MLN Connects® for Thursday, June 4, 2020

MLN Connects® for Thursday, June 4, 2020 ICD-10-PCS Procedure Codes: FY 2021 MLN Connects® for Thursday, June 4, 2020 View this edition as a PDF News Trump Administration Unveils Enhanced Enforcement Actions Based on Nursing Home [...]

MLN Connects® for Thursday, June 25, 2020

MLN Connects® for Thursday, June 25, 2020 MLN Connects® for Thursday, June 25, 2020 View this edition as a PDF News Trump Administration Issues Call to Action Based on New Data Detailing COVID-19 Impacts on Medicare Beneficiaries [...]

MLN Connects® for Thursday, June 18, 2020

MLN Connects® for Thursday, June 18, 2020 COVID-19 Diagnostic Laboratory Tests: Billing for Clinician Services MLN Connects® for Thursday, June 18, 2020 View this edition as a PDF News Hospitals: Submit Medicare GME Affiliation [...]

MLN Connects® for Thursday, June 11, 2020

MLN Connects® for Thursday, June 11, 2020 COVID-19: Reopening Health Care Facilities MLN Connects® for Thursday, June 11, 2020 View this edition as a PDF News Nursing Home COVID-19 Data and Inspections Results Available on [...]

MLN Connects® for Thursday, July 9, 2020

MLN Connects® for Thursday, July 9, 2020 ICD-10-CM Diagnosis Codes: FY 2021 MLN Connects® for Thursday, July 9, 2020 View this edition as a PDF News Open Payments: Program Year 2019 Data LTCH Provider Preview Reports: Review [...]

MLN Connects® for Thursday, July 30, 2020

MLN Connects® for Thursday, July 30, 2020 MLN Connects® for Thursday, July 30, 2020 View this edition as a PDF News   CMS Updates Data on COVID-19 Impacts on Medicare Beneficiaries Short-Term Acute Care [...]

MLN Connects® for Thursday, July 23, 2020

MLN Connects® for Thursday, July 23, 2020 Telemedicine Hack: 10-Week Learning Community for Ambulatory Providers MLN Connects® for Thursday, July 23, 2020 View this edition as a PDF News Peripheral Vascular Intervention for [...]

MLN Connects® for Thursday, July 2, 2020

MLN Connects® for Thursday, July 2, 2020 Attend Nursing Home Training Series Webcasts MLN Connects® for Thursday, July 2, 2020 View this edition as a PDF News CMS Proposes to Expand Coverage Policy for Transcatheter Edge-to-Edge [...]

MLN Connects® for Thursday, July 16, 2020

MLN Connects® for Thursday, July 16, 2020 Nursing Homes & COVID: Five Things to Know, Additional Resources, Training MLN Connects® for Thursday, July 16, 2020 View this edition as a PDF News CMS Directs Additional Resources [...]

Medicare Enrollment Application Fee Refunds Through EFT

Medicare Enrollment Application Fee Refunds Through EFT CMS is now issuing application fee refunds through Electronic Funds Transfer (EFT), rather than paper checks. We will request new information if you need an application fee refund for [...]

MLN Connects® for Wednesday, November 25, 2020

MLN Connects® for Wednesday, November 25, 2020 Hospital Price Transparency Webcast on 12/8 MLN Connects® for Wednesday, November 25, 2020 View this edition as a: Webpage | PDF News CMS Announces Historic Changes to Physician [...]

MLN Connects for Wednesday, December 23, 2020

MLN Connects® for Wednesday, December 23, 2020 ICD-10 Code Files for FY 2021 MLN Connects® for Wednesday, December 23, 2020 View this edition as a: Webpage | PDF Editor's Note: Happy holidays from the MLN Connects team! We'll [...]

MLN Connects® for Thursday, September 3, 2020

MLN Connects® for Thursday, September 3, 2020 CMS Acts to Spur Innovation for America’s Seniors MLN Connects® for Thursday, September 3, 2020 View this edition as a PDF News CMS Acts to Spur Innovation for America’s Seniors [...]

