Completing the Advance Beneficiary Notice for Home Health Agency Demand Claims

Completing the Advance Beneficiary Notice of Noncoverage for Home Health Agency Demand Claims The purpose of the ABN is to appropriately notify a Medicare beneficiary of services that the HHA believes Medicare will not cover. In order for the [...]

Home Health Billing When a New MBI is Assigned

Home Health Billing When a New MBI is Assigned A patient’s MBI number is required on all home health billing submitted to Medicare. CMS will issue a new MBI when an original MBI may have been, or has been compromised. There are times a home [...]

Hospice Billing Codes Chart

Hospice Billing Codes Chart Table of Contents Hospice Billing Codes Chart Condition Codes (CC) (UB-04 FL 18-28) Occurrence Codes (OC) and Dates (UB-04 FLs 31-34) Occurrence Span Code and Date (UB-04 FLs 35-36) Value Codes (VCs) and CBSA [...]

Advance Payments to Providers

Accelerated Payments to Providers

Home Health Third Party Liability Demand Billing

Home Health Third Party Liability Demand Billing Table of Contents Background What is a Demand Bill? Requirements for Submission How to Submit a TPL Demand Bill Claim Page 1: Claim Page 2 – Covered and Noncovered Charges Claim [...]

Home Health Demand Billing

Home Health Demand Billing Table of Contents Background What is a Demand Bill? Requirements for Submission How to Submit a Demand Bil Claim Page 1: Claim Page 2: Covered and Noncovered Charges Claim Page 2: All Noncovered Charges [...]

Notice of Admission Questions and Answers

Notice of Admission Questions and Answers Medicare requires HHAs to submit a one-time NOA instead of RAPs for new admissions starting on or after 1/1/2022. HHAs shall no longer submit RAPs, TOB 0322 for any HH periods of care with a “From” [...]

Billing the Home Health Notice of Admission Electronically

Billing the Home Health Notice of Admission Electronically Table of Contents Billing the Home Health Notice of Admission Electronically NOA Claim Page 1 NOA Claim Page 2 NOA Claim Page 3 NOA Claim Page 4 NOA Claim Page 5 Notes [...]

Billing the Home Health Notice of Admission via DDE

Billing the Home Health Notice of Admission via DDE Table of Contents Billing the Home Health Notice of Admission via DDE NOA Claim Page 1 NOA Claim Page 4 Notes Patients Continuing Care in 2022 Related Content [Return to [...]

Hospice Quality Reporting Program

Hospice Quality Reporting Program Along with the other MACs, National Government Services has received several requests from new hospice providers, as well as national and state hospice associations, regarding training and assistance for [...]

Filing an Electronic Notice of Election (Type of Bill 8XA)

Filing an Electronic Notice of Election (Type of Bill 8XA) The NOE, TOB 8XA, is submitted when the hospice receives a signed election statement from the beneficiary acknowledging that he/she wishes to enroll in the Medicare hospice benefit. [...]

Value-Based Insurance Design Model Hospice Benefit Component Overview

Value-Based Insurance Design Model Hospice Benefit Component Overview Beginning on 1/1/2021, CMS is testing the inclusion of the Part A Hospice Benefit within the MA benefits package through the Hospice Benefit Component of the VBID Model. [...]

Canceling a Hospice Notice of Election

Canceling a Hospice Notice of Election When a patient elects hospice, the hospice submits a NOE to the MAC to notify the MAC and all other providers that the patient is now utilizing the Medicare hospice benefit for all services related to the [...]

Create an Account - Standard

Create an Account – Standard Table of Contents Create an Account – Standard Step 1 – Account Step 2 – Individual Step 3 – Business [Return to Top] Create an Account – Standard An NGSConnex Standard Account holder will [...]

Hospice Room and Board Denials

Hospice Room and Board Denials Medicare does not pay the room and board fees for hospice beneficiaries that reside in a SNF or a nursing facility (NF), as these charges are statutorily excluded from Medicare coverage. However, these charges [...]

