PTB Prescription Drug Management

Prescription Drug ManagementWe have received many questions as to what prescription drug management consists of in the new 2021 E/M Medical Decision Making table. The quick answer is that the concept of prescription drug management has not [...]

2021 Medicare Participating Physicians Directory

2021 Medicare Participating Physicians DirectoryThe Medicare Participating Physicians Directory (MEDPARD) listing includes all providers in Part B Jurisdiction 6 and Jurisdiction K who have agreed to accept assignment on all Medicare-covered [...]

Save the Date: National Government Services Spring 2021 Virtual Conference

Save the Date: National Government Services Spring 2021 Virtual ConferenceMedicare 2021: A Journey to a Healthier Future and PartnershipThe National Government Services Provider Outreach and Education Team will be holding our latest bi-annual [...]

New Consolidated Home Page Coming Soon

New Consolidated Home Page Coming SoonComing soon, NGSConnex and NGSMedicare are uniting to become your new consolidated home page - NGSMedicare.com.You will have one single point of entry on NGSMedicare.com to access both NGSConnex, the secure [...]

New Home Health Video Tutorials

New Home Health Video TutorialsGreat news for our HH providers! The NGSMedicare.com YouTube video portal is now fully loaded with eight short, educational HH eligibility videos. Be the first to take a look by heading out to our YouTube channel [...]

National Government Services Part B Medical Review Newsletter March 2021

National Government Services Part B 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 this [...]

Article Updates for February and March 2021

Article Updates for February and March 2021Billing and Coding: IUD (Hormone-Eluting) for Endometrial Hyperplasia - CPT 58999 (A58649)This article contains coding and other guidelines that reflect proper billing for insertion of an IUD [...]

COVID-19 Vaccine and/or Monoclonal Antibodies in Rural Health Clinics and Federally Qualified Health Centers

COVID-19 Vaccine and/or Monoclonal Antibodies in Rural Health Clinics and Federally Qualified Health CentersAdministration of the COVID-19 vaccine and/or monoclonal antibodies does not qualify as a stand-alone visit. Independent and [...]

COVID-19 Vaccine and Monoclonal Antibody

COVID-19 Vaccine and Monoclonal AntibodyThe National Government Services COVID-19 Vaccine and Monoclonal Antibody web page is now available. In addition to important resources, the Medicare Part A and Part B Billing for the COVID-19 Vaccine and [...]

Reminders on the Prior Authorization Program for Certain Hospital Outpatient Department Services

Reminders on the Prior Authorization Program for Certain Hospital Outpatient Department ServicesEffective for dates of service on or after 7/1/2020, a PAR is required for certain OPD services.Hospital Responsibility: Submission of [...]

Nuclear Medicine Billing Reminder

Nuclear Medicine Billing ReminderNational Government Services has identified an issue with billing for nuclear medicine services under CPT codes 78429-78434.We are receiving claims without the service facility location on the electronic claim. [...]

National Government Services Gap-fill Pricing Requests 2021

National Government Services Gap-fill Pricing Requests 2021NGS, the MAC for Jurisdictions 6 and K has received the new laboratory test codes identified by CMS that require gap-fill pricing for 2021.The Protecting Access to Medicare Act (PAMA) [...]

Medicare Diabetes Programs

Medicare Diabetes ProgramsDiabetes 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 complications from the [...]

Psychotherapy Coverage Criteria: Approved Providers of Service

Psychotherapy Coverage Criteria: Approved Providers of ServiceApproved providers of service include physicians (MD/DO), clinical psychologists, clinical social workers, nurse practitioners, clinical nurse specialists and physician’s [...]

Psychotherapy Coverage Criteria: Treatment Plans

Psychotherapy Coverage Criteria: Treatment PlansIndividualized Treatment Plan: (A plan is not required if only a few brief services will be furnished)The plan must include:Date plan was established (can be no older than one year prior to the [...]

Medicare Opioid Treatment Program Enrollment and Billing 2021 Updates

Medicare Opioid Treatment Program Enrollment and Billing 2021 UpdatesThe CMS has modified coverage for the Medicare OTP beginning 1/1/2021.The modifications include:Coverage of OTP services in outpatient hospital settingA CMS-855A provider [...]

