276 Claim Status Inquiry Near Real-Time Response

276 Claim Status Inquiry Near Real-Time Response We are excited to announce a process change for our Part A providers that will return a 277 Claim Status Inquiry Response in “near real time.” Beginning in October, 2019, we will return the 277 [...]

Medicare Beneficiary Identifier Monthly Tip

Medicare Beneficiary Identifier Monthly Tip Are you receiving claim rejections because of an invalid beneficiary identifier? It could be that you are using the wrong characters on the MBI. The new Medicare number will not include the letters [...]

Changes to National Government Services Local Coverage Determination Process

Changes to National Government Services Local Coverage Determination Process In accordance with Section 4009 of H.R. 34-21st Century Cures Act (Public Law No: 114-255), CMS is updating the “Medicare Program Integrity Manual” with detailed [...]

Attention PIP Hospitals – Delay in Periodic Interim Payment (PIP) Payments

Attention PIP Hospitals – Delay in Periodic Interim Payment (PIP) Payments We have been informed that the biweekly PIP/Pass-Through payment cycle did not initiate as scheduled last night. Therefore, the biweekly payments will be delayed by one [...]

Reminder: ZIP Code Needed on Claims with Flu Vaccine Codes

Reminder: ZIP Code Needed on Claims with Flu Vaccine Codes Medicare Part B requires the location where the service(s) are rendered to be included on the claim for every service payable under the MPFS. In Box 32 on the CMS-1500 claim form, [...]

MLN Connects® for Thursday, June 13, 2019

MLN Connects® for Thursday, June 13, 2019 MLN Connects® for Thursday, June 13, 2019 View this edition as a PDF News DMEPOS Competitive Bidding - Round 2021: Register Now Medicare Shared Savings Program: Submit Notice of Intent to [...]

EDI Front End Rejection Code Lookup Tool

EDI Front End Rejection Code Lookup Tool The EDI Front End Rejection Code Lookup Tool is a simple to use tool that provides a clear and understandable description of edit codes returned on the 277 Claims Acknowledgement (277CA). Using this [...]

Center for Medicare and Medicaid Innovation Payments

Center for Medicare and Medicaid Innovation Payments Section 1115A of the Social Security Act established the CMMI within the CMS to test innovative payment techniques and service delivery models. This payment model is outside the normal [...]

CMS Is Using Multi-Factor Authentication Process for Online Provider Enrollment System Applications

CMS Is Using Multi-Factor Authentication Process for Online Provider Enrollment System Applications CMS announced they utilize an MFA process for users of their Provider Enrollment Systems.  MFA is a second layer of security used to [...]

Local Coverage Determination and Article revisions August‒September 2019

Local Coverage Determination and Article revisions August‒September 2019 Please note that consistent with Change Request 10901, all coding information, national coverage provisions and Associated Information (Documentation Requirements, [...]

Important Update for Skilled Nursing Facilities - CMS Updated the SNF PDPM Web Page

Important Update for Skilled Nursing Facilities - CMS Updated the SNF PDPM Web page The SNF PPS PDPM was implemented on 10/1/2019 to replace the Resource Utilization Group, Version IV (RUG-IV) for the SNF PPS. SNF PDPM will improve [...]

Genetic Testing Fraud Scam Directed at Medicare Beneficiaries

Genetic Testing Fraud Scam Directed at Medicare Beneficiaries The U.S. Department of Health and Human Services Office of Inspector General is alerting the public about a fraud scheme involving genetic testing. Please review the Fraud Alert: [...]

Ensure Referral Forms Include the MBI

Ensure Referral Forms Include the MBI Providers have expressed concern regarding referral forms that do not include the new Medicare number, the MBI, they receive from providers who have referred a Medicare beneficiary to them for services. [...]

July 2019 Release Dark Days for the Common Working File Host

July 2019 Release Dark Days for the Common Working File Host For the upcoming July 2019 Release, CWF will be observing dark days starting Friday, 6/28/2019, through Sunday, 6/30/2019 to accommodate the anticipated duration of this activity and [...]

July 2019 Fiscal Intermediary Standard System Direct Data Entry Screen Changes

July 2019 Fiscal Intermediary Standard System Direct Data Entry Screen Changes The following updates will be made to existing screens and implemented on 7/1/2019. MAP1716 Claim page (6) – INIT DRG field will be displayed this is a 4-byte [...]

