Payment Rates

Payment Rates Medicare-enrolled OTPs are paid flat dollar payment rates for the codes describing the OTP bundled services (HCPCS codes G2067 through G2080, and G2215 to G2216). Payment rates are based on the OTP provider’s geographic location. [...]

Medicare Coverage for Zika Virus Testing

Medicare Coverage for Zika Virus Testing In February, 2016 the Zika virus was declared a PHE by the WHO. In the United States, the CDC considers the Zika virus disease to be a nationally notifiable condition. The Zika virus is primarily [...]

Molecular Pathology: Claims Review and Supporting Information to Submit on the Claim

Molecular Pathology: Claims Review and Supporting Information to Submit on the Claim Table of Contents Molecular Pathology: Claims Review and Supporting Information to Submit on the Claim Prepayment and/or Post Payment Review Tier 2 Codes [...]

Pathology Interpretation Services

Pathology Interpretation Services National Government Services has noted that there is some confusion and questions regarding the billing of professional components on some laboratory services. There is a certain subset of CPT codes for which [...]

Background/Overview

Background/Overview Effective for dates of service on and after 1/1/2020, CMS pays OTPs, through weekly bundled payments, to deliver OUD treatment services to Medicare beneficiaries. OTP is a Medicare Part B benefit that provides coverage for [...]

How to Become a Medicare-Enrolled OTP Supplier

How to Become a Medicare-Enrolled OTP Supplier Table of Contents How to Become a Medicare-Enrolled OTP Supplier National Government Services Provider Enrollment Call Center NGS Provider Enrollment Mailing Address [Return to Top] How [...]

Psychotherapy Services

Psychotherapy Services Table of Contents Regulations and Targeted Probe and Educate Resources Medicare Regulations CMS TPE Resources NGS Resources Psychotherapy Treatment Plans Required Treatment Plan Components [...]

Psychotherapy Services

Part B Overview of Medicare Dental Coverage

Medicare covers a limited number of dental services. The purpose of this webinar is to familiarize dental providers with Medicare Part B dental coverage. Discussion will include an overview of dental coverage, who can provide dental services, [...]

Utilizing Modifiers for Medicare Part B Dental Services

The purpose of this webinar is to discuss the modifiers that are currently allowed to be appended to inextricably linked dental services. We’ll also review the correct placement and billing guidelines for these modifiers when submitting [...]

The Medicare Appeals Process: What You Need to Know

This informative session will help you navigate Medicare’s appeals process by providing information on what an appeal is, how to determine if a claim can be appealed, who may file an appeal, the appeal levels, timeframes and documentation [...]

MLN Connects® Newsletter: September 5, 2024

MLN Connects® Newsletter: September 5, 2024 News Osteogenesis Stimulators: Prior Authorization Requirements Suspended Hospice Benefit: Expanding Prepayment Review in 4 States Skilled Nursing Facility Advance Beneficiary Notice: Revised [...]

Related Content

Related Content Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 32, Cardiac Rehabilitation (CR) Programs, Intensive Cardiac Rehabilitation (ICR), [...]

Pulmonary Rehabilitation

Pulmonary Rehabilitation Effective 1/1/2010, Medicare Part B pays for PR if specific criteria are met by the Medicare beneficiary, the PR program itself, the setting in which it is administered and the physician administering the program, as [...]

Cardiac Rehabilitation and Intensive Cardiac Rehabilitation

Cardiac Rehabilitation and Intensive Cardiac Rehabilitation Medicare Part B pays for CR and ICR programs and related items/services. Specific criteria must be met by the Medicare beneficiary, the cardiac rehabilitation program itself, the [...]

Other Medicare Contacts

Other Medicare Contacts   Organization Contact Information ALJ BP Tower & Garage 200 Public Square, Suite 1300 Cleveland, OH 44114-2316 American Medical Association Website Phone: [...]

Psychotherapy Services and Targeted Probe and Educate

Psychotherapy Services and Targeted Probe and Educate We’ve added a new section to our website for Psychotherapy Services. Visit this page for informative instruction about completing a psychotherapy treatment plan, the required components to [...]