The NGS Immunization Roster Billing Job Aid is Now Available

The NGS Immunization Roster Billing Job Aid is Now AvailableWe’ve developed the Immunization Roster Billing Job Aid to provide you with instructions that will help you submit your claims correctly the first time. If you are enrolled as a mass [...]

April 2021 Release "Dark Days" for the Common Working File Hosts

April 2021 Release "Dark Days" for the Common Working File HostsFor the upcoming April 2021 Release:For Production, CWF will be observing the Gray Day on Thursday, 4/1/2021 and Dark Days starting Friday, 4/2/2021 through Sunday, 4/4/2021 to [...]

Penalty for Requests for Anticipated Payments Received More Than Five Days Early

Penalty for Requests for Anticipated Payments Received More Than Five Days EarlyThere has been an issue identified in which the Home Health Pricer program is incorrectly applying a penalty to RAPs received more than five days earlier than the [...]

Diabetes and Mental Health Awareness Policy Education Topics Are Available

Diabetes Awareness and Mental Health Awareness Policy Education Topics Are AvailableWe’ve enhanced our policy education web page to provide you with detailed information about Diabetes Awareness and Mental Health Awareness services.Did you know [...]

2020 Calendar Year 1099 Form Information

2020 Calendar Year 1099 Form Information National Government Services will mail all 1099 Forms for calendar year 2020 by 1/31/2021.Medicare providers and beneficiaries, who are serviced by NGS regardless of their location, will receive a single [...]

LCD and Article Updates for January and February 2021

LCD and Article Updates for January and February 2021Billing and Coding: Filgrastim, Pegfilgrastim, Tbo-filgrastim and biosimilars (A52408)HCPCS code Q5122 has been added to the "CPT/HCPCS Codes" section.Billing and Coding: Intravenous Immune [...]

Chiropractors and Physical Therapists Billing Medicare for Therapy Services

Chiropractors and Physical Therapists Billing Medicare for Therapy ServicesIf a chiropractor or a physical therapist submits an “always therapy” code, they MUST submit the appropriate physical therapy modifier (GN, GO, GP) with the code.If the [...]

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 [...]

COVID-19 Cost Report Due Date Extensions

COVID-19 Cost Report Due Date Extensions                 Due to updated instructions received from CMS relative to the COVID-19 public health emergency, and in [...]

Caring for Medicare Patients is a Partnership

Caring for Medicare Patients is a PartnershipCaring and treating your patients is not something that is done within a silo for any practitioner. In order to provide the best possible service and the best medical outcome for any patient requires [...]

IDM Go-Live Guidance for Providers using PS&R and/or MCReF

IDM Go-Live Guidance for Providers using PS&R and/or MCReFThe EIDM system that you use for accessing PS&R and MCReF is being replaced by the new IDM system on the weekend of 1/15/2021. Your account will be automatically converted from [...]

POE Advisory Group

POE Advisory GroupMeeting MinutesMeeting SchedulesMembership RostersMission and Charter

POE Advisory Group

POE Advisory GroupMeeting MinutesMeeting SchedulesMembership RostersMission and Charter

Medicare Diabetes Prevention Program (MDPP)

This section gives you access/education about first time Enrollment.

Supplemental Right Side Content Part A

Helpful ResourcesTPE Manual

How to Respond to Additional Development Requests for Herceptin Billing

How to Respond to Additional Development Requests for Herceptin BillingSeveral providers are responding to Herceptin-related ADRs without providing the required information. Herceptin billing must contain the number of milligrams that were used [...]

How to View and Print ADRs from FISS/DDE

How to View and Print ADRs from FISS/DDESteps to View and Print ADRs from FISS/DDE Provider Online SystemAccess the claims through the Claims Inquiry screen/option. Type 01 at the FISS/DDE Online System Main Menu and then type 12 on the [...]

Outpatient Department Prior Authorization for Implanted Spinal Neurostimulators Alert

Outpatient Department Prior Authorization for Implanted Spinal Neurostimulators AlertImplanted Spinal Neurostimulator Prior AuthorizationNational Government Services Medical Review initiated prior authorization reviews for the outpatient [...]

Anesthesia Furnished in Conjunction with Colonoscopy (Modifier 33 Versus Modifier PT) Policy Update

Anesthesia Furnished in Conjunction with Colonoscopy (Modifier 33 Versus Modifier PT) Policy UpdateIn the CY 2018 PFS Final Rule, the CMS modified reporting and payment for anesthesia services furnished in conjunction with and in support [...]

