Tobacco Counseling via Telehealth

Tobacco Counseling via Telehealth Health equity in telehealth is the opportunity for everyone to receive the health care they need and deserve, regardless of social or economic status. Medicare Part B covers intermediate and intensive tobacco [...]

Micro-invasive Glaucoma Surgery Update

Micro-invasive Glaucoma Surgery Update The MIGS LCD, L37244, and Billing and Coding Article, A56588, will not become final and therefore have been removed from the Medicare Coverage Database. Accordingly, at this time there will be no change [...]

January 2024 Billing and Coding Articles Updates

January 2024 Billing and Coding Articles Updates Billing and Coding: Denosumab (Prolia ™, Xgeva ™) (A52399) Coding Information #2 has been removed based on Transmittal 12397 (CR 13468), Payment of Codes for Chemotherapy Administration and [...]

January Code Set Update for PC Print: January 2024

January Code Set Update for PC-Print: January 2024 The PC-Print January code set update will be available on our website 1/3/2024. The update contains the following enhancements: CR13303 Implement Operating Rules - Phase III Electronic [...]

Improving Customer Experience

Improving Customer Experience We are committed to improving your experience. Please watch this two-minute video that explains how each day we review comments from providers who submit surveys to let us know what is working well and how we can [...]

New Version of PC-ACE: January 2024

New Version of PC-ACE: January 2024 PC-ACE Version 6.1 contains several CMS mandates and product enhancements including but not limited to the items listed below. MLN Matters® MM13248 Revised: Processing Services During Disenrollment from [...]

Medicare Part B Final Rule

New Medicare Topic – Medicare Part B Final Rule 2024

New Medicare Topic – Medicare Part B Final Rule 2024 CMS issued the final rule on 11/2/2023, which announces finalized policy changes for Medicare payments under the PFS and other Medicare Part B issues, effective on or after 1/1/2024. There [...]

CMS Region 2 Office Hours

CMS Region 2 Office Hours The CMS Region 2 Office recently began conducting a series of “Office Hours” calls. The purpose of these sessions is to provide brief updates on Medicare topics of current interest to Part A facilities, physicians and [...]

Hospice Cap Self-Reporting Reminder for the 2023 Cap Year

Hospice Cap Self-Reporting Reminder for the 2023 Cap Year The Hospice Cap Self-Reporting for the 2023 Cap Year (10/1/2022-9/30/2023) is due no later than 2/29/2024. Hospice providers should submit the pro-forma calculation along with [...]

Hospice Cap Self-Reporting

Hospice Cap Self-Reporting Table of Contents Hospice Cap Self-Reporting Cap Year (10/1/XXXX–9/30/XXXX) Completing the Pro-Forma Submitting the Pro-Forma Repaying an Overpayment Requesting an Extended Repayment Plan [...]

Therapy Requirements for Inpatient Rehabilitation Facilities

Therapy Requirements for Inpatient Rehabilitation Facilities The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 1 is the primary source for inpatient [...]

Correct Coding Reminder for Breast Imaging

Correct Coding Reminder for Breast Imaging When there are no abnormal and inconclusive findings on mammography and the only finding is dense breast tissue (ICD-10-CM codes R92.30-R92.34), the provision of an ultrasound is considered screening. [...]

MLN Connects® Newsletter: January 4, 2024

MLN Connects® Newsletter: January 4, 2024 News CMS Roundup (Dec 29, 2023) In-Home Vaccine Administration: Additional Payment Organizational Providers: Do You Need to Revalidate Your Enrollment Record Soon? Value-Based Insurance Design [...]

340B Drug Payment Policy Remedy Payment for CY 2018 to CY 2022

340B Drug Payment Policy Remedy Payment for CY 2018 to CY 2022 On 6/15/2022, the Supreme Court held in American Hospital Association v. Becerra that because CMS had not conducted a survey of hospitals’ acquisition costs, it could not vary the [...]

30-Day Home Health Therapy Reassessment Schedule

Intensive Outpatient Program

Medical Review

Education Partnership Request Form

Chimeric Antigen Receptor (CAR) T-cell Therapy

MLN Connects® Newsletter: January 11, 2024

MLN Connects® Newsletter: January 11, 2024 News Marriage and Family Therapist & Mental Health Counselor Services: Overpayments to Critical Access Hospitals Billing under Method II Medicare Part A Cost Report Exhibits: New Electronic [...]

