Telehealth Frequently Asked Questions are Updated

Telehealth Frequently Asked Questions are Updated We’ve updated our telehealth frequently asked questions to include changes and flexibilities due to the end of the PHE on 5/11/2023. Please view these FAQs for the answers you need to common [...]

Providers Using NGSConnex to Submit Appeals and Supporting Documentation

Providers Using NGSConnex to Submit Appeals and Supporting Documentation We strongly recommend our providers use NGSConnex to submit your redetermination requests and any supporting documentation. Please be aware that if you do not submit [...]

Medicare University Continuing to Experience Intermittent Issues

Medicare University Continuing to Experience Intermittent Issues We are continuing to experience intermittent outages with Medicare University. You do not need to report these issues with Medicare University to our Provider Contact Center. We [...]

MLN Connects® Newsletter: April 20, 2023

MLN Connects® Newsletter:  April 20, 2023 News Billing Medicare Part B for Insulin with New Limits on Patient Monthly Coinsurance Medical Review & Compliance: Respond to Additional Documentation Requests Hospice: [...]

Hot Topics

Medicare Important Hot Topics Medicare and Coronavirus Medicare and Coronavirus – How to stay up-to-date! Medicare Beneficiary Fact Sheets Beneficiary Fact Sheets for Medicare Cost and Coverage Medicare Coverage Database The MCD [...]

Introduction

Introduction The Congressional Affairs Outreach team at National Government Services, Inc. and our partners are committed to ensuring that congressional offices receive a timely response to all inquiries. For your convenience, National [...]

LCD, Billing and Coding Article Updates for April and May 2023

LCD, Billing and Coding Article Updates for April and May 2023 Billing and Coding Article (A56937): Psychiatry and Psychology Services Removed sentence from article text section - “For psychotherapy sessions lasting 90 minutes or longer, the [...]

Medicare Secondary Payer

Medicare Secondary Payer CMS transitioned COB activities for GHP and non-GHPs from the COBC and Non-GHP recovery functions from the BCRC to the new Medicare Secondary Payer Contractor. There will be no change to any of the COB processes under [...]

Congressional Offices

Congressional Offices Home Communications Hot Topics MAC Directory Contacts Resources

MLN Connects® Special Edition for Monday, August 1, 2022

MLN Connects® Special Edition for Monday, August 1, 2022 New CMS Rule Increases Payments for Acute Care Hospitals & Advances Health Equity, Maternal Health​​​​​​​ On August 1, CMS issued a final rule for inpatient and long-term care [...]

EDI Enrollment Spotlights Packet Completion Times

EDI Enrollment Spotlights Packet Completion Times We ask that you allow seven – ten business days for processing of all requests. All requests are worked in the order in which they are received. Currently, our processing times are taking a [...]

MLN Connects® Newsletter: April 27, 2023

MLN Connects® Newsletter:  April 27, 2023 News Hospital Price Transparency Enforcement Updates For the First Time, HHS Is Making Ownership Data for All Medicare-Certified Hospice and Home Health Agencies Publicly Available [...]

NGS Cost Report Submission Reminders

NGS Cost Report Submission Reminders We strongly encourage filing of the cost report via the Medicare Cost Report E‐Filing (MCReF) System. If the cost report is submitted via MCReF, it does not need to be mailed Cost Report submissions [...]

Ways to Submit Requests

Ways to Submit Requests NGSConnex Part A: NGSConnex User Guide Part B: NGSConnex User Guide esMD Content type 8.5 Fax JK: 317-841-4530 J6: 317-841-4528 Mail National Government Services, Inc. [...]

MLN Connects® Newsletter: May 4, 2023

MLN Connects® Newsletter:  May 4, 2023 News FAQs on CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency Guidance for the Expiration of the COVID-19 Public Health Emergency COVID-19 Over-the-Counter [...]

New versus Established Patients

New versus Established Patients We’ve updated this frequently asked question based on recent clarification from CMS. Please clarify appropriate billing for outpatient/office services when a consulting provider has already performed a [...]

Oxygen and Oxygen Equipment: A/B and DME Collaborative Presentation

Oxygen and Oxygen Equipment: A/B and DME Collaborative Presentation   View the A/B and DME Oxygen and Oxygen Equipment YouTube video for information on oxygen. Posted 5/5/2023

[URGENT] Part A DDE is Available!

[URGENT] Part A DDE is Available! Part A DDE is available and can be accessed by Part A, HHH and FQHC providers. The issue of providers not being able to sign is due to an unexpected change in the Data Center Menu options. Part A DDE [...]

Urgent News: May 2023 Dark Days for Data Center Migration Postponed

Urgent News: May 2023 Dark Days for Data Center Migration Postponed The Medicare Part A CMS Data Center Migration scheduled for 5/12/2023 to 5/15/2023 has been postponed. All systems and IVR will be available on 5/15/2023. For FISS DDE users, [...]

