About Appeals

About Appeals Providers and beneficiaries have the right to appeal claim determinations made by National Government Services. The purpose of the appeals process is to ensure the correct adjudication of claims. Appeals activities conducted by [...]

What Documents are Needed

What Documents are Needed? You are required to submit all necessary medical documentation to support the services billed on your claim as part of your participation agreement; you must submit a complete medical record when requesting an [...]

PCACE Download Email

Thank you for downloading the full installation or upgrade for PC-ACE. Please print this e-mail and keep this for your records. The PC-ACE installation code is: NGSMAC1 Once you have successfully installed or upgraded PC-ACE, the “Sign On” [...]

Tutorial

Centers for Medicare & Medicaid Services

Centers for Medicare & Medicaid Services CMS has ten regional offices to assist with Congressional inquiries. For Congressional inquiries or questions specific for Medicare Part D, try contacting the Medicare Part D Plan first. Another [...]

Credit Balance Status Lookup

Prior Authorization Exemption Process FAQ

Prior Authorization Exemption Process FAQ How many days notice will I receive before I switch from PAR submissions to an exemption cycle? Answer: MACs will provide a 60-day notice prior to any transition period, continuation, or withdrawal [...]

NGSConnex User Guide

Initiate a Claim Status Lookup

Initiate a Claim Status Lookup Click the Claim Status Lookup button from the NGSConnex homepage. In the Select a Provider panel, click the Select button next to the applicable provider account. To search for claims use the filter [...]

Check Status of Prior Authorization Requests

CMS Newsroom

CMS Newsroom CMS Newsroom Homepage

Tip Sheet #2

National Government Services Office of Congressional Affairs Inquiry: Tip Sheet #2 Tips for a Congressional Inquiry to Move Forward Without Delay Each congressional inquiry includes a ‘Consent for Release’ form of Medicare personal records [...]

Reopening Not Appropriate to Change Diagnosis on Paid Claims

Reopening Not Appropriate to Change Diagnosis on Paid Claims National Government Services periodically receives reopening requests to change the diagnosis on a paid claim.  Submitting a new, or corrected diagnosis on a claim that has [...]

MLN Connects® Newsletter for Thursday, December 2, 2021

MLN Connects® Newsletter for Thursday, December 2, 2021 National Influenza Vaccination Week News National Influenza Vaccination Week Clinical Laboratory Fee Schedule: CY 2022 Final Payment Determinations Skilled Nursing Care & [...]

MLN Connects® Special Edition for Friday, January 7, 2022

MLN Connects® Special Edition for Friday, January 7, 2022 COVID-19: New HCPCS Code for Remdesivir Antiviral Medication Following the recent statement from the National Institutes of Health (NIH) COVID-19 Treatment Guidelines Panel regarding [...]

MLN Connects® Newsletter for Thursday, February 3, 2022

MLN Connects® Newsletter for Thursday, February 3, 2022 Provider Compliance Virtual Focus Group — February 24 News COVID-19: Letter to Health Care Facility Administrators on Health Care Worker Vaccination Rule COVID-19 Vaccine & [...]

MLN Connects® Newsletter for Thursday, February 17, 2022

MLN Connects® Newsletter for Thursday, February 17, 2022 Expanded Coverage: Lung Cancer Screening with Low Dose Computed Tomography News CMS Expands Coverage of Lung Cancer Screening with Low Dose Computed Tomography There’s Still Time [...]

MLN Connects® Special Edition for Friday, February 18, 2022

MLN Connects® Special Edition for Thursday, February 18, 2022 COVID-19 Monoclonal Antibodies: FDA Authorized Bebtelovimab On February 11, the FDA authorized the emergency use of the monoclonal antibody bebtelovimab for the treatment of [...]

MLN Connects® Newsletter for Thursday, February 24, 2022

MLN Connects® Newsletter for Thursday, February 24, 2022 CMS Released Skilled Nursing Facility & ESRD Web Pricers News Podiatry Nail Debridement & Evaluation and Management Services: Comparative Billing Report Skilled Nursing [...]