July 2019 EDI Front-End Quarterly Release

July 2019 EDI Front-End Quarterly Release Please be advised that while the CMS-mandated quarterly release for July 2019 will be installed the weekend of 6/30/2019, the code set updates included with this release will not be effective in the [...]

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

January 2020 Release "Dark Days" for the Common Working File Hosts For the upcoming January 2020 Release: New Year’s Day holiday – observed Wednesday, January 1st – No cycles (onlines available). CWF will be observing dark days starting [...]

Center for Medicare and Medicaid Innovation Remittance Remark

Center for Medicare and Medicaid Innovation Remittance Remark Attention providers: If you are receiving a remark stating "CMMI" payment on your remittance this is regarding a QPP payment. Please direct any questions regarding QPP to [...]

October is National Breast Cancer Awareness Month

October is National Breast Cancer Awareness Month Breast Cancer Screening and Mammography Breast cancer is one of the most common kinds of cancer in women. According to the U.S. Department of Health and Human Services, about one in eight [...]

Important News from CGS, Jurisdiction B DME MAC: Prior Authorization Condition of Payment for Certain Power Mobility Devices

Important News from CGS, Jurisdiction B DME MAC: Prior Authorization Condition of Payment for Certain Power Mobility Devices If you have Medicare patients who are seeking prior authorization of a power mobility devices, please review the CGS [...]

Coding for Sinuva™ Claims

Coding for Sinuva™ Claims This notice is a coding instruction, and not an indication of coverage. FDA labels should be consulted for indications and usage. Claims submitted to National Government Services for endoscopic placement of Sinuva™ [...]

MLN Connects® Special Edition for Monday, December 2, 2019

MLN Connects® Special Edition for Monday, December 2, 2019 HHAs: Get Help Registering for iQIES by December 23 Avoid payment delays. You need access to the upgraded Internet Quality Improvement and Evaluation System (iQIES) to submit [...]

MLN Connects® Special Edition - Thursday, June 6, 2019

MLN Connects® Special Edition - Thursday, June 6, 2019 CMS Seeks Public Input on Patients over Paperwork Initiative to Further Reduce Administrative, Regulatory Burden to Lower Healthcare Costs On June 6, CMS issued a Request for Information [...]

MLN Connects® Special Edition - Monday, September 30, 2019

MLN Connects® Special Edition - Monday, September 30, 2019 New HCPCS Code J0642 for Levoleucovorin Injection For dates of service on or after October 1, use HCPCS code J0642 for levoleucovorin injection products marketed under the brand name [...]

MLN Connects® for Thursday, November 14, 2019

MLN Connects® for Thursday, November 14, 2019 New Medicare Card: If an MBI Changes MLN Connects® for Thursday, November 14, 2019 View this edition as a PDF News New Medicare Card: If an MBI Changes Medicare Shared Savings [...]

Local Coverage Determination and Article Revisions: May–June 2019

Local Coverage Determination and Article Revisions: May–June 2019 All medical policies and related articles can be found on the NGS Medical Policy Center. Intravenous Immune Globulin (IVIG) - Related to LCD L33394 (A52446) Corrected product [...]

Local Coverage Determination and Article Revisions: June–July 2019

Local Coverage Determination and Article Revisions: June–July 2019 All medical policies and related articles can be found on the NGS Medical Policy Center.  LCD Revisions for June 2019 Psychiatric Partial Hospitalization Programs [...]

MLN Connects® Special Edition - Thursday, July 11, 2019

MLN Connects® Special Edition - Thursday, July 11, 2019 HHAs: CY 2020 and 2021 New Home Infusion Therapy Benefit and Payment and Policy Changes On July 11, CMS issued a proposed rule [CMS-1711-P] that proposes routine updates to the home [...]

MLN Connects® Special Edition Article for Tuesday, November 26, 2019

MLN Connects® Special Edition for Tuesday, November 26, 2019 HHAs: Avoid Payment Delays, Register for iQIES by December 23 Act now. Home Health Agencies (HHAs) need access to the upgraded Internet Quality Improvement and Evaluation System [...]