MLN Connects® for Thursday, September 24, 2020

MLN Connects® for Thursday, September 24, 2020 Need Help Checking Medicare Eligibility? MLN Connects® for Thursday, September 24, 2020 View this edition as a PDF News CMS to Expand Successful Ambulance Program [...]

MLN Connects® for Thursday, September 17, 2020

MLN Connects® for Thursday, September 17, 2020 MLN Connects® for Thursday, September 17, 2020 View this edition as a PDF News SNF Healthcare-Associated Infections Measure: Submit Comments by October 14 Participate in Medical [...]

MLN Connects® for Thursday, September 10, 2020

MLN Connects® for Thursday, September 10, 2020 CMS Care Compare Empowers Patients MLN Connects® for Thursday, September 10, 2020 View this edition as a PDF News CMS Care Compare Empowers Patients When Making Important Health [...]

MLN Connects® for Thursday, October 8, 2020

MLN Connects® for Thursday, October 8, 2020 17 Provider Compliance Tips Fact Sheets MLN Connects® for Thursday, October 8, 2020 View this edition as a:  Webpage | PDF  News Hospice Quality Reporting [...]

MLN Connects® for Thursday, October 29, 2020

MLN Connects® for Thursday, October 29, 2020 Quality Payment Program APMs: Update Billing Information to Get Paid MLN Connects® for Thursday, October 29, 2020 View this edition as a: Webpage | PDF News Quality Payment Program [...]

MLN Connects® for Thursday, October 22, 2020

MLN Connects® for Thursday, October 22, 2020 Medicare Coverage for Opioid Use Disorder Treatment MLN Connects® for Thursday, October 22, 2020 View this edition as a: Webpage | PDF News Opioid Use Disorder Treatment: Medicare [...]

MLN Connects® for Thursday, October 15, 2020

MLN Connects® for Thursday, October 15, 2020 COVID-19 Testing: Protecting Integrity MLN Connects® for Thursday, October 15, 2020 View this edition as a: Webpage | PDF News CMS Takes Action to Protect Integrity of COVID-19 [...]

MLN Connects® for Thursday, October 1, 2020

MLN Connects® for Thursday, October 1, 2020 Hospital Price Transparency: Requirements Effective January 1 MLN Connects® for Thursday, October 1, 2020 View this edition as a: Webpage | PDF Editor’s Note: This edition includes a [...]

MLN Connects® for Thursday, November 5, 2020

MLN Connects® for Thursday, November 5, 2020 COVID-19 Vaccine: Find Out How to Prepare MLN Connects® for Thursday, November 5, 2020 View this edition as a: Webpage | PDF News COVID-19 Vaccine: Find Out How to Prepare Hospital [...]

MLN Connects® for Thursday, November 19, 2020

MLN Connects® for Thursday, November 19, 2020 Nursing Homes: Take COVID-19 Training MLN Connects® for Thursday, November 19, 2020 View this edition as a: Webpage | PDF News CMS Releases Nursing Home COVID-19 Training Data with [...]

MLN Connects® for Thursday, November 12, 2020

MLN Connects® for Thursday, November 12, 2020 COVID-19: Non-Physician Practitioner Billing for Audio Services MLN Connects® for Thursday, November 12, 2020 View this edition as a: Webpage | PDF News Critical Care: Comparative [...]

Notification of the 2020 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review

Notification of the 2020 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review The amount that must remain in controversy for ALJ hearing requests filed on or [...]

New Version of PC-ACE: April 2020

New Version of PC-ACE:  April 2020 PC-ACE Version 4.6 contains several CMS mandates and product enhancements including but not limited to the items listed below. CR 11353 - New Medicare Provider Specialty Code (D5) and Billing Codes [...]

New Uniform Thresholds for Determining Low Medicare Utilization Providers

New Uniform Thresholds for Determining Low Medicare Utilization Providers Effective for all cost reports received on or after 6/19/2020, the MACs are instructed to use the following defined “Low Medicare Utilization Thresholds” compared to [...]

New NGS Part A Redetermination Request Form

New NGS Part A Redetermination Request Form Save time and money by using of the following options instead of mailing a written redetermination request form: Initiate an adjustment in the FISS DDE for fully covered or rejected claims Use [...]

