Search Results - NGSMEDICARE

Posting Date: 11/03/2023

MLN Connects® Newsletter: PFS, OPPS/ASC, & OPPS 340B-Acquired Drug Final Rules - November 2, 2023

MLN Connects® Newsletter: PFS, OPPS/ASC, & OPPS 340B-Acquired Drug Final Rules - November 2, 2023 Final Rules CMS Finalizes Physician Payment Rule that Advances Health Equity CMS Makes Hospital Prices More Transparent and Expands [...]

Posting Date: 02/02/2021

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 Required Elements When to Submit the [...]

Posting Date: 02/02/2021

Submit an Appeal Electronically with NGSConnex

Submit an Appeal Electronically with NGSConnex Table of Contents Submit an Appeal Electronically with NGSConnex Step 1: Access NGSConnex Step 2: Submit an Electronic Appeal and Attach Documentation Step 3: Attach Documentation [...]

Posting Date: 08/11/2021

Get Help Submitting an Appeal Hard Copy

Get Help Submitting an Appeal Hard Copy Table of Contents Get Help Submitting an Appeal Hard Copy Step 1: Complete the Appeals Request Form Helpful Tips: [Return to Top] Get Help Submitting an Appeal Hard Copy All levels of appeals [...]

Posting Date: 02/24/2022

Reopenings for Minor Errors and Omissions

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

Posting Date: 06/02/2023

Billing Original Fee-for-Service Medicare? You can Help STOP Assignment Violations!

Billing Original Fee-for-Service Medicare? You can Help STOP Assignment Violations! Table of Contents Billing Original Fee-for-Service Medicare? You can Help STOP Assignment Violations! What is the Definition of Medicare Assignment? [...]

Posting Date: 11/03/2023

Overpayment: How Should I Respond?

Table of Contents Overpayment: How Should I Respond? What Action Should I Take? Complete a Voluntary Refund Where Should I Send my Forms and Payments? [Return to Top] Overpayment: How Should I Respond? An overpayment may be [...]

Posting Date: 02/02/2021

What Documents are Needed

What Documents are Needed Table of Contents What Documents are Needed Supporting Medical Records Ambulance Ambulatory Surgery, Operating Room, Lithotripsy and Preadmission Testing Cardiac Rehabilitation Clinic and Therapeutic [...]

Posting Date: 03/23/2015

Medicare Provider & Supplier Search

Medicare Provider & Supplier Search Search the CMS Website Find a doctor Find a supplier Search the National Government Services Website Medicare Participating Physicians Directory

Posting Date: 12/19/2016

Social Security Administration Resources

Social Security Administration Resources Common Issues Handled by the Social Security Administration The following Medicare-related issues are the responsibility of the Social Security Administration (SSA) and should be handled by your local [...]

Posting Date: 10/07/2010

Social Security Administration

Social Security Administration All Medicare/Social Security-related questions are handled by the closest Social Security office in each Congressional district for each state. The following describe reasons to contact the SSA regarding [...]

Posting Date: 04/26/2023

Tobacco Cessation Counseling Doesn’t Have To Be Lengthy or Intimidating

Tobacco Cessation Counseling Doesn’t Have To Be Lengthy or Intimidating Did you know that tobacco cessation counseling is a covered Medicare service? Brief tobacco counseling provides substantial health benefits while producing cost savings. [...]

Posting Date: 11/06/2023

Common Definitions for Claim Submission Types

Common Definitions for Claim Submission Types Appeals An appeal is an independent review of the initial or revised determination. Proceeding with an appeal is the responsibility of the provider. Overall there are five levels of appeal the [...]

Posting Date: 10/10/2022

The Great American Smokeout is Coming!

The Great American Smokeout is Coming! As a health care professional who provides care to patients with Medicare, you can help protect the health of your patients by encouraging them to take advantage of Medicare-covered preventive services, [...]

Posting Date: 01/26/2015

State Health Insurance Assistance Program

State Health Insurance Assistance Program The State Health Insurance Assistance Program (SHIP) is a national program available in all states that offers free and unbiased one-on-one counseling and assistance to People with Medicare and [...]