MLN Connects® Special Edition for Thursday, December 26, 2019

MLN Connects® Special Edition for Thursday, December 26, 2019 Feedback on Scope of Practice The Centers for Medicare & Medicaid Services (CMS) is seeking additional input and recommendations regarding elimination of specific Medicare [...]

MLN Connects® for Thursday, May 23, 2019

MLN Connects® for Thursday, May 23, 2019 MLN Connects® for Thursday, May 23, 2019 View this edition as a PDF News No Shortcuts to Safer Opioids Prescribing: CDC Commentary CMS Takes Action to Lower Prescription Drug Prices and [...]

MLN Connects® for Thursday, May 9, 2019

MLN Connects® for Thursday, May 9, 2019 MLN Connects® for Thursday, May 9, 2019 View this edition as a PDF News DMEPOS Competitive Bidding: Registration and Bid Window for Round 2021 Comprehensive Strategy to Foster Innovation for [...]

MLN Connects® for Thursday, May 2, 2019

MLN Connects® for Thursday, May 2, 2019 MLN Connects® for Thursday, May 2, 2019 View this edition as a PDF News New Medicare Card: Transition Period Ends in 8 Months Addressing Social Determinants of Health Will Help Achieve [...]

MLN Connects® for Thursday, July 18, 2019

MLN Connects® for Thursday, July 18, 2019 MLN Connects® for Thursday, July 18, 2019 View this edition as a PDF News Is Your Vendor/Clearinghouse Submitting Your Claims with the MBI? DMEPOS Competitive Bidding: Round 2021 Bid [...]

MLN Connects® for Thursday, July 11, 2019

MLN Connects® for Thursday, July 11, 2019 MLN Connects® for Thursday, July 11, 2019 View this edition as a PDF News New Medicare Card: Transition Period Ends in Less Than 6 Months HHS To Transform Care Delivery for Patients with [...]

MLN Connects® for Thursday, June 27, 2019

MLN Connects® for Thursday, June 27, 2019 MLN Connects® for Thursday, June 27, 2019 View this edition as a PDF News Medicare Shared Savings Program: Submit Notice of Intent to Apply by June 28 MIPS Data Validation and Audit for [...]

MLN Connects® for Thursday, June 20, 2019

MLN Connects® for Thursday, June 20, 2019 MLN Connects® for Thursday, June 20, 2019 View this edition as a PDF News New Medicare Card: 75% of Claims Submitted with MBI IRF: Voluntary Appeals Settlement Options CMS Proposes to [...]

MLN Connects® for Thursday, June 6, 2019

MLN Connects® for Thursday, June 6, 2019 MLN Connects® for Thursday, June 6, 2019 View this edition as a PDF News Medicare Shared Savings Program: Submit Notice of Intent to Apply Beginning June 11 Promoting Interoperability Program: [...]

MLN Connects® for Thursday, May 30, 2019

MLN Connects® for Thursday, May 30, 2019 MLN Connects® for Thursday, May 30, 2019 View this edition as a PDF News New Medicare Card Flyer for Your Patients Programs of All-Inclusive Care for the Elderly Final Rule Hospice [...]

National Government Services Proposed Local Coverage Determinations for Comment

National Government Services Proposed Local Coverage Determinations for Comment The following proposed LCDs are open for comment from 6/6/2019‒7/20/2019 and are listed on the Local Coverage Determination Open Meeting Announcement agenda: [...]

Sleep Study Scoring and Testing Physician Letter

Sleep Study Scoring and Testing Physician Letter CGS and Noridian, the DME MAC for J6 and JK respectively, have issued a new Dear Physician letter in regard to sleep study scoring and testing. The letters were issued by these contractors as [...]

External Counterpulsation Billing (G0166)

External Counterpulsation Billing (G0166) National Government Services has discovered providers are billing invalid places of services for G0166 (External Counterpulsation, per treatment session) as per The Centers for Medicare & Medicaid [...]

September is Prostate Cancer Awareness Month

September is Prostate Cancer Awareness Month Prostate cancer is the most common non skin cancer among men in the United States. It is a disease that in which malignant cancer cells form in the tissues of the prostate. Prostate cancer is [...]

Opt Out Affidavits Database

Opt Out Affidavits Database Need to verify if a provider has opted out of Medicare? A resource for a list of opt out providers is located on the Medicare Opt Out Affidavits Database, verify status with effective date range. Instructions for [...]