MLN Connects® Newsletter for Thursday, March 17, 2022

MLN Connects® Newsletter for Thursday, March 17, 2022 Kidney Health: Help Address Disparities News Medicare Shared Savings Program: Application Deadlines for January 1, 2023, Start Date Kidney Health: Help Address Disparities Claims, [...]

MLN Connects® Newsletter for Thursday, February 10, 2022

MLN Connects® Newsletter for Thursday, February 10, 2022 COVID-19: New HCPCS Code for Convalescent Plasma in Outpatient Setting News COVID-19: New HCPCS Code for Convalescent Plasma in Outpatient Setting Long-term Care Hospital [...]

MLN Connects® Newsletter for Thursday, January 20, 2022

MLN Connects® Newsletter for Thursday, January 20, 2022 COVID-19: Long-term Care, RHCs, & FQHCs   News COVID-19: Vaccine Access in Long-term Care Settings There’s Still Time: Recommend the Flu Shot Chiropractic Treatment of [...]

Save the Dates: National Government Services 2022 Spring Virtual Conference!

Save the Dates! National Government Services 2022 Spring Virtual Conference! Medicare for You 5/11/2022 – 5/12/2022 “Seasons change, and so do we.” - Nikkiche We also see many changes occur in Medicare. We want our provider community to have [...]

MLN Connects® Newsletter for Thursday, March 3, 2022

MLN Connects® Newsletter for Thursday, March 3, 2022 2022 Payment, Quality & Policy Changes News Ambulance Prior Authorization Model Expands April 1 Nutrition-related Health Conditions: Recommend Medicare Preventive Services [...]

Place of Service 10 for Telehealth Services Not for Medicare Billing

Place of Service 10 for Telehealth Services Not for Medicare Billing National Government Services is receiving calls from providers to our call center in regard to the usage of the new Place of Service 10 code.  POS 10 was established [...]

2022 CMS Evaluation and Management Regulation Modifications

2022 CMS Evaluation and Management Regulation Modifications On 2/23 and 2/24/2022, National Government Services presented webinars titled “2022 CMS Evaluation and Management Regulation Modifications”. Subsequent to those sessions, we sought [...]

Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2022

Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2022 This announcement provides information that may be helpful to clinicians in determining whether to become a Medicare participating provider, or to continue [...]

April 2022 Release "Dark Days" for the Common Working File Hosts

April 2022 Release "Dark Days" for the Common Working File Hosts For the upcoming April 2022 Release: For Production, CWF will be observing the Gray Day on Thursday, 3/31/2022 and Dark Days starting Friday, 4/1/2022 through Sunday, 4/3/2022 [...]

Chronic Care Management with Transitional Care Management Clarification

Chronic Care Management with Transitional Care Management Clarification TCM policy indicates that it is billable in the same month that CCM services are performed. MLN® Booklet Transitional Care Management Services includes a listing of the [...]

Social Security Income Ratios

Social Security Income Ratios The federal fiscal year 2020 SSI ratios for IPPS hospitals, IRFs and LTCHs were posted on the CMS website. IPPS IRF LTCH We will update the latest published 2020 SSI ratios in the Provider Specific File of [...]

Medicare Advantage Plan Beneficiaries Receiving the COVID-19 Vaccine and Monoclonal Antibody

Medicare Advantage Plan Beneficiaries Receiving the COVID-19 Vaccine and Monoclonal Antibody Effective 1/1/2022, claims for COVID-19 vaccinations or monoclonal antibody treatment provided to patients enrolled in MA plans on or after 1/1/ 2022, [...]

February and March 2022 Billing and Coding Article Updates

February and March 2022 Billing and Coding Article Updates Billing and Coding: Peripheral Nerve Blocks (A57452) This article has been updated due to a provider request to add diagnosis code G58.0 to Group 1 in the "ICD-10 codes that support [...]

Provider Compliance Virtual Focus Group - February 24, 2022

Provider Compliance Virtual Focus Group - February 24, 2022 Thursday, 2/24/2022 from 1:00–4:00 p.m. ET Register by Friday, 2/18/2022 - Registration Closed How can CMS improve its processes and eliminate unnecessary requirements for [...]