Posting Date: 06/04/2020

Beneficiary Contact Center

Beneficiary Contact Center People with Medicare have a single Medicare point-of-contact at: 1-800-MEDICARE 1-800-633-4227 TTY/TDD: 1-877-486-2048 1-800-MEDICARE connects you to a seamless network of customer service entities that [...]

Posting Date: 09/16/2020

Using Touch-Tone

Using Touch-Tone Table of Contents Using Touch-Tone Using Touch-Tone for Alpha-Numeric Elements Using Touch-Tone to Enter a Letter [Return to Top] Using Touch-Tone The IVR is programmed to allow for the entry of all data [...]

Posting Date: 09/16/2020

Claim Status <2>

Claim Status <2> If you are part of a group, remember to use the group NPI, PTAN and TIN for authentication purposes. When Claim Status is selected, the IVR will request and collect the following elements: NPI PTAN Last five [...]

Posting Date: 09/16/2020

Checks <3>

table, td, th { border: 1px solid black; } table { border-collapse: collapse; width: 50%; } Checks <3> Table of Contents Checks <3> My Checks Information Checks Navigation Check Number Check Status [...]

Posting Date: 09/16/2020

Offsets <4>

table, td, th table { border-collapse: collapse; width: 50%; } Offsets <4> Upon selecting Offsets, the provider will need to authenticate the following information: NPI PTAN Last five digits of the TIN Next, a submenu will [...]

Posting Date: 11/08/2023

Set Up an Extended Repayment Schedule

If repaying an overpayment would constitute a “hardship” on the provider, a request for an ERS should be submitted immediately. While you may request an ERS at any time during the debt-collection process, timely submission of a valid request [...]

Posting Date: 11/08/2023

Set Up an Extended Repayment Schedule

If repaying an overpayment would constitute a “hardship” on the provider, a request for an ERS should be submitted immediately. While you may request an ERS at any time during the debt-collection process, timely submission of a valid request [...]

Posting Date: 11/08/2023

Set Up an Extended Repayment Schedule

If repaying an overpayment would constitute a “hardship” on the provider, a request for an ERS should be submitted immediately. While you may request an ERS at any time during the debt-collection process, timely submission of a valid request [...]

Posting Date: 11/08/2023

Provider Enrollment: Reminder for Open Enrollment and Participation Agreement

Provider Enrollment: Reminder for Open Enrollment and Participation Agreement The 2024 Annual Participation Open Enrollment Period is approaching for another year. While this is an important time (from mid-November to December 31) for [...]

Posting Date: 09/16/2020

Provider Enrollment <6>

table, td, th table { border-collapse: collapse; width: 50%; } Provider Enrollment <6> When Provider Enrollment is selected, the IVR will request and collect the following information: Case number (If case number is unavailable, [...]

Posting Date: 09/16/2020

Appeals <7>

table, td, th table { border-collapse: collapse; width: 50%; } Appeals <7> When the Appeals option is selected, the IVR will request and collect the following elements: Provider authentication elements: NPI PTAN TIN Note: [...]

Posting Date: 09/16/2020

General Information <8>

table, td, th table { border-collapse: collapse; width: 50%; } General Information <8> When the general information option is selected, the IVR will prompt you to choose from the following options: Phone numbers Addresses [...]

Posting Date: 09/16/2020

Phonetic Alphabet

table, td, th table { border-collapse: collapse; width: 50%; } Phonetic Alphabet To assist you when speaking terms that are alpha-numeric, we have implemented the phonetic alphabet. When speaking an alpha character, please use the either [...]

Posting Date: 09/16/2020

Using Touch-Tone

Using Touch-Tone The IVR is programmed to allow for the entry of all data using touch‐tone in the event the user is unable to successfully speak to the IVR. These instructions detail how to use touch‐tone to enter various types of information [...]

