MLN Connects® Newsletter for Thursday, June 16, 2022

MLN Connects® Newsletter for Thursday, June 16, 2022 ICD-10-CM Diagnosis Codes: Fiscal Year 2023 News Comprehensive Error Rate Testing Program Report: Sample Reduced for Reporting Year 2023 Men’s Health: Talk to Your Patients About [...]

MLN Connects® Newsletter for Thursday, June 9, 2022

MLN Connects® Newsletter for Thursday, June 9, 2022 Learn about the CMS National Quality Strategy News CMS National Quality Strategy: A Person-Centered Approach to Improving Quality Strategy to Strengthen Behavioral Health Care [...]

MLN Connects® Newsletter for Thursday, June 2, 2022

MLN Connects® Newsletter for Thursday, June 2, 2022 ICD-10-PCS Procedure Codes: Fiscal Year 2023 News Medicare Shared Savings Program: Application Deadlines for January 1 Start Date Claims, Pricers, & Codes ICD-10-PCS Procedure [...]

MLN Connects® Newsletter for Thursday, May 26, 2022

MLN Connects® Newsletter for Thursday, May 26, 2022 Biosimilars: Interchangeable Products May Increase Patient Access News COVID-19: New Administration Code for Pfizer Pediatric Vaccine Booster Dose Biosimilars: Interchangeable [...]

Physicians/Practitioners Who Order Ambulance Transport: Helping Your Patients With Prior Authorization

Physicians/Practitioners Who Order Ambulance Transport: Helping Your Patients With Prior Authorization The RSNAT Prior Authorization Model is a Medicare Fee-for-Service program that was recently instituted throughout the National Government [...]

MLN Connects® Newsletter for Thursday, June 23, 2022

MLN Connects® Newsletter for Thursday, June 23, 2022 Medical Records Correspondence Address News Ambulance Prior Authorization Model Expands August 1 Orthoses Referring Providers: Comparative Billing Report in June Medical Records [...]

June/July 2022 Billing and Coding and Self-Administered Drug Article Updates

June/July 2022 Billing and Coding and Self-Administered Drug Article Updates Billing and Coding Articles Billing and Coding: Bevacizumab and biosimilars (A52370) Based on compendia review, ICD-10 code C45.2 has been added to the Group 1 [...]

Attention Ambulance Suppliers: Important Information on Claim Denials

Attention Ambulance Suppliers: Important Information on Claim Denials If you are billing claims with either A0426 or A0428, please continue to read. National Government Services has been receiving electronic claims with the 2300 REF segment [...]

A/B Rebilling Facts

A/B Rebilling Facts The following information applies to inpatient hospital admissions on/after 10/1/2013 per final rule CMS-1599-F. Background When a Medicare Part A payment cannot be made because an inpatient admission is found to not be [...]

Condition Code G0 Reminder

Condition Code G0 Reminder National Government Services has noticed an increase in the number of claims reporting CC G0 (zero) inappropriately. Please review the following information so that your claims are not rejected or denied due to [...]

Federally Qualified Health Centers Behavioral Health Claims Job Aid

Federally Qualified Health Centers Behavioral Health Claims Job Aid Historically, FQHCs reported behavioral health with codes 90805, 90807 and 90809 with revenue code 0900. However, those codes terminated effective 12/31/2012. Effective [...]

Federally Qualified Health Centers Contracting with Medicare Advantage Plans

Federally Qualified Health Centers Contracting with Medicare Advantage Plans Requirements to Receive Wrap-Around Payments from Medicare The FQHC must have a written contract with the Medicare Advantage (MA) plan that contain the terms [...]

MLN Connects® Newsletter for Thursday, May 5, 2022

MLN Connects® Newsletter for Thursday, May 5, 2022 COVID-19 Patients Can Get Free Over-the-Counter Tests from Participating Providers News COVID-19: Patients Can Get Free Over-the-Counter Tests from Participating Providers [...]

J6 Medicare Secondary Payer Part B Carrier Voluntary Refund Form

MLN Connects® Newsletter for Thursday, July 7, 2022

MLN Connects® Newsletter for Thursday, July 7, 2022 Expanding Access to Emergency Care Services in Rural Communities News Taking Action to Expand Access to Emergency Care Services in Rural Communities People with Disabilities: Help [...]

