National Government Services: Raising Awareness about Care Management

National Government Services: Raising Awareness about Care ManagementAccording to the Center for Disease Control (CDC), an estimated 117 million adults have one or more chronic health conditions, and one in four adults have two or more chronic [...]

Medicare Telehealth versus Telemedicine

Medicare Telehealth versus TelemedicineWe have received many questions that have indicated confusion between telehealth and telemedicine, and which rules apply to which services within these two benefit categories. While there is a perceived [...]

Billing Tip for COVID-19 Vaccine as a Mass Immunizer Roster Biller - Use the Taxonomy Code

Billing Tip for COVID-19 Vaccine as a Mass Immunizer Roster Biller - Use the Taxonomy CodeNational Government Services highly recommends that Part B providers who are credentialed as a Mass Immunizer (specialty 73) and have multiple PTANs [...]

Annual Security Training/Certifying Access

Annual Security Training/Certifying AccessEvery 365 days NGSConnex LSOs and users are required to review the annual Security Awareness Training, including the rules of behavior and acknowledge access still is required. NGSConnex will display [...]

Use NGSConnex to Submit Quarterly Credit Balance Reports

Use NGSConnex to Submit Quarterly Credit Balance ReportsWe recently posted a news article that explained the process and benefits of using NGSConnex to submit quarterly credit balance reports. Today’s article contains the resolutions for common [...]

Reminder: General Anesthesia and Conscious Sedation is Not Medically Necessary for Facet Joint Interventions

Reminder: General Anesthesia and Conscious Sedation is Not Medically Necessary for Facet Joint InterventionsOn 4/25/2021 National Government Services revised the Local Coverage Determination L35936 “Facet Joint Interventions for Pain [...]

Prior Authorization Exemption: Part B Provider Role

Prior Authorization Exemption: Part B Provider RoleCMS has identified certain Part A HOPDs as having a prior authorization affirmation rate of 90% or greater. As a result, these HOPDs are currently exempt from submitting prior authorization [...]

National Government Services Proposed LCDs for Comment

National Government Services Proposed LCDs for CommentThe proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 6/3/2021 through 7/17/2021.These draft [...]

Why Use NGSConnex?

Why Use NGSConnex?Each day, thousands of claims and eligibility-based inquiries and other Medicare transactions are successfully completed through NGSConnex. As a registered NGSConnex user you will have instant online access to invaluable [...]

Registration is Now Open for the 2021 Home Health and Hospice Medicare Administrative Contractor Collaborative Summit

Registration is Now Open for the 2021 Home Health and Hospice Medicare Administrative Contractor SummitRegistration is now open for the HH+H MAC Collaborative Summit, Operation Collaboration: We are all in this Together. This summit will [...]

Lower Limb Orthosis: A/B and DME Collaborative Presentation

Lower Limb Orthosis: A/B and DME Collaborative PresentationThe A/B and DME MAC’s Lower Limb Orthosis: A/B and DME Collaborative Presentation - YouTube presentation is available. This video presentation provides suppliers information on the [...]

What To Do If You Can’t Log Into NGSConnex

What To Do If You Can’t Log Into NGSConnexIf you attempt to log into NGSConnex and are unsuccessful you must first determine the reason you can’t log in.First Attempt to Log InOn your first attempt if you enter your User ID and/or password [...]

New NGSMedicare.com is Coming Soon

New NGSMedicare.com is Coming SoonWe continue to listen and gain invaluable insight from you on our provider content website, NGSMedicare.com. Coming mid-Summer 2021, you will be able to see your feedback put into action.Watch this video for a [...]

Action Needed: Update Your Browser Now

Action Needed: Update Your Browser NowStarting July 2021, the NGSMedicare.com site will not support the Internet Explorer (IE) browser. For an optimal NGSMedicare.com experience, to access either the secure, self-service provider portal [...]

A/B and DME MAC Collaborative Therapeutic Shoes for Persons with Diabetes

A/B and DME MAC Collaborative Therapeutic Shoes for Persons with DiabetesProviders – Do you need assistance in understanding what is needed when ordering diabetic shoes? This collaborative webinar on therapeutic shoes for persons with diabetes [...]

