End of Public Health Emergency

End of the Public Health Emergency Frequently Asked Questions

End of the Public Health Emergency Frequently Asked Questions We’ve added new frequently asked questions to our website. We encourage our providers to view answers to questions about the End of the Public Health Emergency to ensure you have [...]

Drugs and Biologicals Frequently Asked Questions

Drugs and Biologicals Frequently Asked Questions We’ve added new frequently asked questions to our website. We encourage our providers to view answers to common questions about Drugs and Biologicals to ensure you have the information you need [...]

Government Efforts to Combat Cancer Deaths Related to Tobacco

Government Efforts to Combat Cancer Deaths Related to Tobacco Tobacco use is the leading preventable cause of cancer and cancer deaths. Lung cancer is what normally is thought of when talking about tobacco and cancer, but there are other [...]

Ways to Submit Requests

Ways to Submit Requests Suppliers have multiple options to submit PA requests to NGS. NGSConnex (preferred) Electronic submission of medical documentation (esMD) Fax JK: 315-442-4178 J6: 717-565-3840 U.S. Mail National [...]

Rhinoplasty and Related Services

General Documentation Requirements for Rhinoplasty and Related Services Checklist of prior authorization request (PAR) information to include: Medical documentation, with evaluation and management, supporting medical necessity of the [...]

MLN Connects® Newsletter: June 15, 2023

MLN Connects® Newsletter: June 15, 2023 News Inflation Reduction Act Continues to Lower Out-of-Pocket Prescription Drug Costs for Drugs with Price Increases Above Inflation CMS Announces Multi-State Initiative to Strengthen Primary Care [...]

Reactivating Reason Code 31755

Reactivating Reason Code 31755 As of 1/3/2023, reason code 31755 was reactivated per CMS instructions. This means the revenue code 0023 line-item date of service must match the date of service for the first home health visit on the claim. [...]

Manual Review of Claims for Replacement of Supplies and Accessories used with External Ventricular Assist Device

Manual Review of Claims for Replacement of Supplies and Accessories used with External Ventricular Assist Device VAD supplies and accessories are billed using HCPCS codes Q0507, Q0508 and Q0509 as applicable. When billing for VAD supplies, [...]

Claims Department Requires Additional Information for Processing Certain Services

Claims Department Requires Additional Information for Processing Certain Services Are you having difficulty with what must be provided when we ask for additional information to process your claim? If so, the following articles should assist in [...]

Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (Including Lipectomy) and Related Services

General Documentation Requirements for Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (Including Lipectomy) and Related Services Checklist of prior authorization request (PAR) information to include: Stable weight loss [...]

MLN Connects® Newsletter: June 22, 2023

MLN Connects® Newsletter: June 22, 2023 News CMS Roundup (June 16, 2023) Lower Endoscopy: Comparative Billing Report in June Medicare Physician Fee Schedule Database: July Update Behavioral Health Integration Services: Get Information [...]

Prior Authorization Request for Outpatient Services: Facet Joint Interventions

Dental Services 2023

Dental Services 2023 The CMS clarified what Medicare payments may be made for medically necessary dental services that are an integral part of a covered primary medical procedure. We’ve posted this new information in the Dental Services [...]

End of the Public Health Emergency

End of the Public Health Emergency We’ve received many questions related to end of the public health emergency and changes to waivers that CMS put in place during the COVID-19 PHE. To assist our providers, we’ve developed the CMS Waivers and [...]

COVID-19 Vaccine Administration Returning to Providers - Reason Code 32287

Claims for COVID-19 vaccine administration performed on the same DOS as another vaccine administration (e.g., PPV, flu or tetanus) are incorrectly being returned to providers with RC 32287.

Part A Anesthesia Claim Returning to Providers in Error

CMS has instructed all MACs to hold all Part A 13X and 85X TOBs for anesthesia services with DOS on or after 1/1/2022 until CMS fully implements a replacement file for these claims.

Temporary Holding for Some Part B Claims

The CMS billing instructions for G0378 indicate a single line of coding with a NOS of at least eight, with all UOS on a single line and the DOS being the date of the original observation order. Claim editing changes implemented in July, 2021 [...]

Billing and Coding Article Updates for July 2023

Billing and Coding Article Updates for July 2023 Billing and Coding: Bevacizumab and Biosimilars (A52370) Based on Compendia review, ICD-10 codes Z85.09 and Z85.42 have been added to the Group 1 code list effective for dates of service on or [...]

Telehealth Home Health Billing

Telehealth Home Health Billing  As a reminder to all home health agencies, telehealth billing becomes mandatory on home health claims for periods of care that start on or after 7/1/2023. There is an article detailing how to report [...]

New and Improved EDI Enrollment Process Coming Soon

New and Improved EDI Enrollment Process Coming Soon We are improving our online EDI Enrollment process based on provider feedback. The new process will include ‘real time’ verification of data entered into many of the fields. This ‘real time’ [...]

MLN Connects® Newsletter: June 29, 2023

MLN Connects® Newsletter: June 29, 2023 News CY 2024 ESRD Prospective Payment System Proposed Rule Transforming Medicare Coverage: A New Medicare Coverage Pathway for Emerging Technologies and Revamped Evidence Development Framework New [...]

Conflict of Interest Disclosure

Conflict of Interest Disclosure Statement Form

CR13220 - Technical Revisions Only to the National Coverage Determination (NCD) Manual, Publication (Pub) 100-03

CR13220 - Technical Revisions Only to the National Coverage Determination (NCD) Manual, Publication (Pub) 100-03 Posted 7/5/2023

MLN Connects® Newsletter: July 6, 2023

MLN Connects® Newsletter: July 6, 2023 News CY 2024 Home Health Prospective Payment System Proposed Rule HHS Announces Actions to Lower Health Care Costs and Allow Medicare to Negotiate Lower Drug Prices CMS Roundup (June 30, 2023) [...]

