NPPES

Remittance Advice Codes

USA.gov

American Medical Association

Prepare and Submit an MSP Conditional Claim 

Maximum Payment Limits for Rural Health Centers

Coverage of Rural Air Ambulance Services

Federally Qualified Health Center Payment Limits

New York State Ambulance Services in Rural Areas

Health Professional Shortage Area

FISS/DDE Provider Online Guide: Chapter IV - ZIP Code File (19)

Submit Supporting Documentation

Ambulance Rural ZIP Code Search

Fundamentals of Medicare: Skilled Nursing Facility Inpatient Care

Get Help Submitting an Appeal Hard Copy

Get Help Submitting an Appeal Hard Copy All levels of appeals may be submitted by mail. The only types of appeals submitted to National Government Services are reopening and redetermination requests. For information on other types of appeals, [...]

Get Help Submitting an Appeal Hard Copy

Get Help Submitting an Appeal Hard Copy All levels of appeals may be submitted by mail. The only types of appeals submitted to National Government Services are reopening and redetermination requests. For information on other types of appeals, [...]

Request a Redetermination

Request a Redetermination The first level of appeal is the redetermination and is carried out by the MAC. Time limit to initiate = 120 days from date of receipt of the initial determination notice Time limit to complete the [...]

PC-ACE Roster Billing Guide

PC-ACE Roster Billing Guide Roster billing is a feature of PC-ACE that allows the provider to create many nearly identical claims for flu and pneumonia vaccines quickly. PC-ACE is now equipped for COVID-19 vaccine roster billing as well. [...]

Appeals Decision Tree

Appeals Decision Tree

Complete a Voluntary Refund

A voluntary refund is when you have self-identified you have been overpaid and you need to refund the excess funds to Medicare. All checks are made payable to National Government Services. Whenever possible the refund to Medicare should be [...]

Complete a Voluntary Refund

A voluntary refund is when you have self-identified you have been overpaid and you need to refund the excess funds to Medicare. All checks are made payable to National Government Services. All checks are made payable to National Government [...]

Complete a Voluntary Refund

A voluntary refund is when you have self-identified you have been overpaid and you need to refund the excess funds to Medicare. All checks are made payable to National Government Services. Whenever possible, the refund to Medicare should be [...]

5010 Top Page for Part B

EDI Front End Rejection Code Lookup Tool To view easy-to-understand descriptions associated with the reject code(s) returned on the Status Information segment (STC) of the version 5010 277CA – Claim Acknowledgement, enter the following code [...]

Person(s) with Medicare

Person(s) with Medicare  Home Contacts & Resources Coverage & Billing Education Medicare Plans News

Cardiac Positron Emission Tomography Pricing Change

Cardiac Positron Emission Tomography Pricing Change Effective 1/1/2020 there nine CPT codes that describe PET as noted in the lists below. Of the nine listed codes, six (group 1) are new for 2020 and are contractor priced codes for the TC and [...]

Don’t Forget the CMS-588 Electronic Funds Transfer Authorization Agreement

Don’t Forget the CMS-588 Electronic Funds Transfer Authorization Agreement The CMS-588 Electronic Funds Transfer Authorization Agreement is to be submitted for billing providers upon initial enrollment, change in bank information and during [...]

Opioid Treatment Add-on Code G2078 and G2079 MUE Values

Opioid Treatment Add-on Code G2078 and G2079 MUE Values The July 2020 quarterly update for the NCCI added an MUE value of one for OTP HCPCS codes G2067-G2075 and G2078 and G2079. It was later determined by CMS that the incorrect MUE value was [...]

October 2020 Release "Dark Days" for the Common Working File Hosts

October 2020 Release "Dark Days" for the Common Working File Hosts For the upcoming October 2020 Release: For Production, CWF will be observing dark days starting Friday, 10/2/2020 through Sunday, 10/4/2020 to accommodate the anticipated [...]

October 2020 Fiscal Intermediary Standard System Direct Data Entry Screen Changes

October 2020 Fiscal Intermediary Standard System Direct Data Entry Screen Changes The DDE CWF Inquiry Screen (MAP175M) will display the ABPM and will include the technical and professional dates for HCPCS 93784. The MBI Eligibility FROM and [...]