Posting Date: 09/16/2020

Checks <3>

table, td, th table { border-collapse: collapse; width: 50%; } Checks <3> If you are part of a group, remember to use the group NPI, PTAN and TIN for authentication purposes. Upon selecting Checks, the provider will need to [...]

Posting Date: 09/16/2020

Remittance Statements <4>

table, td, th table { border-collapse: collapse; width: 50%; } Remittance Statements <4> Upon selecting Remittance Statements, the provider will need to authenticate the following information: NPI PTAN Last five (5) digits of [...]

Posting Date: 09/16/2020

Patient Status <6>

table, td, th table { border-collapse: collapse; width: 50%; } Patient Status <6> When Patient Status is selected, the IVR will request and collect the following information: NPI PTAN TIN Once the authentication elements [...]

Posting Date: 09/16/2020

Appeal Status <7>

Appeal Status <7> When Appeal Status is selected, the IVR will request and collect the following information: NPI PTAN TIN HICN or MBI Refer to the Phonetic Alphabet for assistance with speaking alpha characters [...]

Posting Date: 11/08/2023

Determine Beneficiary Responsibility on an MSP Claim

Table of Contents Determine Beneficiary Responsibility on an MSP Claim Step 1: Review the Remittance Advice Step 2: Assess the Beneficiary’s Responsibility The MSP Patient Responsibility Formula: The Beneficiary’s Responsibility on [...]

Posting Date: 11/09/2023

MLN Connects® Newsletter: November 9, 2023

MLN Connects® Newsletter: November 9, 2023 News CMS Roundup (Nov 3, 2023) Marriage and Family Therapists & Mental Health Counselors: Enroll in Medicare Now American Indians or Alaska Natives: Help Your Patients Achieve Optimal [...]

Posting Date: 05/03/2022

Vein Ablation and Related Services

General Documentation Requirements for Vein Ablation and Related Services Checklist of prior authorization request (PAR) information to include: Doppler ultrasound results Documentation stating presence or absence of DVT (deep vein [...]

Posting Date: 03/17/2016

Electrical Stimulation Therapy: Important Coverage and Documentation Reminders

Electrical Stimulation Therapy: Important Coverage and Documentation Reminders Table of Contents CPT/HCPCS: 97032 Coverage and Documentation Provider Actions Related Content [Return to Top] CPT/HCPCS: 97032 National Government [...]

Posting Date: 02/26/2016

Documentation Reminder: Psychiatry and Psychology Services

Documentation Reminder: Psychiatry and Psychology Services Table of Contents Documentation Reminder: Psychiatry and Psychology Services Submitting Documentation Provider Actions Related Content [Return to Top] Documentation [...]

Posting Date: 05/03/2022

Botulinum Toxin Injections

General Documentation Requirements for Botulinum Toxin Injections Prior authorization is only required when one of the required Botulinum Toxin codes (J0585, J0586, J0587, or J0588) is used in conjunction with one of the required CPT injection [...]

Posting Date: 11/09/2023

Processing Issue Botulinum Toxin Claims Returned to Provider with 5PRIA

Part A claims that have been submitted with Botulinum J codes (J0585, J0586, J0587, J0588) have incorrectly RTP with reason code 5PRIA.

Posting Date: 08/04/2022

Medicare Part B Coverage and Billing Guidance for Breast Ultrasound

Medicare Part B Coverage and Billing Guidance for Breast Ultrasound Breast ultrasound uses sound waves to produce pictures of the inside of the breast and can show changes that are more difficult to see on a mammogram. Breast ultrasound is not [...]

Posting Date: 01/08/2021

Corporate Holiday Schedule

Corporate Holiday Schedule The National Government Services Provider Contact Centers will be closed in 2024 to observe the following corporate holidays: Date Corporate Holiday Observed Monday, January 1, 2024 New [...]

Posting Date: 04/27/2023

KX Modifier on Outpatient Physical Therapy, Occupational Therapy or Speech Language Pathology Claims

KX Modifier on Outpatient Physical Therapy, Occupational Therapy or Speech Language Pathology Claims Reminders Providers report KX modifier on a claim line(s) to confirm the medical records contain specific required documentation that meets [...]