MLN Connects® Special Edition for Tuesday, June 21, 2022

MLN Connects® Special Edition for Tuesday, June 21, 2022 Home Health & ESRD Proposed CY 2023 Payment Rules Home Health Agencies: Calendar Year 2023 Proposed Rule — Submit Comments by August 16 ESRD Facilities: Calendar Year 2023 [...]

Reminder: 340B-Acquired Drug Claim Appeal Requests

Reminder: 340B-Acquired Drug Claim Appeal Requests Beginning 1/1/2018, separately payable Part B drugs (assigned status indicator “K”), other than vaccines (assigned status indicator “L” or “M”) and drugs on pass-through payment status [...]

Billing Not Otherwise Classified Codes

Billing Not Otherwise Classified Codes When billing NOC codes, if you give a comparable code for the service performed, please include the actual name of the surgical or medical procedure. In some cases, this will eliminate the need to develop [...]

MLN Connects® Special Edition for Thursday, July 7, 2022

MLN Connects® Special Edition for Thursday, July 7, 2022 CMS Proposes Physician Payment Rule to Expand Access to High-Quality Care On July 7, CMS issued the Calendar Year 2023 Physician Fee Schedule (PFS) proposed rule, which would [...]

MLN Connects® Special Edition for Friday, July 15, 2022

MLN Connects® Special Edition for Friday, July 15, 2022 CMS Proposes Rule to Advance Health Equity, Improve Access to Care & Promote Competition and Transparency CMS is proposing actions to advance health equity and improve access to care [...]

MLN Connects® Special Edition for Thursday, April 7, 2022

MLN Connects® Special Edition for Thursday, April 7, 2022 Returning to Certain Pre-COVID-19 Policies & Coverage of Monoclonal Antibodies for Alzheimer's Disease Stakeholder Call CMS Returning to Certain Pre-COVID-19 Policies in [...]

Your Feedback In Action – Medical Policies

Your Feedback In Action – Medical Policies We frequently receive comments through our customer experience surveys that providers cannot find an associated LCD or billing and coding article for a specific procedure within our Medical Policies [...]

You Asked – We Listened: Locating our Contact Information

You Asked – We Listened: Locating our Contact Information We often receive comments through our customer experience surveys that providers are not able to find our contact information. NGS contact information is located in the Resources [...]

Changing or Resetting Your EDI Gateway Password

Changing or Resetting Your EDI Gateway Password The EDI Gateway Self-Service Password Portal is a simple/secure, web-based process for changing or resetting passwords for EDI Trading Partners. There are differences in the steps for these [...]

MLN Connects® Newsletter for Thursday, July 21, 2022

MLN Connects® Newsletter for Thursday, July 21, 2022 988 Suicide & Crisis Lifeline Available Nationwide News 988 Suicide & Crisis Lifeline Available Nationwide COVID-19: Novavax Vaccine, Adjuvanted — New Codes Allergy & [...]

MLN Connects® Newsletter for Thursday, July 14, 2022

MLN Connects® Newsletter for Thursday, July 14, 2022 COVID-19: FDA Authorizes Pharmacists to Prescribe PAXLOVID with Certain Limits News COVID-19: FDA Authorizes Pharmacists to Prescribe PAXLOVID with Certain Limits COVID-19: Moderna [...]

MLN Connects® Newsletter for Thursday, September 23, 2021

MLN Connects® Newsletter for Thursday, September 23, 2021 COVID-19: Compare Nursing Homes by Vaccination Rate View this edition as a: Webpage | PDF News CMS Launches New Medicare.gov Feature to Compare Nursing Homes by [...]

MLN Connects® Newsletter for Thursday, October 14, 2021

MLN Connects® Newsletter for Thursday, October 14, 2021 Pneumococcal Conjugate Vaccine, 20 Valent View this edition as a: Webpage | PDF News Pneumococcal Conjugate Vaccine, 20 Valent DATA 2000 Waiver Training Payments Still [...]

MLN Connects® Newsletter for Thursday, December 9, 2021

MLN Connects® Newsletter for Thursday, December 9, 2021 CY 2022 Medicare Deductible, Coinsurance, & Premium Rates News PECOS: Multi-Factor Authentication Requirement Delayed HHS Seeks Public Comments to Advance Equity & [...]

MLN Connects® Newsletter for Thursday, December 16, 2021

MLN Connects® Newsletter for Thursday, December 16, 2021 2% Payment Adjustment (Sequestration) Changes News Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Changes Flu Shot Disparities Opioid Treatment Programs: New [...]

