Mission and Charter

​​National Government Services Provider Outreach and Education Advisory Group Charter National Government Services serves as the MAC for J6 and JK Part A, Part B and Home Health and Hospice. We maintain four POE AGs: Part A POE [...]

Contractor Advisory Committee Meeting Records

Contractor Advisory Committee (CAC) Meeting Records Jurisdiction 6 and Jurisdiction K CAC Meeting Records Meeting Date Audio Transcript Key Questions Bibliography 10/17/2024 ‒ Topic: Superficial Radiation [...]

Medicare Part B Electronic Claims that Exceed the Threshold for Charges and Units of Service

Medicare Part B Electronic Claims that Exceed the Threshold for Charges and Units of Service  Medicare Part B electronic claims (ANSI X12 837P) with total charges exceeding $99,999.99 cannot be processed in the MCS. If a single claim [...]

Appeals/Reopenings

Medicare Part B 101 Manual Appeals/Reopenings Table of contents Reopenings for Minor Errors and Omissions Telephone Reopening Unit Appeals Time Limit for Filing Appointment of Representative Redeterminations Acceptable Signature [...]

Fraud and Abuse

Medicare Part B 101 Manual Fraud and Abuse Fraud and Abuse Unified Program Integrity Contractors Defining Fraud and Abuse Fraud Abuse Bribes, Kickbacks and Rebates Penalties Waiving Deductible and Coinsurance What You Can Do As a [...]

Report a Change of Tax ID (Other than Change of Ownership)

Step 1: Determine You are in the Right Place If you are currently an enrolled health care organization that is changing your Tax ID and the change does not involve a change of ownership, it is essential that you report changes of Tax ID within [...]

Report a Change of Tax ID (Other than Change of Ownership)

Step 1: Determine You are in the Right Place If you are currently an enrolled health care organization that is changing your Tax ID and the change does not involve a change of ownership, it is essential that you report changes of Tax ID within [...]

Let's Chat About Provider Enrollment Revalidation

During this session, you’ll have the opportunity to ask questions about all accepts of provider enrollment. Answers will be provided by a panel of subject-matter experts. As this is a question-and-answer session, there is no presentation available.

Report a Change of Tax ID (Other than Change of Ownership)

Table of Contents Step 1: Determine You are in the Right Place Step 2: Complete the Medicare Application Step 3: Submit Required Documentation Related Content [Return to Top] Step 1: Determine You are in the Right Place If you are [...]

Podiatry Services - Routine Foot Care and Debridement of Nails

While the Medicare Program generally excludes routine foot care services from coverage, there are specific indications or exceptions under which there are program benefits. Medicare payment may be made for routine foot care when the patient has [...]

Top Claim Errors Reviewed and Updated

Top Claim Errors Reviewed and Updated Using data analysis, we review and update the Top Claim Errors on a quarterly basis and provide: the error reason code; a description of the error; the error type; details that include steps you [...]

Don’t Wait Until 11/18/2024 To Use NGSConnex for Beneficiary Eligibility Information

Don’t Wait Until 11/18/2024 To Use NGSConnex for Beneficiary Eligibility Information  As we’ve communicated, beginning 11/18/2024, Beneficiary Eligibility information will not be offered on the IVR. This includes all beneficiary [...]

MLN Connects® Newsletter: October 31, 2024

MLN Connects® Newsletter: October 31, 2024 News Medicare Shared Savings Program Continues to Deliver Meaningful Savings and High-Quality Health Care Compliance Major Hip & Knee Replacement or Reattachment of Lower Extremity: [...]

Additional Events Links

Resources Education Partnership Request Form Five Steps to Webinar Success Provider Outreach and Education Reminders

Additional Events Links

Resources Education Partnership Request Form Five Steps to Webinar Success Provider Outreach and Education Reminders

Additional Events Links

Resources Education Partnership Request Form Five Steps to Webinar Success Provider Outreach and Education Reminders

Additional Events Links

Resources Education Partnership Request Form Five Steps to Webinar Success Provider Outreach and Education Reminders

Membership Rosters

Membership Rosters Member Lists JK Part A J6 Part A Federally Qualified Health Center (All States) Revised 11/4/2024

NGS Review of Prior Authorization Request

NGS Review of Prior Authorization Request Table of Contents NGS Review of Prior Authorization Request Number of Trips Extended Affirmation Periods for Beneficiaries with Chronic Conditions Decision Letters Resubmitting a Prior [...]

