How to Prevent Common Skilled Nursing Facility Denials

How to Prevent Common Skilled Nursing Facility Denials This resource was developed to increase awareness and educate SNFs on the top errors found by our Medical Review team. The information includes suggestions to ensure documentation [...]

Skilled Nursing Facility Town Hall Question and Answers

Skilled Nursing Facility Town Hall Questions and Answers Are daily notes required for skilled rehabilitation? Answer: Daily notes for rehabilitation are not required, however, they do support that therapy performed was skilled and [...]

Coverage Requirements

Coverage Requirements Eligibility, preadmission, and 30-day transfer are components of coverage requirements for Skilled Nursing Facilities. There are several components to each of the coverage requirements; please utilize the links below to [...]

Skilled Nursing Facility Educational Center

Skilled Nursing Facility Educational Center As part of the effort to lower the SNF improper payment rate, CMS has initiated a five claim Skilled Nursing Facility Probe & Educate allowing for outreach to all Medicare billing SNFs in the [...]

How to Find and Respond to Post Payment Review ADR

How to Find and Respond to Post Payment Review ADR Table of Contents How to Find and Respond to Post Payment Review ADR Responding to Post Payment Review ADR Steps to View and Print ADRs from FISS/DDE Provider Online System Related [...]

Patient Driven Payment Model

Patient Driven Payment Model Table of Contents Assessment Schedule Administrative Presumption Lookback Period (Observation Period) Examples General PDPM Resources [Return to Top] Assessment Schedule Learn more about the [...]

LCD and Article Updates for June/July 2024

LCD and Article Updates for June/July 2024 Articles Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms A56867  Due to the quarterly CPT/HCPCS code update, PLA code 0204U was deleted from CPT/HCPCS Codes [...]

Attention Clearinghouses and Vendors!

Attention Clearinghouses and Vendors! National Government Services is ready to accept Medicare Part B dental claims from your dental providers using the 837D dental claim transaction. Dental providers have the following options for submission [...]

Modifier GY

Modifier GY Providers should be aware of the guidelines for submitting the noncovered outpatient dental service for a denial when the patient has supplemental insurance or if a denial is needed for any other reason. Modifier GY is reported [...]

Inpatient Services in Connection With Dental Procedures

Inpatient Services in Connection With Dental Procedures When a patient is an inpatient of a hospital for a dental procedure and the dentist's service is covered under Part B, the inpatient hospital services furnished are covered under Part [...]

Dental Services

Dental Services If you're a new or seasoned provider billing dental services to Fee-for-Service Medicare or Original Medicare, this article guides you through recently clarified payment provisions for dental services in 2023, the provider [...]

Standard Companion Guide Health Care Claim: Dental (837D)

Medicare Coverage Exclusion: Dental Services

Medicare Coverage Exclusion: Dental Services It is imperative that our providers are educated regarding the exclusion of dental services from the Medicare Program. Medicare generally does not cover dental services. Since the inception of [...]

Medicare Coverage Exclusion: Dental Services

Medicare Coverage Exclusion: Dental Services Table of Contents Medicare Coverage Exclusion: Dental Services Dental Services Excluded Under Medicare Part B Exceptions to Dental Service Exclusion Inpatient Services in Connection With [...]

New Medicare Provider

New Medicare Provider To assist you in understanding the Medicare Program, visit our New Provider Center and review our Medicare Part B 101 Manual; which will provide you with an overview and additional resources. The Part B Provider Outreach [...]

Enrolling in Medicare

Enrolling in Medicare To be eligible to bill and receive direct payment for professional services under Medicare Part B, the medical professional and dentist must be enrolled in Medicare and meet all other requirements for billing under the [...]

MLN Connects® Newsletter: June 27, 2024

MLN Connects Newsletter: June 27, 2024 News CY 2025 Home Health Prospective Payment System Proposed Rule PrEP Using Antiretroviral Therapy to Prevent HIV Infection: Technical FAQs for Pharmacies Claims, Pricers, & Codes Medicare [...]

People with Medicare

Welcome! Please note that the Medicare website at https://www.medicare.gov is the official U.S. government site for the Medicare Program and your primary source for Medicare information. However, National Government Services also includes links [...]

Medicare Plan Choices

Medicare Plan Choices Your Medicare Health Plan Options Medicare Part D (Prescription Drug Coverage) Medigap Rates and Insurers Find your states’ Department of Insurance What's Medicare Supplement (Medigap) Insurance?

Request an Accelerated Payment

Medicare Part A guidelines provide for accelerated payments under highly exceptional circumstances. Accelerated payment criteria and eligibility requirements are outlined in the CMS Paper-Based Manuals Publication 15-1, Medicare Provider [...]