MLN Connects® Newsletter for Thursday, December 23, 2021

MLN Connects® Newsletter for Thursday, December 23, 2021 COVID-19 Vaccine Access in Long-Term Care Settings   News COVID-19 Vaccine Access in Long-Term Care Settings DMEPOS Final Rule NPPES: Public Reporting of Digital Contact [...]

MLN Connects® Newsletter for Thursday, January 6, 2022

MLN Connects® Newsletter for Thursday, January 6, 2022 Provider Compliance Product List Updated   News COVID-19 Vaccine Access in Long-term Care Settings SNF VBP: Nominate Technical Expert Panel Members by January 16 COVID-19 [...]

MLN Connects® Newsletter for Thursday, January 13, 2022

MLN Connects® Newsletter for Thursday, January 13, 2022 COVID-19: Long-term Care, Remdesivir, & Booster Doses   News COVID-19: Updated Materials for Visiting Nursing Homes During Omicron Surge COVID-19: Vaccine Access in [...]

MLN Connects® Newsletter for Thursday, January 27, 2022

MLN Connects® Newsletter for Thursday, January 27, 2022 COVID-19: Tools to Determine if Vaccine Requirements Apply   News COVID-19: Tools to Determine if Vaccine Requirements Apply COVID-19 Vaccine Codes: Pfizer Pre-Diluted Vaccine [...]

MLN Connects® Newsletter for Thursday, March 10, 2022

MLN Connects® Newsletter for Thursday, March 10, 2022 COVID-19 Monoclonal Antibodies: Revised Emergency Use Authorization for EVUSHELD News COVID-19 Monoclonal Antibodies: Revised Emergency Use Authorization for EVUSHELD Program for [...]

MLN Connects® Newsletter for Thursday, March 31, 2022

MLN Connects® Newsletter for Thursday, March 31, 2022 Continuous Glucose Monitor: Provide Supplies for a Calendar Month News Home Health Providers: Services Provided Data for April 2022 Refresh Continuous Glucose Monitor: Provide [...]

MLN Connects® Newsletter for Thursday, April 7, 2022

MLN Connects® Newsletter for Thursday, April 7, 2022 Improve the Health of Minority Populations with Covered Preventive Services News Fiscal Year 2021 Program for Evaluating Payment Patterns Electronic Reports Preventive Services & [...]

MLN Connects® Special Edition for Monday, April 11, 2022

MLN Connects® Special Edition for Monday, April 11, 2022 HHS Takes Actions to Promote Safety & Quality in Nursing Homes On April 11, CMS issued its FY 2023 SNF PPS proposed rule, which includes asking for public feedback on how staffing [...]

MLN Connects® Newsletter for Thursday, April 14, 2022

MLN Connects® Newsletter for Thursday, April 14, 2022 COVID-19: New Codes for Moderna Vaccine Booster Doses News Launch of the Cross-Cutting Initiatives Value-Based Insurance Design Model: Medicare Advantage Organizations Pay for [...]

MLN Connects® Newsletter for Thursday, April 21, 2022

MLN Connects® Newsletter for Thursday, April 21, 2022 Medicare Provider Compliance News News Hospice Quality Reporting Program: Key Dates & Measure Change Ambulance Ground Transport: Comparative Billing Report in April Hospices: [...]

MLN Connects® Newsletter for Thursday, April 28, 2022

MLN Connects® Newsletter for Thursday, April 28, 2022 Get Patient Eligibility Information for Additional Services News Patient Eligibility Information for Additional Services — Now Available Physicians, Teaching Hospitals, Physician [...]

U537F Assigning in Error On Some Notices of Admission

National Government Services has identified an issue where U537F is assigning incorrectly on some NOAs, due to the CWF not correctly recognizing discharges (patient status other than 30 on the last HH period). There is no workaround. Please [...]

MLN Connects® Special Edition for Thursday, September 9, 2021

MLN Connects® Special Edition for Thursday, September 9, 2021 Biden-Harris Administration to Expand Vaccination Requirements for Health Care Settings New action will protect patients of the 50,000 providers and over 17 million health care [...]

Important Information on How to Resolve NGSConnex Account Suspensions

Important Information on How to Resolve NGSConnex Account Suspensions If you are an NGSConnex user and not the LSO for your provider organization and your NGSConnex account has been suspended for one of the following reasons, you must contact [...]