Related Content

Related Content Ambulance Services Center MLN® Booklet: Medicare Ambulance Transports Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, [...]

Billing for A0426 or A0428

Billing for A0426 or A0428 National Government Services has been receiving electronic claims with the 2300 REF segment (G1 qualifier) for prior authorization, however, the value entered in REF02 is a ZIP code. This segment is intended for the [...]

Ambulance Medical Necessity

Ambulance Medical Necessity According to the Centers for Medicare & Medicaid Services’ (CMS) Internet Only Manual (IOM) 100-02, Medicare Benefit Policy Manual, Chapter 10, Ambulance Services; (400 KB) 10.2 - Necessity and Reasonableness [...]

Prior Authorization of Repetitive Scheduled Non-Emergent Ambulance Transport

Medical Necessity of Ambulance Services

Medical Necessity of Ambulance Services Table of Contents Medical Necessity of Ambulance Services What You Can Do Nearest Appropriate Facility: GY Modifier What You Can Do Related Content [Return to Top] Medical [...]

Proper Claim Submission for Repetitive, Scheduled, Non-Emergent Ambulance Transports

Proper Claim Submission for Repetitive, Scheduled, Non-Emergent Ambulance Transports The CMS implemented the prior authorization of RSNAT. NGS J6 states Illinois, Minnesota, and Wisconsin were added to the RSNAT Model effective with dates [...]

Ambulance Transports Excluded from SNF Consolidated Billing

Ambulance Transports Excluded from SNF Consolidated Billing When a Medicare beneficiary is a resident in a SNF under a Part A stay, not all ambulance transports are included in the PPS (prospective payment system) payment for a SNF. SNF [...]

Ambulance Medical Necessity Reminder for ESRD Patients

Ambulance Medical Necessity Reminder for ESRD Patients National Government Services receives a significant amount of dialysis facility ambulance transports that do not meet medical necessity criteria. Documentation must explicitly describe the [...]

Responsibility of Providing a Properly Executed Physician Certification Statement/Certificate of Medically Necessity

Responsibility of Providing a Properly Executed Physician Certification Statement/Certificate of Medically Necessity Recent National Government Services educational efforts have highlighted an issue between facilities and the ambulance [...]

Ambulance Transports Included in SNF Consolidated Billing

Ambulance Transports Included in SNF Consolidated Billing Transport Description Medical Necessity Met Ambulance Billing Modifiers and Other Considerations Who is Responsible for Payment? Reference(s) SNF to [...]

Coming Soon ‒ The CY 2025 Medicare Physician Fee Schedule

Coming Soon ‒ The CY 2025 Medicare Physician Fee Schedule The CY 2025 MPFS will soon be available on the Fee Schedule Lookup tool located on NGSMedicare.com, after the CY 2025 physician fee schedule regulation is put on display. Once the Fee [...]

Time Requirements to Notify Medicare of Changes

Report Changes to Your Enrollment Records You must report changes of information in your Medicare enrollment records within 30 days for: Change(s) in ownership or control, including changes in authorized officials(s) All other changes to [...]

End Stage Renal Disease Claims Returning to Providers with Reason Code 31773

Due to an issue with the October 2024 release, ESRD facility claims, type of bill 72X, are RTPing in error.

Report a Change of Information

Report change of enrollment information timely. Changes can be either submitted electronically via PECOS or by mail with the paper CMS-855A and/or CMS-588 EFT agreement. A change in the Tax ID with no ownership change will need to submit [...]

Report a Change of Information

Report change of enrollment information timely. Changes can be either submitted electronically via PECOS or by mail with the paper CMS-855A and/or CMS-588 EFT agreement. A change in the Tax ID with no ownership change will need to submit [...]

