Billing and Coding Article Updates for July 2023

Billing and Coding Article Updates for July 2023 Billing and Coding: Bevacizumab and Biosimilars (A52370) Based on Compendia review, ICD-10 codes Z85.09 and Z85.42 have been added to the Group 1 code list effective for dates of service on or [...]

Telehealth Home Health Billing

Telehealth Home Health Billing  As a reminder to all home health agencies, telehealth billing becomes mandatory on home health claims for periods of care that start on or after 7/1/2023. There is an article detailing how to report [...]

New and Improved EDI Enrollment Process Coming Soon

New and Improved EDI Enrollment Process Coming Soon We are improving our online EDI Enrollment process based on provider feedback. The new process will include ‘real time’ verification of data entered into many of the fields. This ‘real time’ [...]

MLN Connects® Newsletter: June 29, 2023

MLN Connects® Newsletter: June 29, 2023 News CY 2024 ESRD Prospective Payment System Proposed Rule Transforming Medicare Coverage: A New Medicare Coverage Pathway for Emerging Technologies and Revamped Evidence Development Framework New [...]

Conflict of Interest Disclosure

Conflict of Interest Disclosure Statement Form

CR13220 - Technical Revisions Only to the National Coverage Determination (NCD) Manual, Publication (Pub) 100-03

CR13220 - Technical Revisions Only to the National Coverage Determination (NCD) Manual, Publication (Pub) 100-03 Posted 7/5/2023

MLN Connects® Newsletter: July 6, 2023

MLN Connects® Newsletter: July 6, 2023 News CY 2024 Home Health Prospective Payment System Proposed Rule HHS Announces Actions to Lower Health Care Costs and Allow Medicare to Negotiate Lower Drug Prices CMS Roundup (June 30, 2023) [...]

MLN Connects® Newsletter: Broader Medicare Coverage of Leqembi Available Following FDA Traditional Approval - July 7, 2023

MLN Connects® Newsletter: Broader Medicare Coverage of Leqembi Available Following FDA Traditional Approval - July 7, 2023 News Broader Medicare coverage is now available for Biogen and Eisai’s Leqembi (the brand name for lecanemab) following [...]

Overcoming Barriers to Tobacco Counseling 

Overcoming Barriers to Tobacco Counseling Healthcare providers face several challenges when implementing tobacco cessation counseling into a clinical practice routine. These various factors influence the healthcare professionals’ performance [...]

Submitting Necessary/Appropriate Documentation

Submitting Necessary/Appropriate Documentation National Government Services has noticed an increase in the submission of improper documentation. We’ve added two new sections to our Submit Medical Record Documentation Electronically job aid to [...]

MLN Connects® Newsletter: July 13, 2023

MLN Connects® Newsletter: July 13, 2023 News Hospital Outpatient Prospective Payment System: Remedy for the 340B-Acquired Drug Payment Policy for Calendar Years 2018-2022 National Coverage Determination: Pre-exposure Prophylaxis Using [...]

MLN Connects® Newsletter: PFS & OPPS/ASC Proposed Payment Rules – July 13, 2023

MLN Connects® Newsletter: PFS & OPPS/ASC Proposed Payment Rules – July 13, 2023 Proposed Rules CMS Physician Payment Rule Advances Health Equity CMS Proposes Policies to Expand Behavioral Health Access and Further Efforts to Increase [...]

Frequently Asked Questions Reviewed and Updated

Frequently Asked Questions Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Topics available are: ASCA Appeals CAR T-cell Therapy [...]

Frequently Asked Questions Reviewed and Updated

Frequently Asked Questions Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Topics available are: ASCA CAR T-cell Therapy Claims EDI [...]

Frequently Asked Questions Reviewed and Updated

Frequently Asked Questions Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Topics available are: ASCA CAR T-cell Therapy Claims EDI [...]

Frequently Asked Questions Reviewed and Updated

Frequently Asked Questions Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Topics available are: ASCA CAR T-cell Therapy Claims EDI [...]

Update: End Stage Renal Disease Claim Adjustments Needed Due to CWF Error in Date of First Dialysis

Update: End Stage Renal Disease Claim Adjustments Needed Due to CWF Error in Date of First Dialysis As of 7/18/2023, CMS has identified that the CWF continues to have some inaccurate dates for the first date of dialysis. We will advise when [...]

Targeted Probe and Educate: Medical Review Topics

Targeted Probe and Educate: Medical Review Topics The Medical Review team has developed a comprehensive list of common denials found during Targeted Probe and Educate reviews along with resources to assist you in understanding how to avoid [...]