Provider Enrollment: Resumed Revalidation Activities

Provider Enrollment: Resumed Revalidation Activities Attention: Provider Enrollment and Credentialing Departments Activities have resumed with revalidation due dates starting with 1/31/2022. Don’t wait to revalidate if CMS assigned a current [...]

Accessing the NGS FISS DDE System

Accessing the NGS FISS DDE System As we previously communicated via the May 2023 Dark Days for CMS Data Migration - Rescheduled May 2023 Dark Days for Data Center Migration, the Medicare Part A CMS Data Center Migration took place this past [...]

How to Avoid Duplicate Claim Denials

Announcing Service Specific Post-Payment Audits of Individual Psychotherapy Services for J6 A Regions: IL, WI and MN

Edit Reason Code: 5FSEP Bill Type = 13X, 85X CPT/HCPCS/Modifiers:90832- 90834 Overview The Medical Review Department of National Government Services will be performing service specific post-payment reviews for claims submitted to Medicare [...]

Tips for Documenting Homebound Status

Tips for Documenting Homebound Status Comprehensive and accurate documentation is crucial to providing safe and effective care to Medicare beneficiaries. National Government Services' medical review team reviews this documentation while making [...]

Physicians and Nonphysician Practitioners: Revised CMS-855I Medicare Enrollment Application Required November 1 (Combined CMS-855I and CMS-855R)

Physicians and Nonphysician Practitioners: Revised CMS-855I Medicare Enrollment Application Required November 1 (Combined CMS-855I and CMS-855R) If you don’t use PECOS, use the revised CMS-855I (Medicare Enrollment Application - Physicians and [...]

Update: End Stage Renal Disease Claim Adjustments Needed Due to CWF Error in Date of First Dialysis

Update: End Stage Renal Disease Claim Adjustments Needed Due to CWF Error in Date of First Dialysis As of 7/18/2023, CMS has identified that the CWF continues to have some inaccurate dates for the first date of dialysis. We will advise when [...]

I Am a Provider and “I Want to Complete an EDI Registration Form”

I Am a Provider and “I Want to Complete an EDI Registration Form” This selection will prompt you to complete the EDI Registration Form. This option is for providers who wish to submit claim files using a third party such as a billing service [...]

I Am a Provider and “I Want to Complete a Connex Registration Form”

I Am a Provider and “I Want to Complete a Connex Registration Form” This selection will prompt you to complete the Connex Registration Form. This option is for providers who wish to send claims or receive remits through the NGSConnex portal. [...]

Clearinghouse

Clearinghouse When Clearinghouse is selected as your submitter type the following objective will be displayed. Select the objective and then click Next. I am a Clearinghouse and “I want to complete an EDI Registration Form” This objective [...]

Common Questions

Common Questions What is the Entity Name? This is the EXACT provider’s name that was submitted in section 2 of the CMS-855/PECOS enrollment application when applying to participate with Medicare.   What information should be put in [...]

I Am a Provider and “I Want to Connect Directly to the Part A FISS/DDE System”

I Am a Provider and “I Want to Connect Directly to the Part A FISS/DDE System” This selection will prompt you to complete the Logon Request Form. This option is for providers who need to request, modify, reinstate, or add additional access to [...]

I Am a Provider and “I Want to Allow a 3rd Party Billing Service to Bill for Me Using the Part A FISS DDE System”

I Am a Provider and “I Want to Allow a 3rd Party Billing Service to Bill for Me Using the Part A FISS DDE System” This selection will prompt you to complete the Letter of Authorization Form. This option is for providers who wish to allow [...]

I Am a Billing Service and “I Want to Complete an EDI Registration Form”

I Am a Billing Service and “I Want to Complete an EDI Registration Form” This selection will prompt you to complete the EDI Registration Form. This objective is for billing services who need to obtain a new TPID or make a change to an [...]

Hierarchy of Medicare Regulations

Hierarchy of Medicare Regulations Have you wondered how Medicare determines what is covered? Below you will find the hierarchy of how Medicare regulations are created. Social Security Act Title XVIII of the Social Security Act is [...]

MLN Connects® Newsletter: October 19, 2023

MLN Connects® Newsletter: October 19, 2023     News 2024 Medicare Parts A & B Premiums and Deductibles Help CMS Improve Provider Resources — Respond by November 9 CMS Health Information Handler Helps You Submit [...]

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 [...]

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 - For Institutional Users: Importing and Reading the 999 and 277CA Files PC-ACE [...]

Browser Compatibility

Browser Compatibility Access NGSConnex using one of the supported browsers below. Microsoft Edge version 88.0 and above Google Chrome version 45.0 and above  Mozilla Firefox version 31.0 and above Apple Safari version 9 and [...]

Mental Health Services

Mental Health Services Medicare Part B provides benefits for psychiatric services, which are medically necessary for the diagnosis or treatment of diagnostic and/or behavioral health treatment. Medicare recognizes the following Part B [...]

Register Today! National Government Services Fall 2023 Medicare Virtual Conference: Understanding Medicare Compliance for Part B Providers

Register Today! National Government Services Fall 2023 Medicare Virtual Conference: Understanding Medicare Compliance for Part B Providers This three full-day virtual conference will offer a variety of Part B sessions geared toward Medicare [...]

