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: [...]

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

CMS-855I Completion Tips for Managing Employee Information in Section 6

CMS-855I Completion Tips for Managing Employee Information in Section 6 Table of Contents Section 6: Managing Employee Information Instructions for Completing Section 6 Section 6A ‒ Managing Employee Identifying Information Section [...]

Understanding Participating, Nonparticipating and Opt Out Status

Understanding Participating, Nonparticipating and Opt Out Status Principles Participating Status Nonparticipating Status Opt Out Status Explanation When a physician/practitioner enrolls as a new provider in [...]

Resolving PECOS Common Errors and Warnings

Table of Contents Error/Warning PECOS Reference Guide and Help Desk Information [Return to Top] Error/Warning Error indicated, correct all topic errors Warning indicated, verify information for accuracy PECOS Topic [...]

CMS-855B Completion Tips for Clinics/Group Practices and Other Suppliers Revalidation Application

CMS-855B Completion Tips for Clinics/Group Practices and Other Suppliers Revalidation Application Follow the instructions printed on the CMS-855B application and refer to this list of sections required for revalidation. Section [...]

CMS-855I Completion Tips for Physicians and NPPs that Reassign All Benefits Revalidation Application

CMS-855I Completion Tips for Physicians and NPPs that Reassign All Benefits Revalidation Application Follow the instructions printed on the CMS-855I application and refer to this list of sections required for revalidation. Sections [...]

CMS-855O Completion Tips for Physicians or Eligible Professionals for the Sole Purpose of Ordering, Certifying or Prescribing Part D Drugs

CMS-855O Completion Tips for Physicians or Eligible Professionals for the Sole Purpose of Ordering, Certifying or Prescribing Part D Drugs CMS-855O is a national enrollment; providers who relocate to another state are not required to disenroll [...]

Provider Enrollment: Opioid Treatment Program

During this webinar, we’ll provide a brief overview of an Opioid Treatment Program (OTP) provider, an understanding of submitting the CMS-855A or CMS-855B paper application and how to complete the provider enrollment Internet-based PECOS to [...]

Counseling to Prevent Tobacco Use

In an effort to raise awareness and increase utilization of tobacco use counseling, we’ll focus on the effects of nicotine dependence including affected health consequences during this webinar. Medicare coverage, coding, billing and [...]

Home Health Billing Coffee Break

Provider Outreach and Education is hosting a 30-minute coffee break to help answer your troublesome billing questions. This is a great opportunity to discuss areas of billing more in depth and review helpful guides and resources. Keep in mind [...]

Steps to Claim Corrections

This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

HETS EDI Enrollment Form User Guide

The HETS ​​​​​​EDI Enrollment Form allows providers to attest their relationship with a 3rd party entity to exchange the ANSI X12 270/271 Beneficiary Eligibility transaction on their behalf. Table of Contents Step 1 – Authorization [...]

HETS EDI Enrollment Form

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

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations) If you disagree with Medicare’s claim determination, you may Appeal. However, please follow these important tips before you submit a first level of appeal [...]

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

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations) If you disagree with Medicare’s claim determination, you may Appeal. However, please follow these important tips before you submit a first level of appeal [...]

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

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations) If you disagree with Medicare’s claim determination, you may Appeal. However, please follow these important tips before you submit a first level of appeal [...]

HETS EDI Enrollment Form

HIPAA Eligibility Transaction System (HETS) allows users to exchange HIPAA compliant ANSI ASC X12 270/271 transactions for the purpose of checking Medicare eligibility.  The HETS EDI Enrollment Form allows providers to attest their [...]

Provider Enrollment: Initially Enrolling a Dentist in the Medicare Program

During this webinar, we’ll address the Medicare dental specialty codes and provide an overview of how to enroll using PECOS as well as using the CMS-855I paper application. This session is intended to initially enroll dentists who are sole [...]

Medicare Bad Debts

Table of Contents Review Medicare Bad Debt Listing Identifying Non-Allowable Fee Schedule Services Fee Schedules Included in Bad Debt Policy Medicare Bad Debts Related Content [Return to Top] Review Medicare Bad Debt Listing [...]