Audit and Reimbursement

Audit and Reimbursement Cost Report Filing State/Region Contact Information Jurisdiction 6 and Jurisdiction K Bobbi Jo Luciano Office: South Portland, ME 207-253-3382 Email: [...]

MLN Connects® Newsletter: Broader Medicare Coverage of Leqembi Available Following FDA Traditional Approval - July 7, 2023

MLN Connects® Newsletter: Broader Medicare Coverage of Leqembi Available Following FDA Traditional Approval - July 7, 2023 News Broader Medicare coverage is now available for Biogen and Eisai’s Leqembi (the brand name for lecanemab) following [...]

Overcoming Barriers to Tobacco Counseling 

Overcoming Barriers to Tobacco Counseling Healthcare providers face several challenges when implementing tobacco cessation counseling into a clinical practice routine. These various factors influence the healthcare professionals’ performance [...]

Submitting Necessary/Appropriate Documentation

Submitting Necessary/Appropriate Documentation National Government Services has noticed an increase in the submission of improper documentation. We’ve added two new sections to our Submit Medical Record Documentation Electronically job aid to [...]

MLN Connects® Newsletter: July 13, 2023

MLN Connects® Newsletter: July 13, 2023 News Hospital Outpatient Prospective Payment System: Remedy for the 340B-Acquired Drug Payment Policy for Calendar Years 2018-2022 National Coverage Determination: Pre-exposure Prophylaxis Using [...]

MLN Connects® Newsletter: PFS & OPPS/ASC Proposed Payment Rules – July 13, 2023

MLN Connects® Newsletter: PFS & OPPS/ASC Proposed Payment Rules – July 13, 2023 Proposed Rules CMS Physician Payment Rule Advances Health Equity CMS Proposes Policies to Expand Behavioral Health Access and Further Efforts to Increase [...]

Frequently Asked Questions Reviewed and Updated

Frequently Asked Questions 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 Therapy [...]

Frequently Asked Questions Reviewed and Updated

Frequently Asked Questions 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 CAR T-cell Therapy Claims EDI [...]

Frequently Asked Questions Reviewed and Updated

Frequently Asked Questions 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 CAR T-cell Therapy Claims EDI [...]

Frequently Asked Questions Reviewed and Updated

Frequently Asked Questions 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 CAR T-cell Therapy Claims EDI [...]

OTP

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

CERT Text Durable Medical Equipment

Need to Appeal a CERT Denial? Log onto our secure NGSConnex online Web application and quickly file an appeal. Submitting an appeal electronically saves postage, print and mail costs and is easy to do through NGSConnex.com. If you do not [...]

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Step 3: Unsubscribe To unsubscribe completely from all e-mail updates, please select the Unsubscribe button below. You will be removed from all of our e-mail lists immediately.

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CEDI NPI Crosswalk Tool:  A crosswalk is the link established between the National Provider Identifier (NPI) and durable medical equipment (DME) Provider Transaction Access Number (PTAN) (supplier ID). Verify your link using the tool [...]

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Overpayment Results-Home Health and Hospice

Immediate Recoupment Request Form - Electronic/E-mail Automatic Response Thank you for using the National Government Services Immediate Recoupment Request Form - Electronic/E-mail. Your request has been received and will be processed within [...]

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Unsubscribe Thank you for your recent submission. What you can expect: A confirmation e-mail will be sent to the e-mail address under which you registered your account.

Travel Allowance Resources

Note: Codes that have a $0 (zero) fee schedule amount will not display a search result. Locality/Area and County Information for New York Locality/Area Counties 01 Manhattan 02 [...]

PsychCal_top

PSYCHIATRIC SERVICES CALCULATOR Due to the complex nature of the psychiatric service reduction, use this calculator in your day-to-day business operations to help determine the correct financial liability for both Medicare [...]

Molecular Pathology Resources

Note: Codes that have a $0 (zero) fee schedule amount will not display a search result. Locality/Area and County Information for Illinois Locality/Area Counties 12 Bond, [...]

DMEFee Form Description

Note: This tool only provides pricing modifiers for the HCPCS entered in your search. Please refer to the medical policies for any additional modifier information for claims submission.

Overpayment E-mail-Part B

Immediate Recoupment Request Form - Electronic/E-mail Automatic Response Please do not reply to this message. This e-mail address is automated, unattended, and cannot help with questions or requests. Thank you for using the National [...]

Influenza Form Description

Overpayment E-mail-Part A

Immediate Recoupment Request Form - Electronic/E-mail Automatic Response Please do not reply to this message. This e-mail address is automated, unattended, and cannot help with questions or requests. Thank you for using the National [...]

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E-mail Account Validation To get started, please validate your e-mail address account information. Step 1:  Please enter your e-mail address:

Travel Form Description

Learn About Deactivation of Billing Privileges, Suspension of Payment and Reactivation

This site area gives you access to important information about deactivation of billing privileges, suspension of payment and reactivation.

PC-ACE Pro Patch for NHIC Text

PC-ACE Pro 2.31 Patch For NHIC

DMEPOS Resources

Note: Codes that have a $0 (zero) fee schedule amount will not display a search result. Locality/Area and County Information for Illinois Locality/Area Counties 12 Bond, Calhoun, Clinton, Jersey, [...]

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Overpayment E-mail-Federally Qualified Health Center

Immediate Recoupment Request Form - Electronic/E-mail Automatic Response Please do not reply to this message. This e-mail address is automated, unattended, and cannot help with questions or requests. Thank you for using the National [...]

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Clinical Social Worker Resources

Psychiatric Services Calculator