May 2021 LCD Updates

May 2021 LCDs UpdatesFACET Joint Interventions for Pain Management (L35936)In the Summary of Evidence section, the following corrections have been made:Under the heading – Diagnostic Facet Joint Injections, a reference number has been added to [...]

Revised Fees for Code G0399

Revised Fees for Code G0399National Government Services has reviewed the fees for code G0399 (Home sleep test [HST] with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG; heart rate and 1 [...]

The Provider Contact Center Has a New Option for Diabetic Self-Management Training and Medical Nutrition Therapy Information

The Provider Contact Center Has a New Option for Diabetic Self-Management Training and Medical Nutrition Therapy InformationCalling the PCC to get information on DSMT and MNT just got easier. When you call the PCC and complete authentication, [...]

Reminder: Billing for Facet Joint Interventions for Pain Management and Anesthesia

Reminder: Billing for Facet Joint Interventions for Pain Management and AnesthesiaAs of 4/25/2021, per LCD L35936, general anesthesia is considered not reasonable and necessary for facet joint interventions. Neither conscious sedation nor [...]

Submitting Refunds to National Government Services

Submitting Refunds to National Government ServicesNational Government Services is receiving an influx of unsolicited voluntary refunds without proper documentation.To facilitate prompt and accurate posting of unsolicited monies or voluntary [...]

Children’s Hospitals Verification of Age for Eligibility

Billing and Coding: Complex Drug Administration Coding for Subcutaneous and Intramuscular Routes (A58620) Reminder

Billing and Coding: Complex Drug Administration Coding for Subcutaneous and Intramuscular Routes (A58620) Reminder National Government Services identified claim billing errors for complex drug administration coding for subcutaneous and [...]

COBA Medigap Claim-Based IDs

Prolonged Services: Non-Face-to-Face

Prolonged Services: Non-Face-to-Face Code Definition Provider Guidance As of 1/1/2017, CMS authorized non face-to-face prolonged services (CPT codes 99358‒99359) as payable services. In conjunction with this approval, CMS [...]

Span Date Billing Guide

Span Date Billing Guide Certain DMEPOS items must be submitted with span dates according to the number of days the item or service is being rendered. When billing with span dates, the “From” date should reflect the date that the item was [...]

Provider Revalidation Interactive Tool_Intro

Provider Revalidation Interactive Tool  This tool is designed to assist Part B applicants who are revalidating enrollment. If the reason for your application is other than revalidation, then please refer to the Enrollment tab on our [...]

Improving Customer Experience in 2021

Improving Customer Experience in 2021We are committed to improving your experience. Each day, we review comments from providers who submit surveys to let us know what is working well and how we can improve. We appreciate your feedback. This is [...]

May is National Mental Health Awareness Month

May is National Mental Health Awareness MonthAlthough May is the month of national focus on mental health awareness, it is a daily focus for many dealing with mental health conditions. Integrating behavioral health care with primary care [...]

Reminder: Medicare Part B Voluntary Refunds

Reminder: Medicare Part B Voluntary RefundsProviders submitting voluntary refunds need to be aware that when completing the Part B Voluntary Overpayment Refund Form, additional claim data is required:Complete the Part B Voluntary Overpayment [...]

Cognitive Assessment and Care Plan Services (CPT 99483)

Cognitive Assessment and Care Plan Services (CPT 99483)Medicare covers a separate visit for a cognitive assessment if your patient shows signs of cognitive impairment at their annual wellness visit or a routine visit. The cognitive assessment [...]

MACs to Host Multi-Jurisdictional CAC Meeting Regarding Facet Joint and Medial Nerve Branch Procedures

MACs to Host Multi-Jurisdictional CAC Meeting Regarding Facet Joint and Medial Nerve Branch ProceduresThe MACs will host a multi-jurisdictional CAC via Teleconference on 5/28/2020 from 1:00 p.m.‒4:00 p.m. CDT, 2:00 p.m.‒5:00 p.m. [...]