Registered Dietitians and COVID-19 Allowances for Billing

Registered Dietitians and COVID-19 Allowances for Billing National Government Services has received clarification from CMS in regard to registered dietitians/nutritionists billing. When CPT codes 98966‒98968 were originally opened to coverage [...]

Radiopharmaceuticals Invoice or Acquisition Cost Submission Reminder

Radiopharmaceuticals Invoice or Acquisition Cost Submission Reminder National Government Services has identified situations where claims are being submitted for radiopharmaceuticals without an invoice or acquisition cost provided. For [...]

Quality Innovation Networks - Quality Improvement Organizations Quality Initiatives

Quality Innovation Networks - Quality Improvement Organizations Quality Initiatives CMS leads a national health care quality improvement network of Quality Innovation Networks – Quality Improvement Organizations (QIN-QIOs). Locally, an [...]

Providers' Obligation to Report and Refund Medicare Overpayments with Appropriate Forms

Providers' Obligation to Report and Refund Medicare Overpayments with Appropriate Forms Healthcare providers have an obligation to report and refund federal program overpayments and continue to do so, but National Government Services would [...]

Provider Enrollment Reconsideration Request Reminders

Provider Enrollment Reconsideration Request Reminders National Government Services has been receiving reconsiderations of provider enrollment credentialing requests that do not fall into the appropriate criteria for reconsiderations due to the [...]

Proper Billing for Telehealth Services Claims

Proper Billing for Telehealth Services Claims We have received a high volume of paper CMS-1500 claim forms for telehealth services with dates of service during the PHE that we have to reject because they are improperly coded with two different [...]

Prior Authorization Request Reminders

Prior Authorization Request Reminders Effective for dates of service on or after 7/1/2020, a PAR is required for certain OPD services. For additional information on the Medicare Prior Authorization Program go to our website > log in to any [...]

Prior Authorization Program Becomes Effective for Dates of Service on/after 7/1/2020

Prior Authorization Program Becomes Effective for Dates of Service on/after 7/1/2020 The CMS is implementing a prior authorization program for certain hospital outpatient department services effective for dates of service on or after 7/1/2020. [...]

Reminder: Providers on Automatic Immediate Recoupments

Reminder: Providers on Automatic Immediate Recoupments If you are set up for automatic recoupments, please refrain from submitting checks and overpayment forms. Submitting receipts run the risk of money being offset and your check being [...]

Physicians/Practitioners Medical Records Play a Vital Role in Ordering and Providing DMEPOS to Your Patients

Physicians/Practitioners: Medical Records Play a Vital Role in Ordering and Providing DMEPOS to Your Patients For any DMEPOS item to be covered by Medicare, the patient’s medical record must contain sufficient information about the patient’s [...]

Update on Claims for COVID-19 Testing

Update on Claims for COVID-19 Testing As per CMS PHE guidelines, National Government Services is modifying internal claim editing to permit the following COVID-19-related procedure codes to process as potentially payable without ICD-10 [...]

The CY 2021 MPFS Is Now Available

The CY 2021 MPFS Is Now Available The CY 2021 MPFS is now available. You can view the new fees using the Fee Schedule Lookup tool page on our website. Posted 12/14/2020

Skin Substitutes and Wound Care Products Billing Reminder

Skin Substitutes and Wound Care Products Billing Reminder CMS provides pricing for some wound care products; however, there are many that do not have established pricing. If a skin substitute/wound care product does not have established [...]

Request for Anticipated Payment Auto-Cancellation Extension

Request for Anticipated Payment Auto-Cancellation Extension Due to CMS guidelines during the Public Health Emergency, all RAPs processed during the PHE will have an additional 90 days from the date of the processed RAP to submit the claim for [...]

Repayment of Accelerated and Advance Payments for Part B Providers Begins July 27

Repayment of Accelerated and Advance Payments for Part B Providers Begins July 27 Did you know that repayment period for the relief funds advanced payment begins 120 days after a provider received the payment? For the first 120 days, claims [...]