Prior Authorization Requests Submitted by Exempt Providers Alert

Prior Authorization Requests Submitted by Exempt Providers Alert The National Government Services PA Department has observed an increase in submission of PAR for exempt providers. These submissions are from the HOPD and/or physician offices on [...]

2022 Gap-Fill Request for Information

2022 Gap-Fill Request for Information National Government Services, the MAC for JK and J6, is in receipt of the new laboratory test codes identified by the CMS to be gap-fill priced for 2022. The PAMA regulations instruct the MACs to establish [...]

January 2022 EDI Front End Quarterly Release

January 2022 EDI Front End Quarterly Release Please be advised that while the Centers for Medicare & Medicaid Services mandated release for January 2022 will be installed the weekend of 1/2/2022, the code set updates included with this [...]

Home Health Bill Type 32A Returning With Reason Code U537I

Home Health Bill Type 32A Returning With Reason Code U537I CMS implemented HH TOB 32A for the NOA effective for period of care claims on or after 1/1/2022. The NOA is required for all HH period of care claim billing, including demand billing [...]

Skilled Nursing Facility Consolidated Billing Services Reminder

Skilled Nursing Facility Consolidated Billing Services Reminder For Medicare beneficiaries in a covered Part A stay, these separately payable, or excluded, services include select items or services in the following categories: physician’s [...]

January and February 2022 LCD and Billing and Coding Article Updates

January and February 2022 LCD and Billing and Coding Article Updates Colon Capsule Endoscopy (CCE) (L38571) LCD revised effective 2/15/2022: coverage criteria expanded to include blood-based biomarker colorectal cancer screening test, [...]

2021 Calendar Year 1099 Form Information

2021 Calendar Year 1099 Form Information Medicare providers and beneficiaries, who are serviced by National Government Services, regardless of their location, will receive a single Part A and Part B combined Form 1099 from NGS for calendar [...]

Transvenous Phrenic Nerve Stimulation in the Treatment of Central Sleep Apnea (L37929)

Transvenous Phrenic Nerve Stimulation in the Treatment of Central Sleep Apnea (L37929) Currently, National Government Services has LCD Transvenous Phrenic Nerve Stimulation in the Treatment of Central Sleep Apnea (L37929) as well as a Draft [...]

How to Avoid Costly Appeals

How to Avoid Costly Appeals National Government Services has noticed an increase in requests for claim appeals. Upon review, we have found that many of the requests are not appropriate and/or necessary for a claim appeal submission. The [...]

MLN Connects® Special Edition for Thursday, May 6, 2021

MLN Connects® Special Edition for Thursday, May 6, 2021 CMS Increases Medicare Payment for COVID-19 Monoclonal Antibody Infusions New payment policy for at-home administration As part of the ongoing response to address the COVID-19 [...]

MLN Connects® Special Edition for Monday, December 6, 2021

MLN Connects® Special Edition for Monday, December 6, 2021 Provider Requirements Under the No Surprises Act Special ODF — December 8 Wednesday, December 8, 2021 from 2:00-3:00 p.m. eastern time ​​​CMS will host a Special Open Door Forum [...]

Medicare Part A and Part B Billing for the COVID-19 Vaccine and Monoclonal Antibody

Medicare Part A and Part B Billing for the COVID-19 Vaccine and Monoclonal Antibody Medicare Billing for COVID-19 Vaccine Shot Administration How to Bill for COVID-19 Shot Administration You’ll be able to bill on single claims for the [...]

National Government Services Billing VEKLURY™ (remdesivir) Antiviral Medication in Outpatient Settings

National Government Services Billing VEKLURY™ (remdesivir) Antiviral Medication in Outpatient Settings CMS created the new HCPCS code J0248 for VEKLURY™ (remdesivir) antiviral medication. This code is effective for dates of service on or after [...]

Home Health and Hospice December Educational Videos are Now Available On-Demand

Home Health and Hospice December Educational Videos are Now Available On-Demand The National Government Services Home Health and Hospice Provider Outreach & Education team “On-Demand Video Library” offers providers the ability to watch or [...]