MAC Customer Experience Survey

MAC Customer Experience SurveyWe often receive feedback from our website users who get frustrated because our MCE survey displays before they are done visiting our website. We understand that it’s better for you to finish your visit before you [...]

Hospice Cap Self-Reporting Reminder

Hospice Cap Self-Reporting ReminderThe Hospice Cap Self-Reporting for the 2020 Cap Year (10/1/2019-9/30/2020) is due no later than 3/1/2021. Hospice providers should submit the pro-forma calculation along with supporting documentation and a [...]

New PC-ACE Version Will Soon Be Available

New PC-ACE Version Will Soon Be AvailableA new version PC-ACE Version 4.6.0.100 will be available 6/2/2020 for download from our website. This new PC-ACE version has been updated to include new HCPCS and ICD-10 diagnosis codes for COVID-19. [...]

There's Still Time to Register for the National Government Services Spring 2021 Virtual Conference

There's Still Time to Register for the National Government Services Spring 2021 Virtual ConferenceMedicare 2021: A Journey to a Healthier Future and PartnershipThe National Government Services POE Team's bi-annual virtual conference is [...]

MCReF/PS&R Official Supported Browser to Change on 6/21/2021

MCReF / PS&R Official Supported Browser to Change on 6/21/2021Beginning, Monday, 6/21/2021, the supported browser for MCReF system and PS&R system is changing from IE to Google Chrome. With this change, MCReF and PS&R will no longer [...]

Multi-Jurisdictional CAC Meeting on Amniotic Product Injections for Musculoskeletal Indications, Non-Wound

Multi-Jurisdictional CAC Meeting on Amniotic Product Injections for Musculoskeletal Indications, Non-WoundNoridian Healthcare Solutions along with CGS Administrators, First Coast Services Options, National Government Services, Novitas [...]

Accelerated and Advanced Payment Nettings/Offsets Across Organization Affiliations

Accelerated and Advanced Payment Nettings/Offsets Across Organization AffiliationsWe are receiving an influx of calls to our Provider Contact Center with regard to recoupment of AAPs with providers questioning recoupments on funds they believe [...]

Outpatient Prospective Payment System Part B Drug Payment and Status Indicator Change for Healthcare Common Procedure Coding System Q5122

Outpatient Prospective Payment System Part B Drug Payment and Status Indicator Change for Healthcare Common Procedure Coding System Q5122The following instructions have been provided by CMS to National Government Services for HCPCS code Q5122. [...]

LCD and Article Updates for April and May 2021

LCD and Article Updates for April and May 2021April 2021 Medical Policy Article UpdatesBilling and Coding: Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography (A52849)This article has been updated due to a provider request to [...]

Clinicians Ordering Oxygen and Oxygen Equipment – COVID-19 PHE Reference Guide

Clinicians Ordering Oxygen and Oxygen Equipment – COVID-19 PHE Reference GuideAs a result of the COVID-19 PHE, CMS has issued waivers and flexibilities to assist Medicare beneficiaries in obtaining the services they need and allowing [...]

Responding to an Additional Documentation Request

Responding to an Additional Documentation RequestMost recently, National Government Services has experienced an increasing volume of 56900 denials: medical records not submitted upon receipt of an ADR. In response to the lack of submission of [...]

CGI Hosting an Upcoming Session on “Easier File Uploads for E-Filing in MCReF”

CGI Hosting an Upcoming Session on “Easier File Uploads for E-Filing in MCReF”Medicare Part A Cost Report: Easier File Uploads for e-Filing in MCReF Webcast:Date: Thursday 4/29/2021Time: 1:00–2:30 p.m. ETRegister today DescriptionMedicare [...]

Behavioral Health Integration Services: Psychiatric Collaborative Care Model

Behavioral Health Integration Services: Psychiatric Collaborative Care ModelIntegrating behavioral health care with primary care (“behavioral health integration” or “BHI”) is an effective strategy for improving outcomes for the millions of [...]