Reminder: Hospitals Billing for the Appropriate Use Criteria for Advanced Diagnostic Imaging

Reminder: Hospitals Billing for the Appropriate Use Criteria for Advanced Diagnostic Imaging On 1/9/2020, CMS issued additional instructions in SE20002, Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging- Approval of Using the K3 [...]

Reminder: 340B Hospital Survey Closes 5/15

Reminder: 340B Hospital Survey Closes 5/15 Reminder: the 340B hospital survey closes on Friday, 5/15/2020. This survey is for hospitals paid under the OPPS, that were enrolled in the 340B program during calendar year Q4 2018 and/or Q1 2019. [...]

Reminder: Medicare Patient Equal Care Policy is the Law

Reminder: Medicare Patient Equal Care Policy is the Law It has come to our attention that some providers are refusing to offer certain services to Medicare patients that they make available to private-pay patients and patients who have other [...]

We Can Now Accept Electronic Appeal Requests Using the X12 275 Version 6020 Transaction

We Can Now Accept Electronic Appeal Requests Using the X12 275 Version 6020 Transaction National Government Services will now allow Medicare Part A and Part B providers to submit their claim appeal requests, including medical record [...]

VBID Hospice Benefit Component Information Now Available

VBID Hospice Benefit Component Information Now Available Beginning on January 1, 2021, CMS is testing the inclusion of the Part A Hospice Benefit within the MA benefits package through the Hospice Benefit Component of the Value-Based Insurance [...]

Updates to Nursing and Allied Health Education Medicare Advantage Payment Policies

Updates to Nursing and Allied Health Education Medicare Advantage Payment Policies Change Request 11642 Revised 12/15/2020 Revised 12/1/2020 Posted 8/24/2020

Updated Future Effective LCD and Article

Updated Future Effective LCD and Article Fluid Jet System Treatment for LUTS/BPH (L38367) The Fluid Jet System Treatment for LUTS/BPH is now considered medically reasonable and necessary for 30-150 cc- sized prostates when the Indications of [...]

Updated Future Effective LCD and Article

Updated Future Effective LCD and Article Fluid Jet System Treatment for LUTS/BPH (L38367) The Fluid Jet System Treatment for LUTS/BPH is now considered medically reasonable and necessary for 30-150 cc- sized prostates when the Indications of [...]

Ambulance Fee Schedule and Medicare Transports Booklet

Ambulance Fee Schedule and Medicare Transports Booklet A new Ambulance Fee Schedule and Medicare Transports Booklet is available. Learn about coverage, billing and payment for ground and air ambulance transport benefits. Posted 8/21/2019

Medicare’s 2020 Open Enrollment: October 15–December 7

Medicare’s 2020 Open Enrollment: October 15–December 7 Medicare Patients May Have Questions - A State Health Insurance Assistance Program Can Help What is the State Health Insurance Assistance Program? A SHIP is a free insurance counseling [...]

Local Coverage Determination and Article Revisions September-October 2019

Local Coverage Determination and Article Revisions September‒October 2019 All medical policies and related articles can be found on the NGS Medical Policy Center. Bevacizumab and Biosimilars - Related to LCD L33394 (A52370) Bevacizumab-awwb [...]

Local Coverage Determination and Article Revisions October-November 2019

Local Coverage Determination and Article Revisions October‒November 2019 The medical policies and related articles can be found in our Medical Policy Center. Updates Billing and Coding: Molecular Pathology Procedures (A56199) Added [...]

LCD and Article Revisions: November/December 2019

Local Coverage Determination and Article Revisions November–December 2019 LCDs and Articles Revised in November and December: B-type Natriuretic Peptide (BNP) Testing (L33573) Consistent with Change Request 10901, all coding information, [...]

CMS to Begin Using MFA Process for Online Provider Enrollment System Applications

CMS to Begin Using MFA Process for Online Provider Enrollment System Applications CMS recently announced they will begin utilizing a MFA process for users of their Provider Enrollment Systems. MFA is a second layer of security used to [...]