Activation of Validation Edits for Providers with Multiple Service Locations (MLN Matters Number: SE19007 Revised)

Activation of Validation Edits for Providers with Multiple Service Locations (MLN Matters Number: SE19007 Revised) Posted 7/20/2023

MLN Connects® Newsletter: July 20, 2023

MLN Connects® Newsletter: July 20, 2023 News Percutaneous Transluminal Angioplasty of Carotid Artery Concurrent with Stenting: Proposed National Coverage Determination Beta Amyloid Positron Emission Tomography in Dementia and [...]

Selecting the Submitter Type

Selecting the Submitter Type Each submitter type includes a description and the available tasks that can be completed for each. There are three submitter types:  Provider – The provider of service.  The Authorized or [...]

Completing the Registration Forms

Completing the Registration Forms  Complete all required fields marked with an asterisk or you will not be able to proceed with the submission of the form. The type of registration form and required information is going to vary depending [...]

EDI Gateway Self-Service Password Portal

EDI Gateway Self-Service Password Portal As an EDI Trading Partner, you will be able to use the EDI Gateway Self-Service Password Portal located on the EDI web page on our website. This provides a simple and secure web-based process for [...]

EDI Enrollment Process User Guide

Selecting Which System To Connect To

Selecting Which System To Connect To Select one objective based on the description provided and then click Next. Note: The options displayed will vary based on the submitter type selected.   

Submitting the Packet

Submitting the Packet After the enrollment packet is submitted, a confirmation message is displayed on the screen with the assigned Packet ID (PID) number. This has completed the submission process. You will be given the options to Print this [...]

Multi-Jurisdictional CAC Meeting Notice on Cervical Fusion

Multi-Jurisdictional CAC Meeting Notice on Cervical Fusion Information has been posted on our website in regards to multi-jurisdictional Contractor Advisory Committee Meeting regarding Cervical Fusion to be held on 8/16/2023. For more [...]

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)

Appeals

Appeals State MAC Appeals Address Qualified Independent Contractor Address All federally qualified health centers National Government Services, Inc. Appeals Department P.O. Box 6474 Indianapolis, IN [...]

Submitter Type - Provider

Submitted Type – Provider  When Provider is selected as the submitter type the four objectives below are displayed.  Select one objective based on the description provided and then click Next. Outlined in the following sections [...]

Submitter Type - Billing Service

Submitter Type – Billing Service When Billing Service is selected as your submitter the three objectives below are displayed.  Select one objective based on the description provided and then click Next. Outlined in the following [...]

Selecting the Contractor Code

Selecting the Contractor Code Select the contract in which the provider of service is enrolled in the Medicare Program in the Contract Code field. Click the drop-down arrow to display the available contractor codes.  Select the [...]

National Government Services CAC Meeting Notice on KidneyIntelX Test

National Government Services CAC Meeting Notice on KidneyIntelX Test Information has been posted on our website in regards to the National Government Services l Contractor Advisory Committee Meeting regarding KidneyIntelX Test to be [...]

Purpose of FISS/DDE Provider Online Guide

Introduction Purpose of FISS/DDE Provider Online Guide This provider online guide was created to assist National Government Services providers in using the FISS/DDE Provider Online System. FISS/DDE is: an application that allows remote [...]

Attention All OPPS Providers with Provider-Based Department(s): Permanent Edit Implementation Begins on/after 8/1/2023

Attention All OPPS Providers: Provider-Based Department Edits Being Implemented on/after 8/1/2023 Certain edits are being implemented on/after 8/1/2023 to ensure you are billing your provider-based locations correctly. The edits are FISS [...]

Attestation

Attestation At the start of an EDI Guided Enrollment submission, you will need to read and accept the attestation in order to proceed.

I Am a Billing Service and “I Want to Use a Provider's PIN From their Letter of Authorization (LOA)”

I Am a Billing Service and “I Want to Use a Provider's PIN From their Letter of Authorization (LOA)” This selection will prompt you to complete the Logon Request with PIN Form. This objective is for a third party who wishes to request, [...]

MLN Connects® Newsletter: July 27, 2023

MLN Connects® Newsletter: July 27, 2023 News CMS Continues Work on Behavioral Health Discarded Drugs and Biologicals: Updated FAQs on JW & JZ Modifiers Expanded Home Health Value-Based Purchasing Model: July 2023 Interim Performance [...]

Reason Codes

Chapter I: Online System Terminology Reason Codes Purpose Reason codes direct the outcome of an edit or process within FISS—they are the traffic cops of the system. Each reason code, when assigned, sends the claim to a specific [...]