Checking the Status of Your Accelerated or Advanced Overpayment

Checking the Status of Your Accelerated or Advanced OverpaymentIf you requested an accelerated or advanced payment (AAP), then the overpayment amount is right at your fingertips. We would like to share some great tips on managing your accounts [...]

COVID-19 Lump Sum Payments for RHCs and FQHCs

COVID-19 Lump Sum Payments for RHCs and FQHCsRHCs and FQHCs may request lump sum payments for administering COVID-19 vaccines in advance of cost report settlement. CMS, through your MAC, will pay you up front for COVID-19 vaccines and [...]

Medicare Diabetes Maintenance Programs

Medicare Diabetes Maintenance ProgramsDiabetes management is an important topic to National Government Services. Patients diagnosed with diabetes may experience challenges with managing their diabetes and are more likely to experience many [...]

Provider Enrollment: Submitting Claims Before the Effective Date

Provider Enrollment: Submitting Claims Before the Effective DateNational Government Services has noticed an increase of Part B claim submissions from Medicare enrolled group practices for rendering providers prior to receiving their approval [...]

LCD and Article Updates for April 2021

LCD and Article Updates for April 2021New LCDs/ArticlesColon Capsule Endoscopy (CCE) (L38571)CCE is a noninvasive procedure that does not require air inflation or sedation and allows for minimally invasive and painless colonic evaluation. It is [...]

About Appeals

About AppealsProviders and beneficiaries have the right to appeal claim determinations made by National Government Services. The purpose of the appeals process is to ensure the correct adjudication of claims. Appeals activities conducted by NGS [...]

New Documentation Requirements for Filing Medicare Cost Reports

New Documentation Requirements for Filing Medicare Cost ReportsAttention: The FY 2019 Medicare IPPS final rule changed the required supporting documentation that must be submitted with the Medicare cost report. CMS also published MLN Matters [...]

Provider Enrollment: Change in Practice Location

Provider Enrollment: Change in Practice LocationThe fastest way to update a provider enrollment record is through PECOS for the individual (NPI Type 1) or entity/group (NPI Type 2). PECOS allows you to edit, add and delete information according [...]

COVID-19 Accelerated/Advance Payment Revised Repayment Terms

COVID-19 Accelerated/Advance Payment Revised Repayment TermsThe recently enacted Continuing Appropriations Act, 2021 and Other Extensions Act amended the repayment terms for the COVID-19 accelerated/advance payments. The changes to the [...]

COVID-19: RHC and FQHC Lump Sum Payments

COVID-19: RHC and FQHC Lump Sum PaymentsRural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) may request lump sum payments for administering COVID-19 vaccines in advance of cost report settlement. CMS will pay you for [...]

Responding to a Hospice ADR

Responding to a Hospice ADRNational Government Services performs medical review audits of services billed to Medicare to validate that the documentation supports coverage and level of services billed.When you receive an ADR, it is important to [...]

Updated Billing Requirements for Home Infusion Therapy (HIT) Services on or After 1/1/2021

Updated Billing Requirements for Home Infusion Therapy (HIT) Services on or After 1/1/2021CR12108Posted 3/29/2021

Update to Rural Health Clinic (RHC) Payment Limits

Update to Rural Health Clinic (RHC) Payment LimitsCR12185Posted 3/29/2021

Local Coverage Determination L33626: Psychiatric Partial Hospitalization Programs

Local Coverage Determination L33626: Psychiatric Partial Hospitalization ProgramsA psychiatric partial hospitalization is a distinct and organized intensive psychiatric outpatient treatment of less than 24 hours of daily care, designed to [...]

Outpatient Prospective Payment System Payment Rate for HCPCS Code A9591

Outpatient Prospective Payment System Payment Rate for HCPCS Code A9591CMS identified an error with the January 2021 OPPS Pricer file where the OPPS payment rate for HCPCS A9591 was incorrect.The correct OPPS payment rate for A9591 [...]

National Government Services Part A Medical Review Newsletter March 2021

National Government Services Part A Medical Review Newsletter March 2021The National Government Services Medical Review department would like to welcome you to our newest service; a regular newsletter. It is our hope that you will find [...]