Medicare Billing Fact Sheet for Electronic (837P) and Paper (Form CMS-1500) Claims

Credit Balance Report Reminder

Credit Balance Report Reminder CBRs for the quarter ending 9/30/2023 are now due. CBRs must be submitted within 30 days of the end of the quarter to be considered timely. FISS DDE users who submit the 838 detail page directly over the [...]

Medicare Overpayments Are Not Redeterminations

Medicare Overpayments Are Not Redeterminations Our records indicate some providers are incorrectly submitting redetermination request forms for MSP overpayment issues. Please use this notification as educational instruction from National [...]

MLN Connects® Newsletter: October 26, 2023

MLN Connects® Newsletter: October 26, 2023 News Help CMS Improve Provider Resources — Respond by November 9 CMS Roundup (Oct 20, 2023) Nursing Facility Evaluation and Management Visits: Comparative Billing Report in October Claims, [...]

Part B Top Claim Errors Are Updated

Part B Top Claim Errors Are Updated Our top claim errors are updated on a quarterly basis to reflect current information. Visit Top Claim Errors to learn what you can do to avoid claim processing delays. We’ve listed the error reason code, a [...]

Prior Authorization Outpatient Department Exemption Additional Documentation Requests

Prior Authorization Outpatient Department Exemption Additional Documentation Requests National Government Services Prior Authorization initiated the process of issuing ADRs to exempt providers. Please monitor your facility’s ADR location [...]

Navigating Medicare Home Health & Hospice Insights for Providers Podcast

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

Coming Soon ‒ The CY 2024 Medicare Physician Fee Schedule

Coming Soon - The CY 2024 Medicare Physician Fee Schedule The CY 2024 MPFS will soon be available on the Fee Schedule Lookup tool located on NGSMedicare.com, after the CY 2024 physician fee schedule regulation is put on display. Once the Fee [...]

Electronic Cost Report Exhibit Templates

Who May File an Appeal

Who May File an Appeal? Table of Contents Who May File an Appeal? Appointment of Representative When Is an Appointment Not Necessary? Who May Be a Representative How to Make and Revoke an Appointment When Is an Appointment Not [...]

Reopenings for Minor Errors and Omissions

Reopenings for Minor Errors and Omissions Table of Contents Reopenings for Minor Errors and Omissions What is a Clerical Error? Clerical Error and Omission Reopening Request Request a Reopening- NGSConnex Request a Reopening- In Writing [...]

Review Bad Debt Listing

Table of Contents Review Bad Debt Listing Identifying Fee Schedule Services Fee Schedules Included in Bad Debt Policy Related Content [Return to Top] Review Bad Debt Listing Bad debts are unrecovered costs due to uncollectible [...]

Hospice Cap

Hospice Cap Table of Contents The Inpatient Day Limitation Aggregate Cap Calculation Beneficiary Count Proportional Method (applies to most hospices) Streamlined Method  [Return to Top] The Inpatient Day Limitation [...]

Proper Use of Modifiers JW and JZ

Proper Use of Modifiers JW and JZ National Government Services Provider Contact Center has received several inquiries regarding claim denials related to the use of the JW and JZ modifier for drugs/biologicals. As a reminder, effective [...]

Claim Denials for Medically Unnecessary Ambulance Transports: Avoiding Reason Code 55B10

Claim Denials for Medically Unnecessary Ambulance Transports Table of Contents Claim Denials for Medically Unnecessary Ambulance Transports Medical Necessity and Coverage Guidelines for Ambulance Transport Avoiding Reason Code 55B10 [...]

Inpatient Psychiatric Facilities Billing When Benefits Exhaust Job Aid

Inpatient Psychiatric Facilities Billing When Benefits Exhaust Job Aid Table of Contents Inpatient Psychiatric Facilities Billing When Benefits Exhaust Job Aid Benefits Exhaust Date Submitting Claims Through the Benefits Exhaust Date [...]

November 2023

In This Issue National Government Services Articles for Part A and Part B Providers Collaborative A/B/DME Therapeutic Shoes for Persons with Diabetes Webinar Decrease Burden and Combine Multiple PDFs in one Document Before Responding to [...]

Submitting a Prior Authorization Request

Submitting a Prior Authorization Request Table of Contents Submitting a Prior Authorization Request Documentation Requirements Documentation Checklist for Medical Professionals Supporting the Physician Certification Statement [Return [...]

MLN Connects® Newsletter: Take Our Provider Survey Today - November 1, 2023

MLN Connects® Newsletter: Take Our Provider Survey Today - November 1, 2023 News Take Our Provider Survey Today Posted 11/1/2023

MLN Connects® Newsletter: November 2, 2023

MLN Connects® Newsletter: November 2, 2023 News CY 2024 Home Health Prospective Payment System Final Rule CY 2024 End-Stage Renal Disease Prospective Payment System Final Rule Behavioral Health: Medicare Pays for 3 Services [...]