Hospice Levels of Care: Routine Home Care

Hospice Levels of Care: Routine Home Care There are four levels of care in the Medicare hospice benefit. Hospices are paid a per diem rate based on the number of days and level of care provided during the election period. The four levels of [...]

New Medical Review Frequently Asked Questions

New Medical Review Frequently Asked Questions We’ve added Medical Review Frequently Asked Questions to our website. Visit our Help and FAQs web page for common questions and answers related to Medical Review and other topics including: EDI, [...]

Medical Review

Registration is Open for the National Government Services Medicare Fall 2021 Virtual Conference!

Registration is Open for the National Government Services Medicare Fall 2021 Virtual Conference! The National Government Services POE Team is holding our latest bi-annual virtual conference on Tuesday, 11/9/2021 and Wednesday, 11/10/2021. This [...]

National Government Services Medicare Fall 2021 Virtual Conference

National Government Services Medicare Fall 2021 Virtual Conference The National Government Services POE Team's biannual virtual conference is scheduled for Tuesday, 11/9/2021 and Wednesday, 11/10/2021. This two full-day virtual conference [...]

Save Time and Money by Submitting your Appeals (Reopenings & Redeterminations) Electronically

Save Time and Money by Submitting your Appeals (Reopenings & Redeterminations) Electronically Two easy ways to submit. National Government Services will now allow Medicare Part A and Part B providers to submit claim appeal requests, [...]

Improving Customer Experience in 2021

Improving Customer Experience in 2021 We are committed to improving your experience. Please watch this two-minute video that explains how each day we review comments from providers who submit surveys to let us know what is working well and how [...]

Provider Action To Be Taken Following the Provider-Based Mid-Build Audit

Provider Action To Be Taken Following the Provider-Based Mid-Build Audit The off-campus PBDs that were “mid-build” prior to 11/2/2015 received mid-build determination letters in January 2021 from the CMS mid-build audit contractor, Cahaba [...]

National Influenza Vaccination Week

National Influenza Vaccination Week National Influenza Vaccination Week is Observed 12/5/2021–12/11/2021 Influenza (flu) is a contagious respiratory illness caused by the influenza virus and causes mild to severe illness. Millions of people [...]

Proper Claim Submission for Repetitive, Scheduled, Non-Emergent Ambulance Transports

Proper Claim Submission for Repetitive, Scheduled, Non-Emergent Ambulance Transports The CMS implemented the prior authorization of RSNAT. NGS J6 states Illinois, Minnesota, and Wisconsin were added to the RSNAT Model effective with dates [...]

July and August 2022 Billing and Coding Article Updates

July/August 2022 Billing and Coding Article Updates Billing and Coding Articles Billing and Coding: Botulinum Toxins (A52848) Based on comments received, ICD-10-CM codes N39.41 and N39.46 have been added to the Group 4 ICD-10 code list [...]

Change Request 10484, Pub.100-20, Rev2357: Additional Instructions to Hospitals on the Election of a Medicare SSI Component of the DSH Payment Adjustment for Cost Reports FY 2004 and Earlier

Change Request 10484, Pub.100-20, Rev2357: Additional Instructions to Hospitals on the Election of a Medicare SSI Component of the DSH Payment Adjustment for Cost Reports FY 2004 and Earlier Please click on the following link to read the [...]

Appeal Submission Process for Claims with Multiple Line Items

Appeal Submission Process for Claims with Multiple Line Items We have identified instances where providers are submitting several appeals for one claim internal control number. If you need to appeal (redetermination) a claim with multiple [...]

MLN Connects® for Thursday, January 16, 2020

MLN Connects® for Thursday, January 16, 2020 Quality Payment Program: Learn About the MIPS 2020 Performance Period MLN Connects® for Thursday, January 16, 2020 View this edition as a PDF News CMS Reduces Psychiatric Hospital Burden [...]

MLN Connects® for Thursday, January 9, 2020

MLN Connects® for Thursday, January 9, 2020 Read the Latest Quality Payment Program Updates MLN Connects® for Thursday, January 9, 2020 View this edition as a PDF News Quality Payment Program: 2018 Performance Data Quality [...]

Notification to Providers: Preventive and Screening Services

Notification to Providers: Preventive and Screening Services Centralized billing is a process in which a provider, who provides mass immunization services for influenza virus and pneumococcal pneumonia virus (PPV) immunizations, can send all [...]