Removal of HCPCS Code

Removal of HCPCS Code Prior Authorization Update Effective immediately, for claims with dates of service on or after 1/7/2022, the Centers for Medicare & Medicaid Services is removing current procedural terminology code 67911 (correction [...]

Coronavirus Resources for Home Care and Hospice

Coronavirus Resources for Home Care and Hospice At National Government Services, the health and well-being of our beneficiary and provider communities is our top priority. The Centers for Medicare & Medicaid Services’ COVID-19 web page is [...]

Home Health Bill Type 32A Returning with Reason Code 32114

Home Health Bill Type 32A Returning with Reason Code 32114 The Centers for Medicare & Medicaid Services implemented new home health bill type 32A effective 1/1/2022. An issue with ZIP codes submitted on EMC claims has been identified, [...]

December 2021-January 2022 LCD and Billing and Coding Article Updates

December 2021-January 2022 LCD and Billing and Coding Article Updates Billing and Coding: Autonomic Function Testing (A57024) Due to the annual CPT/HCPCS code updates, effective 1/1/2022, CPT code 95943 has been deleted from the CPT/HCPCS [...]

MLN Connects® Newsletter for Thursday, November 18, 2021

MLN Connects® Newsletter for Thursday, November 18, 2021 COVID-19: Changes to Nursing Home Visitation & Survey Activities   News CMS Repeals MCIT/R&N; Will Consider Other Coverage Pathways to Enhance Access to Innovative [...]

MLN Connects® Newsletter for Thursday, November 4, 2021

MLN Connects® Newsletter for Thursday, November 4, 2021 COVID-19: Changes for Medicare Advantage Plan Claims Starting January 1   News COVID-19 Vaccines for Children COVID-19 Vaccine & Monoclonal Antibody Products: Changes for [...]

MLN Connects® Special Edition for Friday, September 24, 2021

MLN Connects® Special Edition for Friday, September 24, 2021 CMS Will Pay for COVID-19 Booster Shots, Eligible Consumers Can Receive at No Cost Coverage without cost-sharing available for eligible people with Medicare, Medicaid, CHIP, and [...]

MLN Connects® Newsletter for Thursday, September 30, 2021

MLN Connects® Newsletter for Thursday, September 30, 2021 Flu Season is Here: Protect Your Patients, Yourself, & Your Loved Ones View this edition as a: Webpage | PDF News Flu Season is Here: Protect Your Patients, Yourself, [...]

MLN Connects® Special Edition for Monday, September 20, 2021

MLN Connects® Special Edition for Monday, September 20, 2021 Help CMS Improve Your Experience with Provider Resources CMS is conducting a study to help us improve your experience with resources about the Medicare program and correct billing. [...]

MLN Connects® Newsletter for Thursday, August 19, 2021

MLN Connects® Newsletter for Thursday, August 19, 2021 COVID-19: Vaccinate Your Patients View this edition as a: Webpage | PDF News Immunization: Medicare Covers Vaccines Compliance Chiropractic Services: Comply with Medicare [...]

MLN Connects® Newsletter for Thursday, August 26, 2021

MLN Connects® Newsletter for Thursday, August 26, 2021 Health Care Code Sets: ICD-10 — Revised View this edition as a: Webpage | PDF News Impact of the PHE on Telehealth: Comparative Billing Report in August COVID-19 Monoclonal [...]

MLN Connects® Newsletter for Thursday, September 9, 2021

MLN Connects® Newsletter for Thursday, September 9, 2021 SNF: WBT & COVID-19 Reminder View this edition as a: Webpage | PDF    News PEPPERs for Short-term Acute Care Hospitals Outpatient Clinic Visit Services at [...]

MLN Connects® Special Edition for Friday, August 13, 2021

MLN Connects® Special Edition for Friday, August 13, 2021 COVID-19 Vaccine Additional Dose Medicare stands ready to pay for administering an additional dose of COVID-19 vaccine consistent with the FDA EUA. We’ll pay the same amount to [...]