National Government Services and the Public Health Emergency

National Government Services and the Public Health Emergency The health and well-being of our beneficiaries, providers, associates and communities is our top priority. We understand the uncertainty and concerns you may be experiencing during [...]

National Government Services Provider Enrollment Appeals Mailbox Reminder

National Government Services Provider Enrollment Appeals Mailbox Reminder National Government Services, Inc. has seen an increase in submissions to the PE appeals mailbox (NGS-PE-Appeals@Anthem.com) that are not appropriate. The NGS PE appeals [...]

National Government Services Accepting and Processing Claims for Expanded Coverage of Telehealth Services as of 3/6/2020

National Government Services Accepting and Processing Claims for Expanded Coverage of Telehealth Services as of 3/6/2020 On 3/17/2020, CMS issued MLN Connects® Special Edition for Tuesday, March 17, 2020, President Trump Expands Telehealth [...]

Medicare Usage of CPT 99072

Medicare Usage of CPT 99072 National Government Services has received many questions regarding CPT 99072 for Medicare usage since the AMA announced the code on 9/8/2020. Many providers have been asking if CMS will cover this code for Medicare [...]

Chiropractors Billing Medicare for Therapy Services

Chiropractors Billing Medicare for Therapy Services Chiropractors in the Medicare fee-for-service realm are only allowed to be considered for spinal manipulation via submission of CPT codes 98940‒98942. Medicare pays for these services when [...]

Top Reasons for Unprocessable Claims

Top Reasons for Unprocessable Claims National Government Services has composed a list of the top reasons for returning claims as unprocessable; due to missing, incomplete, insufficient or invalid claim information. An unprocessable claim is [...]

What Part B Providers Need to Know About the Prior Authorization Program for Certain Medicare Services Performed in the Hospital Outpatient Department

What Part B Providers Need to Know About the Prior Authorization Program for Certain Medicare Services Performed in the Hospital Outpatient Department Hospitals submitting claims for certain outpatient department services will be required to [...]

Reminder: 2020 New Codes for Care Management

Reminder: 2020 New Codes for Care Management We are reminding you that the 2020 final rule with regard to the new care management codes is not policy at this time. CMS is considering these changes identified in the final rule. If CMS decides [...]

Proper Billing for Opioid Treatment Program Weekly Bundles for HCPCS Codes G2067-G2075

Proper Billing for Opioid Treatment Program Weekly Bundles for HCPCS Codes G2067-G2075 Medicare introduced the OTP as a covered Part B benefit beginning with dates of service on and after 1/1/2020. Payment is made to Medicare-enrolled OTP [...]

Prior Authorization: Part B Physician Implications

Prior Authorization: Part B Physician Implications For dates of service on and after 7/1/2020, CMS has implemented a prior authorization program for certain hospital OPD services. This has been done to ensure that Medicare beneficiaries [...]

Fee Schedule Adjustments Reminder for 99441-99443

Fee Schedule Adjustments Reminder for 99441-99443 National Government Services has received several inquiries from providers regarding the adjustment of CPT codes 99441-99443. When CMS announced that they were changing the fee schedule [...]

Chiropractors Billing Medicare for Therapy Services

Chiropractors Billing Medicare for Therapy Services Chiropractors in the Medicare fee-for-service realm are only allowed to be considered for spinal manipulation via submission of CPT codes 98940‒98942. Medicare pays for these services when [...]

2021 E/M Prolonged Service Billing Changes for Medicare

2021 E/M Prolonged Service Billing Changes for Medicare National Government Services has received several inquiries regarding changes to office or other outpatient prolonged service coding effective 1/1/2021. When the AMA released the changes [...]

Don’t Forget the CMS-588 Electronic Funds Transfer Authorization Agreement

Don’t Forget the CMS-588 Electronic Funds Transfer Authorization Agreement  The CMS-588 Electronic Funds Transfer Authorization Agreement is to be submitted for billing providers upon initial enrollment, change in bank information and [...]

Social Security Income Ratios

Social Security Income Ratios Attention All Part A Inpatient Prospective Payment System Hospitals, Inpatient Rehabilitation Facilities and Long-Term Care Hospitals The federal fiscal year 2018 SSI ratios for IPPS hospitals, IRFs and LTCHs [...]