PS&R/Cost Report Crosswalk

PS&R/Cost Report Crosswalk Did you know you have access to crosswalks between the PS&R Summary Report and the Medicare cost report? Our Medicare Audit and Reimbursement Department created crosswalk tools for hospitals and [...]

Request an Interim Rate Adjustment

When requesting an interim rate adjustment, it's important to submit your interim financial data to National Government Services using the appropriate Interim Rate Review Documentation Request Form. These forms are designed to capture important [...]

Request an Interim Rate Adjustment

When requesting an interim rate adjustment, it's important to submit your interim financial data to National Government Services using the appropriate Interim Rate Review Documentation Request Form. These forms are designed to capture important [...]

Provider Based Determinations

Table of Contents Provider Based Determinations Processing of Provider-Based Determinations MAC Provider-Based Designation Checklist Related Content [Return to Top] Provider Based Determinations On 4/18/2003, CMS issued a Program [...]

FY 2025 Occ Mix Hospital Letter Final

FY 2025 Occ Mix Hospital Letter Final CY 2022 Medicare Occupational Mix Survey Submission Section 1886(d) (3) (E) of the Social Security Act requires CMS to collect data every three years on the occupational mix of employees for each [...]

Contacting Medicare

Contacting Medicare Medicare constituents (or People with Medicare) can have their Medicare questions answered by calling 1-800-MEDICARE (1-800-633-4227) 24-hours a day; 7-days a week. 1-800-MEDICARE users can speak to a live person either by [...]

Claim Data Entry

Chapter V: Claims/Attachments Submenu (02) Claim Data Entry Purpose The Claims Entry options allows the provider to enter claims and roster bills electronically into the FISS DDE Provider Online System. To initiate claim data entry [...]

Revenue Codes (13)

Chapter IV: Inquiries Submenu (01) Revenue Codes (13) Purpose The purpose of the REVENUE CODES option is to provide access to details related to the revenue codes available to be reported on a claim. A revenue code is a four-digit number [...]

Advance Payments to Providers

Accelerated Payments to Providers

Avoiding Reason Code 38200

Avoiding Reason Code 38200 Claims are rejected with reason code 38200 when the FISS finds a previously submitted billing transaction that is a duplicate of the recently submitted billing transaction where all of the following fields on the [...]

Billing the Home Health Period of Care Claim - PDGM

Billing the Home Health Period of Care Claim – PDGM Table of Contents Billing the Home Health Period of Care Claim – PDGM Claim Page 1: Claim Page 2: Claim Page 3 Claim Page 4 Claim Page 5 Related Resources [Return to Top] [...]

Disposable Negative Pressure Wound Therapy Services Under Home Health

Disposable Negative Pressure Wound Therapy Services Under Home Health Effective for services furnished on or after 1/1/2017, Medicare will make separate payment to HHAs for dNPWT services for patients under the home health benefit. NPWT [...]

Education Partnership Request Form

Home Health Third Party Liability Demand Billing

Home Health Third Party Liability Demand Billing Table of Contents Background What is a Demand Bill? Requirements for Submission How to Submit a TPL Demand Bill Claim Page 1: Claim Page 2 – Covered and Noncovered Charges Claim [...]

Home Health Demand Billing

Home Health Demand Billing Table of Contents Background What is a Demand Bill? Requirements for Submission How to Submit a Demand Bil Claim Page 1: Claim Page 2: Covered and Noncovered Charges Claim Page 2: All Noncovered Charges [...]

Notice of Admission Questions and Answers

Notice of Admission Questions and Answers Medicare requires HHAs to submit a one-time NOA instead of RAPs for new admissions starting on or after 1/1/2022. HHAs shall no longer submit RAPs, TOB 0322 for any HH periods of care with a “From” [...]

Billing the Home Health Notice of Admission Electronically

Billing the Home Health Notice of Admission Electronically Table of Contents Billing the Home Health Notice of Admission Electronically NOA Claim Page 1 NOA Claim Page 2 NOA Claim Page 3 NOA Claim Page 4 NOA Claim Page 5 Notes [...]

Billing the Home Health Notice of Admission via DDE

Billing the Home Health Notice of Admission via DDE Table of Contents Billing the Home Health Notice of Admission via DDE NOA Claim Page 1 NOA Claim Page 4 Notes Patients Continuing Care in 2022 Related Content [Return to [...]

Home Health Transfers

Home Health Transfers Table of Contents Background What To Do As a Receiving HHA What To Do As the Initial HHA What To Do In Case of a Dispute Related Content [Return to Top] Background A home health transfer occurs when a [...]