MLN Matters® MM13331: Incorporation of Recent Provider Enrollment Regulatory Changes into Chapter 10 of CMS Publication (Pub.) 100-08 - Physician Fee Schedule (PFS) Final Rule

MLN Matters® MM13331 - Incorporation of Recent Provider Enrollment Regulatory Changes into Chapter 10 of CMS Publication (Pub.) 100-08 - Physician Fee Schedule (PFS) Final Rule Revised 1/12/2024

Low and No Medicare Utilization Cost Report

Low and No Medicare Utilization Cost Report No Utilization Cost Reports To comply with program cost reporting requirements, a provider that has not furnished any covered Medicare services during a cost reporting period must only complete the [...]

MLN Connects® Newsletter: January 18, 2024

MLN Connects® Newsletter: January 18, 2024 News CMS Finalizes Rule to Expand Access to Health Information and Improve the Prior Authorization Process Acute Hospital Care at Home Data Release CMS Roundup (Jan 12, 2024) Medicare Part B [...]

Medicare Requirements for Marriage and Family Therapists and Mental Health Counselors

Medicare Requirements for Marriage and Family Therapists and Mental Health Counselors Effective 1/1/2024, Medicare added two new nonphysician specialties. To enroll with Medicare, all the requirements for the specialty must be met. [...]

Teaching Physician Virtual Supervision in 2024 Clarification

Teaching Physician Virtual Supervision in 2024 Clarification This article is to clarify virtual supervision provided by the teaching physician for the key portions of the service of a resident. There has been some confusion on the setting in [...]

12/14/2023 Part B POE Advisory Group Meeting

12/14/2023 Part B POE Advisory Group Meeting Meeting Minutes Meeting Time: 10:00 a.m.‒12:00 p.m. ET Member Attendees: Jennifer Asencio, Doris Barnes, Aurelio Barraco, Madelon Berger, Joanna Bielak, Brenda Bedard, Sheila Bembenek, Madelon [...]

Revised: Interactive Voice Response System Feature Ending Soon

Revised: Interactive Voice Response System Feature Ending Soon It was announced on 1/10/2024 that the following function will no longer be available on our IVR System as of 2/16/2024. This change is currently delayed. Once a new date is [...]

Membership Rosters

Membership Rosters Jurisdiction 6 and Jurisdiction K Home Health POE Advisory Group Roster Member Provider/Institution State Anderson, Jade Promedica Senior Care (Heartland Home Health) Multi [...]

Telehealth Changes for 2024 – Modifier 95 and Place of Service Codes

Telehealth Changes for 2024 – Modifier 95 and Place of Service Codes National Government Services has received many questions regarding the use of modifier 95 going forward. CMS implemented the usage of modifier 95 during the COVID-19 PHE as a [...]

2024 Annual Update to the Therapy Code List: Caregiver Training Codes

2024 Annual Update to the Therapy Code List: Caregiver Training Codes The CMS annual update to the therapy code list includes three new caregiver training “sometimes therapy” codes to include caregiver training when the patient is not [...]

2024 Annual Update to the Therapy Code List: Remote Therapeutic Monitoring

2024 Annual Update to the Therapy Code List: Remote Therapeutic Monitoring CMS is updating Disposition 10, in addition to other modifications, to clarify that, for RTM services, physical and occupational therapists in private practice may [...]

The Part B Top Claim Errors Have Been Reviewed and Updated

The Part B Top Claim Errors Have Been Reviewed and 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 [...]

Frequently Asked Questions Have Been Reviewed and Updated

Frequently Asked Questions Have Been Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Topics available are: ASCA Appeals CAR T-cell [...]

Submit a Quarterly Credit Balance Report

Table of Contents Submit a Quarterly Credit Balance Report How to Submit a Quarterly Credit Balance Report Credit Balance Submission Timeline Failure to Submit/Late Filings Additional Tips for a Successful Credit Balance Report [...]

Credit Balance Report Reminder: Due Date Approaching

Credit Balance Report Reminder: Due Date Approaching For the quarter ending 12/31/2023, CBRs can be submitted starting 1/1/2024 and must be submitted within 30 days to be considered timely. The easiest and fastest way to submit your CBR is [...]