Facet Joint Interventions

Facet Joint Interventions National Government Services will begin accepting PARs for Facet Joint Intervention codes on 6/15/2023 for services provided beginning on or after 7/1/2023.   To meet coverage criteria, the patient’s medical [...]

Home Health Claims Returning to Provider RC 19963

HH claims are returning to provider in error with RC 19963. This impacts HH claims with NOA/processed dates in January 2022. NOAs are being purged after 24 months. Please keep in mind there are claims that edit correctly for this reason code. [...]

Don't Miss Out - Register Today! National Government Services: Medicare Part B Care Management Tuesdays

Don't Miss Out - Register Today! National Government Services: Medicare Part B Care Management Tuesdays According to the CDC, six in ten adults in the U.S. have a chronic disease and four in ten adults have two or more. As your Medicare [...]

Part B

Part B  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us EDI Enrollment EDI Solutions Forms [...]

FQHC

FQHC and RHC  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us Cost Reports EDI Enrollment EDI [...]

Part A

Part A  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us Cost Reports EDI Enrollment EDI [...]

Home Health and Hospice

Home Health and Hospice  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us Cost Reports EDI [...]

Description of NPI and a Link to NPPES Registry

Description of NPI and a Link to NPPES Registry   As mandated by HIPAA, you should maintain (verify and update) your NPI data via NPPES on a regular basis. The NPI: is a ten-digit number and must be submitted on the enrollment form, [...]

Eligible Institutional Providers

Eligible Institutional Providers Certified Providers and Certified Suppliers that Enroll via the Form CMS-855A. Unique statutory and regulatory requirements for these types of providers/suppliers are addressed in the CMS IOM Publication [...]

Accreditation of Advanced Diagnostic Imaging and FDA Mammography Equipment

Reminder, if a hospital, clinic/group or Independent Diagnostic Treatment Facility has ADI screening equipment, certification from a designated ADI accrediting organization needs to be implemented or updated on the Medicare enrollment. The [...]

State License and Registrations for Certified Providers and Suppliers

State License and Registrations for Certified Providers and Suppliers Prior to submitting a provider enrollment application to Medicare, ensure that all applicable state requirements are met for your provider type. Each state has unique [...]

Hospice Billing Coffee Break

Provider Outreach and Education is hosting a 30-minute coffee break to help answer your troublesome hospice billing questions. This is a great opportunity to discuss areas of billing more in depth and review helpful guides and resources. Keep [...]

End-Stage Renal Disease: Medicare Part A Quick Reference Manual

End-Stage Renal Disease: Medicare Part A Quick Reference Manual Table of Contents ESRD Provider PTAN Number Range: Third through sixth digit FL 04 Type of Bill FL 6 Statement Covers Period FL 18-28 Condition Codes FL 18-28 Condition [...]

Disproportionate Share Hospital

The Medicare DSH adjustment provision under Section 1886(d) (5) (F) of the Act was enacted by section 9105 of the COBRA of 1985 and became effective for discharges occurring on or after 5/1/1986. According to section 1886(d) (5) (F) of the Act, [...]

Claim Submission Guidelines

Claim Submission Guidelines CMS developed and transmitted HCPCS and PFS payment and coding files to include revisions to add other CDT codes and indicated parameters for payment to implement the finalized Medicare Parts A and B payment for [...]

IDTF Procedure Codes (65 KB)

Electronically Submitted Claims that Exceed $99,999.99 Reminder

Electronically Submitted Claims that Exceed $99,999.99 Reminder Electronically submitted claims containing a dollar amount in excess of 99,999.99 will be rejected as a front-end EDI edit. The Standard Companion Guide for Health Care Claim: [...]

MLN Connects® Newsletter: August 22, 2024

MLN Connects® Newsletter: August 22, 2024 News Commemorating the 2nd Anniversary of the Lower Cost Prescription Drug Law MolDx Local Coverage Determination Statement Hospital Price Transparency: Get Resources to Help You Comply New [...]

Outpatient Services for Registered Inpatients

Outpatient Services for Registered Inpatients There are occasional circumstances in which a registered inpatient may require a service that is not available at the inpatient facility. These inpatient facilities include acute-care hospitals [...]