Provider Enrollment for Part A Providers

Provider Enrollment for Part A ProvidersHave you changed location? Remember to update your address and phone number in PECOS so National Government Services departments can reach you if needed.How do I update my information?Part A providers can [...]

Provider Enrollment Application Fee Amount for CY 2021

Provider Enrollment Application Fee Amount for CY 2021On 11/23/2020, CMS issued a notice: Provider Enrollment Application Fee Amount for Calendar Year 2021. Effective 1/1/2021, the application fee is $599 for institutional providers (as that [...]

Reopenings for Minor Errors and Omissions

Reopenings for Minor Errors and OmissionsA clerical error/omission reopening is an action taken to change an initial determination to correct minor errors or omissions outside of the Medicare appeal process.Reopening [...]

Electronic Data Interchange Help Desk E-mail Inquiry Form Assistance

EDI E-mail Inquiry Form Assistance*Required Field - An asterisk adjacent to the form field indicates that completion is required.Line of BusinessList the line of business for this inquiry or issue. Choose from the drop-down box.Medicare [...]

Protected Health Information and Personally Identifiable Information Email Guidelines

Protected Health Information and Personally Identifiable Information Email GuidelinesThe following information is considered PHI and PII. Note: These lists are not all-inclusive. If additional information is required to research an inquiry, [...]

Reminder: Medicare Prior Authorization Information Not Valid for Part B Submission – Claims Will Reject as Unprocessable

Reminder: Medicare Prior Authorization Information Not Valid for Part B Submission – Claims Will Reject as UnprocessableThis notice is being published as a reminder to all Medicare Part B providers. When you are submitting a claim to National [...]

Integrating Behavioral Health Care with Primary Care

Integrating Behavioral Health Care with Primary CareWhat is BHI? Medicare Behavioral Health Integration is a service for your patient that does not require the use of a behavioral health care team.Primary care physicians who are treating [...]

Psychiatric Collaborative Care Education for the Provider and Beneficiary

Psychiatric Collaborative Care Education for the Provider and BeneficiaryDid you know that the psychiatric CoCM integrates primary and behavioral health care and is considered an effective strategy in improving outcomes for beneficiaries [...]

End-Stage Renal Disease Laboratory Tests Job Aid

End-Stage Renal Disease Laboratory Tests Job AidDialysis Type: Hemodialysis, CCPD, IPD, HemofiltrationNon-AMCC Laboratory TestsFrequency/CPT CodesTest Name/AbbreviationPer treatment:85013 or 8501485018VariousHematocrit (Hct)Hemoglobin [...]

What Physicians Need to Know: Home Health Patient-Driven Groupings Model

What Physicians Need to Know: Home Health Patient-Driven Groupings ModelIn November 2018, CMS finalized a new case-mix classification model, the PDGM, effective beginning 1/1/2020. The PDGM relies more heavily on clinical characteristics and [...]

Medicare & You

Medicare & YouDownload the official Medicare & You handbook with important information about what’s covered by Medicare, preventive services, health plans, prescription drug plans, and your rights and appeals.

National Correct Coding Initiatives Edits - Physicians

Correcting and Avoiding Reason Code C7080: Inpatient Overlap

Correcting and Avoiding Reason Code C7080: Inpatient OverlapThis edit is applied to a home health episode claim that overlaps an inpatient claim in the system. A home health agency may bill for a visit on the day of inpatient admission and/or [...]

Home Health Prospective Payment System Booklet

Counting 90-Day Election Periods

Counting 60-Day Election Periods

Counting 60-Day Election Periods - Leap Year

Billing Hospice Physician, Nurse Practitioner and Physician Assistant Services (Related To Terminal Diagnosis)

Hospice Notice of Change of Ownership

Hospice Claim Submission Job Aid

Notification Letters

Notification Letters Prior to the start of the TPE, providers are being placed on medical review will receive a notification letter. The notification will have the edit name, the reason for review, instructions for sending in the ADR and [...]

LVAM Request Form

Counting 90-Day Election Periods - Leap Year

Who May File an Appeal?

Who May File an Appeal?Any of the following persons or entities is considered a party to an appeal of a claim for items or services payable under Medicare and, therefore, may appeal the initial claim determination and any subsequent appeal [...]