for Providers -  February 23, 2023     News Public Health Emergency (PHE) 1135 Waivers: Updated Guidance for Providers Posted 2/23/2023

Sacroiliac Joint Injections and Procedures

Sacroiliac Joint Injections and Procedures

MLN Connects® Newsletter: March 15, 2023

MLN Connects® Newsletter: March 15, 2023     News Inflation Reduction Act Tamps Down on Prescription Drug Price Increases Above Inflation Posted 3/15/2023

Frequently Asked Questions

E/M Coding: Medical Decision Making Moderate Point Scoring for Data Elements

Evaluation and Management Coding: Medical Decision Making Moderate Point Scoring for Data Elements On 1/1/2021, CMS approved and issued modifications to E/M coding guidelines that were originally developed and adopted by the AMA. This change [...]

Changes in G2066 Pricing Effective April 1, 2023

Changes in G2066 Pricing Effective April 1, 2023 After reviewing Medicare claims data for G2066 (Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder [...]

CR13122 - Implementation of Consolidated Appropriations Act (CAA) of 2023, Section 4143: Waiver of Cap on Annual Payments for Nursing and Allied Health Education Payments

CR13122 - Implementation of Consolidated Appropriations Act (CAA) of 2023, Section 4143: Waiver of Cap on Annual Payments for Nursing and Allied Health Education Payments

EDI Enrollment Spotlights Top Rejections

EDI Enrollment Spotlights Top Rejections Part A, Part B and DDE Periodically, EDI ​​​​enrollment will publish articles to help eliminate the number of EDI applications that are denied.  This month we are spotlighting the denial for [...]

Modifier 95 as it Relates to Medicare Part B and COVID-19 Billing

Modifier 95 as it Relates to Medicare Part B and COVID-19 Billing Modifier 95 Defined: Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system. During the COVID-19 PHE, and through CY 2023 [...]

Modifier CR as it Relates to Medicare Part B and COVID-19 Billing

Modifier CR as it Relates to Medicare Part B and COVID-19 Billing In 2005, CMS created modifier “CR” (description: Catastrophe/disaster related) to assist MACs in processing claims as a result of Hurricane Katrina. This modifier was also [...]

Home Health Diagnosis Codes Grouper Update for 4/1/2023

Home Health Diagnosis Codes Grouper Update for 4/1/2023 Effective 4/1/2023, CMS is implementing new HH Grouper edits. The HH Grouper program has various data validity edits that make sure it uses consistent and accurate data when calculating [...]

New Fiscal Intermediary Shared System Consistency Edit to Validate Attending Physician National Provider Identifier

New Fiscal Intermediary Shared System Consistency Edit to Validate Attending Physician National Provider Identifier Effective 4/1/2023, CMS implemented a new consistency edit to validate that the attending physician NPI. An Attending Provider [...]

The Advance Beneficiary Notice of Noncoverage

The Advance Beneficiary Notice of Noncoverage We’ve updated our Advance Beneficiary Notice of Noncoverage article to include examples for using an ABN for outpatient therapy and using the KX and GA modifiers appropriately. We encourage you to [...]

MLN Connects® Newsletter: April 13, 2023

MLN Connects® Newsletter:  April 13, 2023 News COVID-19: End of Public Health Emergency CMS Roundup (Apr. 07, 2023) Medicare Shared Savings Program: Application Toolkit Materials Inpatient Rehabilitation Facility [...]

Top Tobacco Counseling Claim Denials and How to Avoid/Correct Them

Top Tobacco Counseling Claim Denials and How to Avoid/Correct Them Providers, are your claims being denied for tobacco counseling services utilizing codes 99406 and 99407? In order to assist our providers in getting claims processed [...]