Therapy Timeframes

Expected Timeframes for Therapy Services

Expected Timeframes for Therapy Services CMS and CPT guidelines for provider time spent and documented on therapy services may vary, depending on the definition of the service and the context in which it is performed. View our Therapy [...]

MBI Lookup

MBI Lookup The MBI Lookup should be used when you have attempted to obtain a copy of the patient’s Medicare card or MBI from the patient or the patient’s caregiver. The MBI Lookup will allow you to search for and receive a patient’s MBI. [...]

Health Professional Shortage Area

Health Professional Shortage Area Table of Contents What is a HPSA Eligible Providers HPSA Eligibility and Designation Claim Coding Requirements and Payment Locating a HPSA Designation on HRSA Website What Is a HPSA? A HPSA is an [...]

CMS Incentive Payment Information

CMS Incentive Payment Information Program Information Quarterly and annually, CMS issues special incentive payments to EPs that participate in the following incentive programs. Providers are welcome to use the information below to [...]

RuralServ

NGS RuralServ Our rural health providers face unique challenges in delivering quality of care to Medicare beneficiaries and in the associated administrative functions to file claims to Medicare. The RuralServ section of our website provides [...]

Comprehensive Error Rate Testing Program

Documentation to Support Spinal Manipulation for CPT Code 98942

Documentation to Support Spinal Manipulation for CPT Code 98942 It is not uncommon for chiropractic doctors to perform a full-spine or multi-level manipulation, even when the symptoms or diagnosis reflect a single region. This is a matter of [...]

Limited Coverage for Services Ordered or Furnished By a Chiropractor

Limited Coverage for Services Ordered or Furnished By a Chiropractor This article is to remind chiropractors and facilities that X-rays and other diagnostic tests are statutorily excluded services when ordered or furnished by a chiropractor. [...]

Proper Billing for Acupuncture

Medicare Coverage of Chiropractic Services Proper Billing for Acupuncture Decision Memo for Acupuncture for Chronic Low Back Pain (CAG-00452N) Reviewed 9/11/2024

Modifiers

Medicare Coverage of Chiropractic Services Modifiers AT Modifier Used to indicate that the covered services billed are for active corrective treatment and the provider’s documentation supports medical necessity and Medicare coverage [...]

Medical Review Audits

Medicare Coverage of Chiropractic Services Medical Review Audits Medicare contractors perform medical review audits to ensure Medicare is paying providers for appropriately covered Medicare services. Medical review examines documentation [...]

Maintenance Care for Chiropractic Services

Medicare Coverage of Chiropractic Services Maintenance Care for Chiropractic Services Medicare coverage for chiropractic services extends only to treatment by means of manual manipulation of the spine to correct a subluxation, provided such [...]

Chiropractic Coverage

Medicare Coverage of Chiropractic Services Chiropractic Coverage Medicare pays chiropractors for spinal manipulation CPT codes 98940–98942, when these services are reasonably and medically necessary and meet all Medicare coverage guidelines [...]

Introduction to Chiropractic Services

Medicare Coverage of Chiropractic Services Introduction to Chiropractic Services A chiropractor must be licensed or legally authorized to furnish chiropractic services by the state or jurisdiction in which the services are furnished. In [...]

State License and Registrations for Individuals and Organizations

State License and Registrations for Individuals and Organizations Prior to submitting a provider enrollment application to Medicare, ensure that all applicable state licensing and/or specialty certification requirements are current. Each state [...]

How to Submit a Hardship Request

How to Submit a Hardship Request To request a hardship consideration, submit with a letter and any supporting documentation describing the hardship and why it justifies the exception for your application. Your hardship request will not be [...]

How to Pay the Application Fee

How to Pay the Application Fee The application fee must be paid electronically. Important: If submitting a hardship request, it must be submitted with the enrollment application. It cannot be accepted separately. To pay the application fee [...]

How to Obtain a Refund

How to Obtain a Refund A refund will only be granted in the following instances: The application fee was not required for the application submitted A hardship request was subsequently approved and a fee was paid An application was [...]