Answers to Common Fee-for-Time Compensation Arrangements Questions

Answers to Common Fee-for-Time Compensation Arrangements Questions Does a fee-for-time compensation arrangement physician need to enroll with Medicare prior to acting as a physician? Answer: Currently, a fee-for-time compensation [...]

Immunization Roster Billing

Immunization Roster Billing Table of Contents Immunization Roster Billing Claim Submission Options for Roster Billing Electronic Claim Submissions Paper Claim Submissions Vaccine Billing and Coding Resources [Return to Top] [...]

Allergen Immunotherapy Preparation (95144-95165)

Allergen Immunotherapy Preparation (95144‑95165) National Government Services will allow the preparation and provision of antigen for allergen immunotherapy, codes 95144 through 95165 when performed incident to by auxiliary personnel. However, [...]

CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy

CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy CMS created the Medicare Physician Fee Schedule Look-up Tool for MACs to follow when processing claims. CMS listed CPT code 15830 as a [...]

Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid

Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid Table of Contents Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid Fee-For-Time Compensation Arrangements Reciprocal Billing Arrangements Related [...]

Nonphysician Practitioners Billing for Surgical Procedures

Nonphysician Practitioners Billing for Surgical Procedures Several providers have asked about the Medicare guidance for NPPs include billing for surgical procedures. For the purpose of this education, NPPs include NPs, PA, and CNSs. State law [...]

Professional Services During a Patient Hospice Election

Professional Services During a Patient Hospice Election Table of Contents Article Overview Hospice Election Medicare Payment During Hospice Election Determining the Correct Entity to Bill Separately Payable Part B Services Hospice and [...]

Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans

Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans Background It has been noted that a high volume of PET scan claims falling between the CPT code range 78811–78816 are being denied upon original claim submission due [...]

Proper Billing for Finger and Toe Procedures

Proper Billing for Finger and Toe Procedures When billing for procedures that are performed on the fingers and/or toes, it’s essential to append the appropriate anatomical modifier for the service rendered. This allows the patient history to [...]

Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements

Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements Table of Contents Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements Fee-For-Time Compensation [...]

Proper Use of Taxonomy Codes

Proper Use of Taxonomy Codes A taxonomy code is a unique ten-character code that designates your classification and specialization and enables providers to identify their specialty at the claim level. CMS developed a crosswalk of [...]

Common Reciprocal Billing Questions and Answers

Common Reciprocal Billing Questions and Answers If a practice, the same specialty as ours, wants us to take calls for them for two weeks, can we bill under their number as a reciprocal billing arrangement? Answer: No. In a reciprocal [...]

Unlisted and Not Otherwise Classified Procedure Codes

Unlisted and Not Otherwise Classified Procedure Codes Table of Contents Unlisted and Not Otherwise Classified Procedure Codes Proper Billing for NOC Procedures Electronic Claims Paper Claims The following tips will help you bill [...]

Fiscal Year/Calendar Year Claim Split

Fiscal Year/Calendar Year Claim Split Part A/B Type of Bill Fiscal Year Split Calendar Year Splint Part A – 11X, 21X prospective payment system (PPS*) No No Part A – 11X, 18X, 21X, non-PPS Yes [...]

Medicare Coverage for Living Organ Transplant Donors

Medicare Coverage for Living Organ Transplant Donors Table of Contents Coverage Hospital Guidelines Physician Guidelines Billing Guidelines Transplant Centers Physicians and Surgeons Related Content [Return to Top] Coverage [...]

The Medicare Home Infusion Therapy Benefit and Home Health Agencies

The Medicare Home Infusion Therapy Benefit and Home Health Agencies If you are a HHA that wants to provide and bill Medicare HIT professional services starting in CY 2021, you are required to enroll with the Part B Medicare Administrative [...]

Kidney Transplant Services

Kidney Transplant Services Table of Contents Kidney Transplant Services Physician Services Pretransplant Services Immunosuppressive Drugs Cadaver Donor Updated CMS-1500 Claim Form Guidelines [Return to Top] Kidney Transplant [...]