Untimely Filed Notice of Election Circumstance Exception: Medicare Beneficiary Is Granted Retroactive Medicare Entitlement

Untimely Filed Notice of Election Circumstance Exception: Medicare Beneficiary Is Granted Retroactive Medicare Entitlement Table of Contents Untimely Filed Notice of Election Circumstance Exception: Medicare Beneficiary Is Granted [...]

Reporting Site of Service Codes for Home Health Care

Reporting Site of Service Codes for Home Health Care HH PPS claim payments are based on the site of the beneficiary’s care. In order for Medicare to accurately capture where home health services are provided, HHAs are required to report the [...]

MLN Connects® Newsletter: May 23, 2024

MLN Connects® Newsletter: May 23, 2024 News Medicare Shared Savings Program: Apply by June 17 for January 1 Start Date Medicare Providers: Deadlines for Joining an Accountable Care Organization Institutional Providers: Medicare Enrollment [...]

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 5/30/2024 through 7/14/2024. These [...]

SNF PPS Web Pricer

Supplemental Insurance

Section 2: Medicare Basics Supplemental Insurance Table of Contents Supplemental Insurance Medigap Plans Medigap Plans A–N Low-Income Beneficiaries Qualified Medicare Beneficiary Program Specified Low-Income Medicare [...]

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 11th Sessions!

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 11th Sessions! We’re gearing up for our second in the series of Medicare Part B 2024 Spring/Summer Virtual [...]

Hospice Pricer Tool

Hospice Pricer Tool The CMS Web Pricer will assist in evaluating your hospice claim reimbursement. Revised 4/18/2024

MLN Connects® Newsletter: April 18, 2024

MLN Connects® Newsletter: April 18, 2024 News PrEP for HIV: Prepare for Potential Medicare Part B Coverage Events Clinical Laboratory Fee Schedule Upcoming Meetings: Register to Present, Speak, or Attend in Person by June 1 [...]

3/13/2024 Part B POE Advisory Group Meeting

3/13/2024 Part B POE Advisory Group Meeting Meeting Minutes Meeting Time: 10:00 a.m.‒12:00 p.m. ET Member Attendees: Doris Barnes, Aurelio Barraco, Madelon Berger, Ilka Collier, Eileen Conlan, Renay Coonan, Tracy Essling, Stephanie [...]

Helpful Reminders on Advance Care Planning

Helpful Reminders on Advance Care Planning ACP billing codes: 99497: Advance care planning, including the first 30 minutes of face-to-face explanation and discussion (when performed) of advance directives such as standard forms. 99498: [...]

Submit Supporting Documentation

Submit Supporting Documentation We encourage you to submit cost reports and supporting documentation electronically whenever possible. In addition to the environmental benefits of this approach, it is also more time and cost efficient. The [...]

Part B Top Claim Errors Updated

Part B Top Claim Errors Updated Using data analysis we update the Top Claim Errors on a quarterly basis and provide: the error reason code; a description of the error; the error type; details that include steps you can take to [...]

Recovery Audit Contractor Reminders

Recovery Audit Contractor Reminders Did you know that Performant is now the RAC for all of National Government Services Part A and Part B lines of business in Jurisdiction 6 and Jurisdiction K? As part of the audit process, Performant may [...]

MLN Connects® Newsletter: May 30, 2024

MLN Connects® Newsletter: May 30, 2024 News Hospice Interdisciplinary Team: Addition of Marriage and Family Therapists & Mental Health Counselors Revised Part B Inflation Rebate Guidance: Using the 340B Modifier — Reminder MLN [...]

FY 2026 Hospital Wage Index Development Timetable Final

National Government Services: Raising Awareness about Care Management

National Government Services: Raising Awareness about Care Management According to the CDC, six in ten adults in the U.S. have a chronic disease and four in ten adults have two or more. As your Medicare Contractor for Jurisdiction 6 and [...]

FY 2026 PUF Release

FY 2026 PUF Release Availability and Revisions to Wage Index PUF On Thursday, 5/23/2024, CMS released the preliminary FY 2026 Worksheet S-3, Parts II and III wage index PUF. The FY 2026 IPPS wage index will be calculated based on Federal FY [...]