New EDI Service Offering for the Part A/FQHC/HHH 276/277 Claim Status Inquiry and Response

New EDI Service Offering for the Part A/FQHC/HHH 276/277 Claim Status Inquiry and Response National Government Services is pleased to announce the availability of a ‘near’ real time response to claim status inquiries submitted to EDI with the [...]

Alcohol Misuse and Counseling

Preventive Services Guide Alcohol Misuse and Counseling Table of Contents Alcohol Misuse and Counseling Two-Part Benefit Cost Sharing Reimbursement Nonparticipating Providers Common Claim Denial Reasons Related Content [Return [...]

Screening Pap Tests

Preventive Services Guide Screening Pap Tests Cervical cytology, also called a Pap test, looks for abnormal changes in cells in the cervix, which is part of a woman’s reproductive organs. Screening for cervical cancer via a Pap test is very [...]

Hospice Claim Reporting Requirements for Attending and Certifying Physicians

Hospice Claim Reporting Requirements for Attending and Certifying Physicians ​​​​Under CMS' current guidelines, the hospice medical director or the hospice physician and the attending physician (if the beneficiary has one), must initially [...]

PC-ACE

Bone Mass Measurements

Preventive Services Guide Bone Mass Measurements Table of Contents Bone Mass Measurements Risk Factors Coverage Guidelines and Frequency Limits Coverage Criteria HCPCS/CPT Coding HCPCS/CPT Codes ICD-10 Codes Diagnosis [...]

LCD and Article Updates for September/October 2024

LCD and Article Updates for September/October 2024 A58152 Billing and Coding: Computed Tomography Cerebral Perfusion Analysis (CTP) The following ICD-10-CM diagnosis codes were added to Group 1- ICD-10-CM Codes That Support Medical necessity [...]

Ultrasound Screening for Abdominal Aortic Aneurysm

Preventive Services Guide Ultrasound Screening for Abdominal Aortic Aneurysm An ultrasound screening for AAA is a procedure using sound waves (or such other procedures using alternative technologies, of commensurate accuracy and cost, as [...]

Provider Enrollment: Completing the CMS-855I Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855I provider enrollment paper application for a group member, sole proprietor, or sole owner and we’ll also focus on reassigning Medicare benefits.

Prostate Cancer Screening

Preventive Services Guide Prostate Cancer Screening Prostate cancer is the second most common cancer in men in the United States, after skin cancer. Older men, African-American men and men who have a family history of prostate cancer have a [...]

Screening Pelvic Examinations

Preventive Services Guide Screening Pelvic Examination A pelvic examination is a type of gynecologic examination for women. Some of the conditions that health care providers look for during a pelvic examination include infections, fibroids, [...]

Screening for Cervical Cancer with Human Papillomavirus Tests

Preventive Services Guide Screening for Cervical Cancer with Human Papillomavirus Tests Cervical cancer is commonly caused by the HPV. The USPSTF found that regular screening greatly reduces the rate of cervical cancer and the number of [...]

MLN Connects® Newsletter: September 26, 2024

MLN Connects® Newsletter: September 26, 2024 News CMS Roundup (September 20, 2024) Cardiovascular Disease: Talk with Your Patients about Screening Claims, Pricers, & Codes Cardiology CPT Code 75580: Issue with Claims Returned to [...]

Medically Unlikely Edits and Related Billing Clarifications

Medically Unlikely Edits and Related Billing Clarifications An MUE is the maximum number of UOS allowable under most circumstances for a single HCPCS/CPT code billed by a provider for a particular date of service for a single beneficiary. [...]

Physical/Occupational Therapy Billing

Join us as we review billing guidelines for physical and occupational therapy. We'll review when to apply the KX modifier and the importance of appropriate medical documentation. National Government Services has a Local Coverage Determination [...]

General Information

General Information In certain circumstances, National Government Services or other contractors working under the CMS may need to request additional information with regard to claims submitted to the Medicare Program. The requests for [...]

Other Audit Contractor ADRs

Other Audit Contractor Additional Development Requests An ADR may be requested from one of the contractors listed below. If you receive correspondence from any one of these contractors, please follow the instructions within their letter. [...]