View a Report (R2)

Chapter VII: Online Reports View Submenu (04) View a Report (R2) Purpose This option allows the provider to go directly to MAP1661 for report viewing. Task To access the View a Report option from the Fiscal Intermediary (FISS)/Direct [...]

FISS UB-04 Data Entry Payer Codes

Resources FISS UB-04 Data Entry Payer Codes The following payer codes may be reported in the CD field on CLAIM PAGE 03 of the online UB-04 claim entry record. Payer Code Description 1 Medicaid 2 Blue [...]

How to Adjust a Claim

Resources How to Adjust a Claim To adjust a claim using the FISS/DDE Provider Online System, follow these steps: Step Action 1 Select the CLAIMS CORRECTION (03) submenu from the MAIN MENU 2 Key the [...]

FISS Claim Change/Condition Reason Codes

Resources FISS Claim Change/Condition Reason Codes The following adjustment/cancel claim change reason codes may be reported in the COND CODE field on CLAIM PAGE 01 of the adjustment/cancel claim record. For Adjustment Claims Only (TOB [...]

How to Cancel a Claim

Resources How to Cancel a Claim To cancel a claim on the FISS/DDE Provider Online System, follow these steps: Step Action 1 Select the CLAIMS CORRECTION (03) submenu from the MAIN MENU 2 Key the [...]

Online System Menu Quick-Reference

Resources Online System Menu Quick-Reference Main Menu Inquires Submenu (01) Claims/Attachments Submenu (02) 01 – Inquires 02 – Claims/Attachments 03 – Claims Correction 04 – Online Reports View 10 [...]

Document Control Number

Chapter I: Online System Terminology Document Control Number Purpose The FISS DDE Provider Online System refers to the claim control number as a DCN. The DCN provides a reference number for the control and monitoring of each claim. To [...]

LCD, Billing and Coding Article Updates for August 2023

LCD, Billing and Coding Article Updates for August 2023 New LCDs and Articles (Effective 8/1/2023) Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin [...]

Text Telephone Changes

Text Telephone Changes TTY-based Telecommunications Relay Services permit persons with a hearing or speech disability to use the telephone system via a TTY or other device to call persons with or without such disabilities. To make using TRS as [...]

Ordering DMEPOS Items

MLN Connects® Newsletter: 5 Final FY 2024 Payment Rules — Aug 1, 2023

MLN Connects® Newsletter: 5 Final FY 2024 Payment Rules — Aug 1, 2023 Final FY 2024 Payment Rules New CMS Rule Promotes High-Quality Care and Rewards Hospitals that Deliver High-Quality Care to Underserved Populations Hospice Payment Rate [...]

Additional Documentation Request (ADR) Quick Reference Guide

MLN Connects® Newsletter: August 3, 2023

MLN Connects® Newsletter: August 3, 2023 News Medicare Dementia Care Model Your Patient’s Medicare Beneficiary Identifier (MBI) May Change CMS Roundup (July 28, 2023) Building on CMS's Accountable Care Vision to Improve Care for Medicare [...]

RA Top Page

Enter the date of the RA demand letter in the displayed format. The calculator will determine the time frames for RA activities.

Recovery Auditor Timeliness Calculator

CMS Waivers and Services Impacted by End of the Public Health Emergency

MLN Connects® Newsletter: January 26, 2023

MLN Connects® Newsletter: January 26, 2023 News Medicare Enrollment in PECOS: Faster and Easier Application Process — Coming Summer 2023 Medicare Enrollment: Maintain the Same Owners in All Enrollment Records Hospitals: Revised [...]

MLN Connects® Newsletter: 4 Proposed FY 2024 Payment Rules — April 4, 2023

MLN Connects® Newsletter: 4 Proposed FY 2024 Payment Rules — April 4, 2023 Proposed Rules FY 2024 Hospice Payment Rate Update Proposed Rule (CMS-1787-P) FY 2024 Medicare Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) [...]

MLN Connects® Newsletter: OPPS/ASC and PFS Final Payment Rules

MLN Connects® Newsletter: OPPS/ASC and PFS Final Payment Rules Final Rules   Final Rules HHS Continues Biden-Harris Administration Progress in Promoting Health Equity in Rural Care Access Through Outpatient Hospital and Surgical [...]

MLN Connects® Newsletter for Thursday, September 8, 2022

MLN Connects® Newsletter for Thursday, September 8, 2022 Prostate Cancer: Talk to Your Patients about Screening News Short-Term Acute Care Hospitals: Program for Evaluating Payment Patterns Electronic Reports Prostate Cancer: Talk to [...]