EDI Solutions J6

Helpful Resources EDI Front End Rejection Code Lookup Tool Reset My EDI Password Contact the EDI Help Desk 877-273-4334 Available by phone or email Monday–Friday* 8:00 a.m.–5:00 p.m. ET 8:00 a.m.–4:00 p.m. CT * Closed for training on the [...]

EDI Solutions JK

Helpful Resources EDI Front End Rejection Code Lookup Tool Reset My EDI Password Contact the EDI Help Desk 888-379-9132 Available by phone or email Monday–Friday* 8:00 a.m.–5:00 p.m. ET 8:00 a.m.–4:00 p.m. CT * Closed for training on the [...]

View Medicare Accountable Care Organization

View Medicare Accountable Care Organization ACOs are groups of doctors, hospitals and other health care providers, who come together voluntarily to give coordinated high quality care to Medicare patients they serve.  Coordinated care [...]

Targeted Probe HHH Right Hand

Helpful Resources Targeted Probe and Educate Manual NGSConnex Log Into NGSConnex NGSConnex User Guide USPS National Government Services, Inc. P.O. Box 7108 Indianapolis, IN 46207-7108 UPS/FedEx National Government Services, Inc. 220 [...]

Targeted Probe Part A Right Hand

Helpful Resources Targeted Probe and Educate Manual NGSConnex Log Into NGSConnex NGSConnex User Guide USPS National Government Services, Inc. P.O. Box 7108 Indianapolis, IN 46207-7108 UPS/FedEx National Government Services, Inc. 220 [...]

Targeted Probe HHH Right Hand

Helpful Resources Targeted Probe and Educate Manual NGSConnex Log Into NGSConnex NGSConnex User Guide USPS National Government Services, Inc. P.O. Box 6474 Indianapolis, IN 46206-6474 UPS/FedEx National Government Services, Inc. 220 [...]

J6 Part B Targeted Probe Right Hand

Helpful Resources Targeted Probe and Educate Manual NGSConnex Log Into NGSConnex NGSConnex User Guide USPS National Government Services, Inc. P.O. Box 6475 Indianapolis, IN 46206-6475 UPS/FedEx National Government Services, Inc. 220 [...]

Targeted Probe Part A Right Hand

Helpful Resources Targeted Probe and Educate Manual NGSConnex Log Into NGSConnex NGSConnex User Guide USPS National Government Services, Inc. P.O. Box 7108 Indianapolis, IN 46207-7108 UPS/FedEx National Government Services, Inc. 220 [...]

Targeted Probe JK B Right Hand

Helpful Resources Targeted Probe and Educate Manual NGSConnex Log Into NGSConnex NGSConnex User Guide USPS National Government Services, Inc. P.O. Box 7108 Indianapolis, IN 46207-7108 UPS/FedEx National Government Services, Inc. 220 [...]

Targeted Probe FQHC Right Hand

Helpful Resources Targeted Probe and Educate Manual

Medical Review Part A JK Right Hand

Helpful Resources Targeted Probe and Educate Manual The preferred method to submit Medical Records is NGSConnex NGSConnex NGSConnex User Guide Visit our Contact Us page for other methods of submission

Medical Review Part A J6 Right Hand

Helpful Resources Targeted Probe and Educate Manual The preferred method to submit Medical Records is NGSConnex: NGSConnex NGSConnex User Guide Visit our Contact Us page for other methods of submission.

Medical Review Part B J6Right Hand

Helpful Resources Targeted Probe and Educate Manual The preferred method to submit Medical Records is NGSConnex: NGSConnex NGSConnex User Guide Visit our Contact Us page for other methods of submission.

Medical Review HHH JK Right Hand

Helpful Resources Targeted Probe and Educate Manual The preferred method to submit Medical Records is NGSConnex: NGSConnex NGSConnex User Guide Visit our Contact Us page for other methods of submission.

Medical Review HHH J6 Right Hand

Helpful Resources Targeted Probe and Educate Manual The preferred method to submit Medical Records is NGSConnex: NGSConnex NGSConnex User Guide Visit our Contact Us page for other methods of submission.