Posting Date: 03/29/2023

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

LCD, Billing and Coding Article Updates for March and April 2023 Pain Management (L33622) Effective 3/19/2023 The LCD has been revised to remove all references to sacroiliac joint injections. Please refer to LCD L39455 Sacroiliac Joint [...]

Posting Date: 06/29/2023

National Government Services Proposed LCDs for Comment (6/22/2023-8/5/2023) - Update

National Government Services Proposed LCDs for Comment (6/22/2023-8/5/2023) - Update The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from [...]

Posting Date: 10/05/2023

National Government Services Proposed LCDs for Comment

National Government Services Proposed LCDs for Comment The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 10/5/2023–11/18/2023. These proposed [...]

Posting Date: 04/07/2022

Panniculectomy Best Practices

Panniculectomy Best Practices Table of Contents Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (including Lipectomy) and Related Services Coverage Documentation Requirements Best practice/documentation [...]

Posting Date: 05/03/2022

Botulinum Toxin Best Practices

Botulinum Toxin Best Practices Table of Contents Botulinum Toxin Injections Coverage Documentation Requirements Best Practice/Documentation Feedback/Tips and Help Related Content [Return to Top] Botulinum Toxin [...]

Posting Date: 10/29/2021

Implantation of Spinal Neurostimulator

Implantation of Spinal Neurostimulator Table of Contents Implantation of Spinal Neurostimulator Coverage Documentation Requirements Best Practice/Documentation Feedback/Tips Related Content [Return to Top] Implantation of [...]

Posting Date: 06/14/2023

Facet Joint Interventions for Pain Management Best Practices

Facet Joint Interventions for Pain Management Best Practices Table of Contents Indications and/or Medical Necessity Coverage Documentation Requirements Diagnostic Facet Joint Injections (IA or MBB) Therapeutic Facet Joint Injection [...]

Posting Date: 01/03/2022

Respiratory Pathogen Panel Testing

Respiratory Pathogen Panel Testing N/A L39027 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39027 A58741 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=58741 A58890 [...]

Posting Date: 10/05/2023

Cardiovascular Nuclear Medicine

Cardiovascular Nuclear Medicine cardiac scan, stress test, heart, coronary, ejection, perfusion, blood pool L33560 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33560 A56743 [...]

Posting Date: 10/05/2023

Epidural Steroid Injections for Pain Management

Epidural Steroid Injections for Pain Management spine, pain, transforaminal, sacral, steroid, spinal L39036 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39036 A58745 [...]

Posting Date: 09/30/2021

Visual Fields Testing

Visual Fields Testing eyes, ophthalmology, vision L33574 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33574 A56551 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56551 92081, 92082, 92083

Posting Date: 04/19/2021

Visual Electrophysiology Testing

Visual Electrophysiology Testing N/A L36831 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=36831 A57060 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57060 A55475 [...]

Posting Date: 06/01/2023

Urodynamics

Urodynamics cystometrogram, uroflowmetry, urethral pressure profile, sphincter electromyogram, sphincter electromyogram, incontinence, voiding dysfunction L33576 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33576 A57455 [...]

Posting Date: 10/12/2022

Transthoracic Echocardiography (TTE)

Transthoracic Echocardiography (TTE) cardiac, doppler, stress, cardovascular, myocardial, heart, contrast L33577 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33577 A56781 [...]

Posting Date: 07/27/2023

Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)

Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) ionizing, stereotactic guidance, robotic L35076 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=35076 A56874 [...]

Posting Date: 10/02/2022

Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) OCT, eyes, cornea, glaucoma L34380 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=34380 A56537 https://www.cms.gov/medicare-coverage-database/view/article.aspx?artic[...]

Posting Date: 07/13/2023

Peripheral Nerve Blocks

Peripheral Nerve Blocks N/A L36850 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=36850 A57452 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57452 A55421 [...]