October 2019 Release Dark Days for the Common Working File Hosts

October 2019 Release Dark Days for the Common Working File Hosts For the upcoming October 2019 Release, CWF will be observing dark days starting Friday, 10/4/2019 through Sunday, 10/6/2019 to accommodate the anticipated duration of this [...]

October 2019 Fiscal Intermediary Standard System Direct Data Entry Screen Changes

October 2019 Fiscal Intermediary Standard System Direct Data Entry Screen Changes The following updates will be made to existing screens and implemented on 10/1/2019. Entry added for new Bone Density HCPCS 0508T eligibility dates to MAP175M. [...]

New Version of PC-ACE: July 2019

New Version of PC-ACE: July 2019 PC-ACE Version 4.3 contains several CMS mandates and product enhancements including but not limited to the items listed below. CR11132 ‒ Update to Mammography Editing CR11192 ‒ April 2019 Integrated [...]

New Version of PC-ACE: October 2019

New Version of PC-ACE: October 2019 PC-ACE Version 4.4 contains several CMS mandates and product enhancements including but not limited to the items listed below. CR11321 - Implement Operating Rules - Phase III Electronic Remittance Advice [...]

New Version of PC Print: July 2019

New Version of PC Print: July 2019 PC Print version 7.1.0 will soon be available on our website. This version contains the following enhancement: Change Request 11204 contains the RARC and CARC published by WPC through March 2019 [...]

New Version of PC Print: October 2019

New Version of PC Print: October 2019 PC Print version 7.1.1 will soon be available on our website. This version contains the following enhancements:   CR11252 contains the RARC and CARC published by WPC through July 2019  [...]

Travel Allowance for Laboratory Services

Travel Allowance for Laboratory Services We have seen an increase in incorrect billing for laboratory service travel allowances. Please see below helpful HCPCS billing information and a link to the CMS IOM on appropriate billing for [...]

Revised Fee for Indium In 111 Capromab Pendetide

Revised Fee for Indium In 111 Capromab Pendetide Effective 1/1/2019, National Government Services is updating the fee for A9507 to $1,5804.00 based on the published price for the kit of this radiopharmaceutical agent.   Posted 6/28/2019

Revised fee for Indium In 111 Capromab Pendetide

Revised fee for Indium In 111 Capromab Pendetide Effective 1/1/2019, National Government Services is updating the fee for A9507 to $1,5804.00 based on the published price for the kit of this radiopharmaceutical agent.   Posted 6/27/2019

Reminder: Use Anesthesia Modifiers Appropriately

Reminder: Use Anesthesia Modifiers Appropriately National Government Services requires placement of pricing modifiers in the first modifier position to process your anesthesia claims correctly. Modifiers for anesthesia pricing must be [...]

Reminder: Important Notice Regarding Handwriting on Claims Submitted to Medicare

Reminder: Important Notice Regarding Handwriting on Claims Submitted to Medicare As a reminder, National Government Services will return to the provider any paper claim submitted with handwriting on the face of the claim that is not a [...]

RAP Overpayment Demand Letters Sent in Error

RAP Overpayment Demand Letters Sent in Error Attention Home Health Agencies As of 10/1/2019, due to the implementation of CR10776, HHAs may have received a demand letter for a RAP overpayment. This letter instructed HHAs to either write [...]

Provider Enrollment Application Fee Amount for CY 2020

Provider Enrollment Application Fee Amount for CY 2020 On November 12, CMS issued a notice: Provider Enrollment Application Fee Amount for Calendar Year 2020 [CMS–6089–N (https://go.usa.gov/xppFM)]. Effective January 1, 2020, the application [...]

Part A East Qualified Independent Contractor (QIC) Telephone Discussion and Reopening Process Demonstration

Part A East Qualified Independent Contractor (QIC) Telephone Discussion and Reopening Process Demonstration C2C Innovative Solutions, Inc., the Part A East QIC, is currently offering providers telephone discussions and reopenings under this [...]

Determine/Pay Application Fee

Blepharoplasty, Eyelid Surgery, Brow Lift and Related Services

General Documentation Requirements for Blepharoplasty, Blepharoptosis Repair, and Brow Ptosis Repair Documented subjective patient complaints which justify functional surgery (vision obstruction, unable to do daily tasks, etc. Documented [...]