Who Needs to Pay Application Fees

Who Needs to Pay Application Fees Institutional providers and certain suppliers must pay an application fee or submit a hardship exception when initially enrolling, revalidating their enrollment or adding a new Medicare practice location. [...]

Interactive Voice Response System

Interactive Voice Response System You may check the status of your provider enrollment application (PECOS or paper) submissions via the IVR by: Case number/web tracker id or NPI and TIN combination Related Content Part B Provider [...]

Check Provider Enrollment Application Status

Check Provider Enrollment Application Status You may run simple search queries to retrieve and view the status of your CMS-855 application via two options. Case number/web tracker id NPI and TIN combination Related Content Check [...]

PECOS Self-Service Application Status

PECOS Self-Service Application Status You may run simple search queries to retrieve and view the status of your PECOS application. Individual View the enrollment application status of an individual provider in an organization or private [...]

Requests for Additional Information

Request for Additional Information While processing the application(s) National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Site Visits

Site Visits Site visits may be required for certain providers and will be unannounced; the contractor representatives must disclose to the provider appropriate identifying credentials and explain the purpose of the visit. CMS has implemented [...]

Requests for Additional Information

Requests for Additional Information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Acknowledgement Email

Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: NGS-PE-Communications@elevancehealth.com containing the NGS case number for tracking [...]

Requests for Additional Information

Requests for Additional Information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Site Visits

Site Visits Site visits may be required and will be unannounced; the contractor representatives must disclose to the provider appropriate identifying credentials and explain the purpose of the visit. CMS has implemented a site visit [...]

Requests for Additional Information

Requests for Additional Information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Introducing the All-New Medicare University!

  Introducing the All-New Medicare University! We encourage you to visit the new Medicare University and explore these exciting enhancements. Simply follow the directions below to check it out. Logging in for the First Time Medicare [...]

CMS-855I Completion Tips for Physicians and NPPs in Private Practice (Sole Owner or Sole Proprietor) Revalidation Application

CMS-855I Completion Tips for Physicians and NPPs in Private Practice (Sole Owner or Sole Proprietor) Revalidation Application Follow the instructions printed on the CMS-855I application and refer to this list of sections required for [...]

Hospice Documentation Checklist

Documentation Requirements for the Medicare Hospice Election Statement

Documentation Requirements for the Medicare Hospice Election Statement Election of Hospice Hospice care is a benefit under the hospital insurance program. To be eligible to elect hospice care under Medicare, the beneficiary must be entitled [...]

General Inpatient Check Off List

Implementation of the Election Statement Addendum

Implementation of the Election Statement Addendum Hospice Election Statement Addendum Hospice care is a benefit under the hospital insurance program. To be eligible to elect hospice care under Medicare, the beneficiary must be entitled to [...]

Tips for Responding to a Hospice ADR

Tips for Responding to a Hospice ADR National Government Services performs medical review audits of services billed to Medicare to validate that the documentation supports coverage and level of services billed. If one of your claims is [...]

Hospice Documentation Tips

Hospice Documentation Tips Medicare coverage of hospice depends on a physician’s certification that an individual’s prognosis is a life expectancy of six months or less if the terminal illness runs its normal course. It is important that the [...]

8/19/2024

Self-Service Pulse: What You Need To Know This Week As your MAC, National Government Services wants to provide you with a comprehensive source containing the most current information available for our self-service tools. Are You Using [...]

Reducing Unprocessable Claim Rejections

When claims are submitted with invalid, incomplete or incorrect information, our claims processing system will detect these errors and will reject claims as unprocessable. Our goal is to assist our providers in submitting claims correctly the [...]

Additional Development Requests for Part A Claims for CPT J9299

Additional Development Requests for Part A Claims for CPT J9299 A system error on 7/25/2024 caused ADR letters to be issued in error on Part A claims for CPT J9299 with DOS on or after 3/1/2024. The issue has been resolved and all impacted [...]

Proper Medicare Part B Claim Submissions

This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments, or denials. We will guide you through the CMS-1500 claim form and the electronic equivalent loops [...]