Report a Change of Information

Table of Contents Report a Change of Information PECOS Submission Related Content Paper Submission Related Content [Return to Top] Report a Change of Information Report change of enrollment information [...]

Report a Change of Ownership, Acquisition/Merger or Consolidation

Table of Contents Step 1: Determine You Are in the Right Place Step 2: Understand Type of CHOW Change of Ownership Acquisition/Merger Consolidation CHOW Reminders Step 3: Make Changes via Enrollment Application Change of [...]

Meeting Minutes

Meeting Minutes Jurisdiction 6 and Jurisdiction K Combined Meeting 9/18/2024 Meeting 6/12/2024 Meeting 3/13/2024 Meeting 12/14/2023 Meeting

MSP Payment and Savings Calculator Bottom

How to Determine the Medicare Secondary Payment Amounts First, the MSP payment is determined by the following: Actual charge by physician/supplier or OTAF minus amount paid by primary Usual Medicare payment determination  Fee [...]

August 2024

In This Issue National Government Services Articles for Part A and Part B Providers LCD and Article Updates for June/July 2024 [Cancelled] Multijurisdictional Contractor Advisory Committee Meeting Notice on Superficial Radiation Therapy [...]

Part B Top Claim Errors Updated

Part B Top Claim Errors Updated Using data analysis, we update the Top Claim Errors on a quarterly basis and provide: the error reason code; a description of the error; the error type; details that include steps you can take to [...]

Psychiatric Collaborative Care Model

Psychiatric Collaborative Care Model The psychiatric CoCM was introduced in 2018 and Medicare began making separate payments using CPT codes 99492, 99493 and 99494. Effective 1/1/2021, G2214 was added to Psychiatric CoCM to cover shorter [...]

Advanced Care Planning

Advanced Care Planning Table of Contents Billing Codes Billing Information Documentation Related Content [Return to Top] Billing Codes 99497: 30 minutes 99498: each additional 30 minutes [Return to Top] Billing Information [...]

Chronic Care Management

Chronic Care Management Table of Contents Billing Codes Billing and Documentation Care management for chronic conditions Related Content [Return to Top] Billing Codes 99490: Provide at least 20 minutes of clinical staff time [...]

Principal Care Management

Principal Care Management Table of Contents Billing Codes Documentation Related Content [Return to Top] Billing Codes 99424: PCM services for a single high-risk disease first 30 minutes provided personally by a physician or [...]

Behavioral Health Integration

Behavioral Health Integration Table of Contents BHI Overview Eligible Conditions Part B Billing/Coding BHI Services New Coding and Payment for BHI Conditions Billed by Clinical Psychologists and Clinical Social Workers Initiating [...]

MLN Connects® Newsletter: August 1, 2024

MLN Connects® Newsletter: August 1, 2024 Final Payment Rules Skilled Nursing Facility FY 2025 Final Rule Inpatient Rehabilitation Facility FY 2025 Final Rule Inpatient Psychiatric Facility FY 2025 Final Rule Hospice FY 2025 Final Rule [...]

Hospice Notice of Election Termination/Revocation (Type of Bill 8xB)

Hospice Notice of Election Termination/Revocation (Type of Bill 8xB) Table of Contents Hospice Notice of Election Termination/Revocation Examples of NOTR Time Frames Reminders/Notes on the NOTR Correcting a Discharge Date on an [...]

Part A Content

Cost Report Contacts: IL, MN, WI, All FQHC: Bobbi Jo Luciano, Manager Office: South Portland, ME Sharon Townsend Office: South Portland, ME J6_Cost_Report_Filing@anthem.com Mailing Address for USPS: National Government Services Attn: Cost [...]

Part A Content

Cost Report Contacts: CT, ME, MA, NH, NY, RI, VT: Bobbi Jo Luciano, Manager Office: South Portland, ME Sharon Townsend Office: South Portland, ME JK_Cost_Report_Filing@anthem.com Mailing Address for USPS: National Government Services Attn: [...]

Medicare University Right Content

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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

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 [...]

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 [...]

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 [...]

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 [...]

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 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 [...]