Home Health Agency Transfer and Dispute Protocol

Home Health Agency Transfer and Dispute Protocol Specific protocol and steps must be followed prior to opening an admission period for a new patient. Step One: Verify the patient’s eligibility You must ensure the patient is not [...]

Late Notice of Admission - The Exception Process

Late Notice of Admission - The Exception Process Table of Contents Timeliness of the NOA and the Penalty Requirements for Submission of the NOA Exception Process Canceling a Timely NOA to Correct an Error Reasons Not to Cancel an NOA [...]

Telehealth Home Health Services: New G-Codes

Telehealth Home Health Services: New G-Codes Prior to 1/1/2023, data on telecommunications technology used during a 30-day period of care at the patient level was not collected on HH claims. Effective 1/1/2023, HHAs may begin voluntarily [...]

Home Health Therapy Billing

Home Health Therapy Billing Table of Contents Home Health Therapy Billing 32X TOB: Billing Therapy Under a Home Health Plan of Care Discipline Revenue Codes (UB-04 FLs 42-43) Discipline HCPCS Codes (UB-04 FL 44) Service Units [...]

Billing Overlap/Dispute Resolution Process

Billing Overlap/Dispute Resolution Process Table of Contents Billing Overlap/Dispute Resolution Process Mailing Addresses and Fax Number JK: J6: General Inquiries JK: J6: [Return to Top] Billing Overlap/Dispute [...]

Overlapping Claim Tips for Resolution

Overlapping Claim Tips for Resolution Table of Contents Overlapping Claim Tips for Resolution Type of Bills Impacted Inpatient Hospital Overlap Tips Hospital Discharge Coding Hospital Overlapping with Home Health Care Hospital [...]

Medicare Beneficiary Identifier

The MBI is the patient identification number assigned to Medicare beneficiaries. Claims submitted to Medicare contractors must contain the MBI. In 2020, CMS removed the SSN based identifier from the Medicare card to protect beneficiaries and [...]

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: [...]

Medicare’s Annual Wellness Visit in Minnesota: Understanding the Benefit and Preventing Denials

Medicare’s Annual Wellness Visit in Minnesota: Understanding the Benefit and Preventing Denials National Government Services Jurisdiction 6 MAC by Michael J. Dorris; Carolyn S. Henson, CPC , CAC, CACO, CPC-I, AAPC I-10 Instructor; and Nathan [...]

Billing & Claim Forms

Billing & Claim Forms Medicare Authorization to Disclose Medicare Information Use this form to advise Medicare of the person or persons you have chosen to have access to your personal health information. Patient's Request for Medical [...]

FQHC and Group Therapy Services Job Aid

FQHC and Group Therapy Services Job Aid Historically, federally qualified health center’s (FQHC’s) billing instructions have been the same. However, effective 1/1/2011, the billing requirements changed for this facility type. Beginning with [...]

Determine if Medicare Will Make Payment on an MSP Claim

Table of Contents Determine if Medicare Will Make Payment on an MSP Claim Step 1: Determine if Medicare will Make an MSP Payment Step 2: Determine the Amount of Secondary Benefits Billing Reminders Which Can Affect your Medicare [...]

Exceptions

The official transition period for the new Medicare Number has ended. The MBI should be used for all of your transactions and inquires. CMS will continue to accept the HICN on the following data exchanges after 1/1/2020. These are the only [...]

Medicare Hospice Quick Reference Sheet

Medicare Hospice Quick Reference Sheet The codes listed below are only those most frequently applicable to hospice claims. For a complete list of codes, see the NUBC manual. The NUBC maintains the UB-04 data element specifications and revenue [...]

MLN Connects® Newsletter: July 11, 2024

MLN Connects® Newsletter: July 11, 2024 Proposed Rules Physician Fee Schedule CY 2025 Proposed Rule Hospital Outpatient Prospective Payment System & Ambulatory Surgical Center Payment System CY 2025 Proposed Rule Mitigating the Impact [...]

July 2024

In This Issue National Government Services Articles for Part A and Part B Providers National Government Services Proposed LCDs for Comment - July 18, 2024 Improving Customer Experience New Version of PC-ACE: July 2024 Common Working File [...]

Medical Documentation Requirements

Medical Documentation Requirements When filing a claim to Medicare for payment, please include all applicable diagnosis codes to the highest level of specificity to establish the medical necessity of the services provided. National Government [...]

National Government Services Proposed LCDs for Comment - July 18, 2024

National Government Services Proposed LCDs for Comment - July 18, 2024 The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 6/27/2024 through [...]