You Can Help Your Patients Quit Tobacco Use - The Great American Smokeout Is Coming!

You Can Help Your Patients Quit Tobacco Use - The Great American Smokeout Is Coming! Join us for our webinar series on Medicare’s preventative services, "Counseling to Prevent Tobacco Use" and “Telehealth and Tobacco Counseling.” Statistics [...]

Attention Illinois, Massachusetts and Rhode Island Providers: Senior Medicare Patrol Can Assist Medicare Providers!

Attention Illinois, Massachusetts and Rhode Island Providers: Senior Medicare Patrol Can Assist Medicare Providers! National Government Services is proud to announce a special project to assist our providers with your Medicare patients [...]

Attention Illinois, Massachusetts and Rhode Island Providers: Senior Medicare Patrol Can Assist Medicare Providers!

June 2024

In This Issue National Government Services Articles for Part A and Part B Providers Important Reminders for Your EDI Enrollment Save the Dates! CMS National Provider Enrollment Conference in San Diego: 8/28/2024-8/29/2024 A/B DME MAC [...]

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers on Tuesday, June 4th

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers on Tuesday, June 4th! Our first in our series of Medicare Part B 2024 Spring/Summer Virtual Conference Tuesdays is right around [...]

MLN Connects® Newsletter: June 6, 2024

MLN Connects® Newsletter: June 6, 2024 News CMS Roundup (May 31, 2024) Quality Payment Program: 2022 Performance Information on Medicare.gov Compare Tool Skilled Nursing Facility Value-Based Purchasing Program: June Confidential Feedback [...]

EDI Enrollment Process User Guide

This guide provides information on the different options available within the National Government Services EDI Enrollment Process User Guide. Please share your thoughts about your experience with our EDI Enrollment process.   Reviewed 6/6/2024

EDI Enrollment

Welcome This page is for providers who wish to submit Part A/B claims to Medicare. Once you have completed the initial provider enrollment and received your Welcome letter with Medicare, you can begin the EDI Enrollment process. Table of [...]

Reset My FISS / DDE Password

CMS has directed it’s datacenters to enforce password requirements set forth in the United States Defense Information Systems Agency’s (DISA) Security Technical Implementation Guide (STIG) with regard to RACF password quality rules. The HPE VDC [...]

Trading Partner ID Recertification

All active trading partners are required to recertify their access annually. CMS requires any changes in demographic, contact information or access for a trading partner ID (TP ID) are communicated to the A/B MAC within 30 days of the change. [...]

National Government Services Contractor Codes

National Government Services Contractor Codes The Contractor Code is a five-digit numeric code that indicates your MAC, also known as the Carrier Code, or Payer ID. Part B Professional: Connecticut 13102 Illinois 06102 Maine 14112 [...]

Benefits of EDI and Real Time Claim Status

There are a number of advantages to enrolling and submitting claims online. Claims and other transactions submitted electronically process considerably faster than paper submission. For example, HIPAA-compliant electronic claims are held in the [...]

I Am Not Yet Enrolled in Medicare

You can only begin set up with EDI if you are a participating provider in the Medicare program. If you have not submitted an application to enroll in Medicare, please visit our Enrollment section of the site for guidelines. If you have a [...]

Supporting Documentation Information

Supporting Documentation Information

Exemption Process for the Prior Authorization Program for Certain Hospital Outpatient Department Services

The Centers for Medicare & Medicaid Services (CMS) implemented a prior authorization program for certain hospital outpatient department (OPD) services for date of service (DOS) on or after 7/1/2020 and subsequently added an exemption process. [...]

1-800-MEDICARE Authorization to Disclose Personal Health Information

Prior Authorization Request for Outpatient Services: Implanted Spinal Neurostimulators

Medicare Correspondence Request Form

Home Health Claims Returned to Providers with Reason Code 31755

CMS reactivated RC 31755 effective 1/3/2023 and some HH claims are being RTP due to billing errors. These claims need to be corrected with the information provided in the Provider Action section of this article. Medicare is still receiving [...]