Provider Qualifications

Podiatry Billing Guide  Provider Qualifications A doctor of podiatric medicine is a physician, but only with respect to those functions which he/she is legally authorized to perform in the State in which he/she performs them. The [...]

National Government Services Contractor Advisory Committee Meeting

National Government Services Contractor Advisory Committee Meeting There will be a multi-jurisdictional CAC meeting held on Thursday 10/17/2024 at 3:00-5:00 p.m. ET, 2:00-4:00 p.m. CT. Meeting details can be found on the National Government [...]

Global Surgery

Global Surgery Table of Contents Definition of a Global Surgical Package Where can I find the postoperative periods for covered surgical procedures? What services are included in the global surgery payment? What services are not [...]

Documentation Information

Documentation Information It is recommended that PARs are submitted at least ten business days prior to the expected date of service to allow National Government Services the full standard timeframe to receive and review requests. For more [...]

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 [...]

Physicians and Nonphysician Practitioners that Reassign All Benefits

Physicians and Nonphysician Practitioners that Reassign All Benefits Download CMS-855I. Complete Sections: 1, 2, 3, 4, 4F, 12, 13 and 15B Note: Submit national board certification and diploma for nonphysician practitioners. If adding [...]

How to Search on the Medicare Revalidation List Tool for Due Date

How to Search on the Medicare Revalidation List Tool for Due Date Table of Contents How to Search on the Medicare Revalidation List Tool for Due Date Find a Provider By NPI By Name Associated Datasets [Return to Top] How [...]

Incident to Office Guidelines

“Incident to” Office Guidelines The CMS rules for billing office services as “incident to” a physician’s services are summarized within this document. Of note, the concept does not apply to services performed in the hospital environment, which [...]

Rebuttal for Deactivation of Medicare Billing Privileges

Rebuttal for Deactivation of Medicare Billing Privileges Pursuant to 42 CFR, Section 424.545(b), a provider or supplier whose Medicare billing privileges have been deactivated may file a rebuttal in accordance with 42 CFR, Section 405.374. A [...]

Description of Revalidation

Description of Revalidation Section 6401(a) of the Affordable Care Act requires that all enrolled providers or suppliers revalidate their Medicare enrollment information under new enrollment screening criteria. To maintain Medicare billing [...]

About Appeals

About Appeals Table of Contents About Appeals Reopening vs. Redetermination Reopening Redetermination [Return to Top] About Appeals Providers and beneficiaries have the right to appeal claim determinations made by National [...]

Description of Application Fee

Description of Application Fee The application fee is imposed on institutional providers and suppliers to cover enrollment costs. The application fee for calendar year 2024 is $709. Related Content Federal Register Notice ‒ information [...]

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, [...]

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, [...]

ASCA Requirements for Paper Claim Submissions

Table of Contents ASCA Requirements for Paper Claim Submissions Submitting Electronic Claims Submitting Paper Claims ASCA Exception Criteria Related Content [Return to Top] ASCA Requirements for Paper Claim Submissions [...]

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, will [...]

“Incident to” Services

“Incident to” Services This article has been specially designed for our providers who perform services “Incident to” the services of a physician/NPP. Table of Contents The “Incident to” Provision of Medicare Your Office Hospital or [...]

Incident to Quick Reference Chart

Incident to Quick Reference Chart Location PT Status Scenario Who Bills Comments Office New patient NPP sees patient - MD not present in office suite NPP bills for the service under the NPP NPI NPP [...]

May 2023

In This Issue National Government Services Articles for Part A and Part B Providers Change in Pricing for Electroencephalogram Long-Term Monitoring Effective 4/1/2023 EDI Enrollment Spotlights Top Rejections Tobacco Cessation [...]

How Will You Know it is Time to Revalidate

How Will You Know it is Time to Revalidate We will contact each provider or supplier when it is time to revalidate their enrollment information by sending a revalidation notice with a revalidation due date.   We will send the [...]

The National Correct Coding Initiative and Medically Unlikely Edits for Part B Providers

This webinar will assist Part B providers with navigating tables for the National Correct Coding Initiative and the medically unlikely edits. We'll also review proper modifiers to use to avoid denials. There will be time for your questions [...]

The National Correct Coding Initiative and Medically Unlikely Edits for Part B Providers

This webinar will assist Part B providers with navigating tables for the National Correct Coding Initiative and the medically unlikely edits. We'll also review proper modifiers to use to avoid denials. There will be time for your questions [...]

Prior Authorization Process and Exemption

The Centers for Medicare & Medicaid Services (CMS) implemented a prior authorization (PA) program for certain hospital outpatient department (OPD) services for DOS on or after 7/1/2020 and subsequently added an exemption process. Join this [...]

Submitting Revalidation via PECOS

During this webinar, we’ll provide an understanding of how to utilize the CMS Internet-based Provider Enrollment Chain & Ownership System (PECOS) to be comfortable in navigating the system to submit a provider enrollment electronic application.

Submitting Revalidation via PECOS

During this webinar, we’ll provide an understanding of how to utilize the CMS Internet-based Provider Enrollment Chain & Ownership System (PECOS) to be comfortable in navigating the system to submit a provider enrollment electronic application.

Utilizing Third Party Billing Companies

During this webinar, we’ll provide education related to using third party billers for your Medicare claims. We’ll identify vulnerabilities, share how to identify inappropriate third-party activities and reduce costs.

Repetitive Scheduled Non-Emergent Ambulance Transports Prior Authorization

Attention All Independent Ambulance Suppliers! If you are providing repetitive, scheduled, non-emergent ambulance transports (RSNAT), you'll want to attend this webinar. Join us to learn everything you need to know about the RSNAT program.

Provider Enrollment: Completing the CMS-855I Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855I provider enrollment paper application for a group member, sole proprietor, or sole owner and we’ll also focus on reassigning Medicare benefits.

Provider Enrollment: Completing the CMS-855A Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855A provider enrollment paper application.

Getting Access to PECOS

During this webinar, we’ll discuss how to obtain access to the Internet-based Provider Enrollment Chain & Ownership System (PECOS) and gain connection to provider enrollment record as well as understand other Centers for Mediacre & Medicaid [...]

Medicare Part B Ambulance Coverage, Basics and Billing

During this webinar, we'll educate new staff, or those needing a refresher on basic Medicare Part B ambulance billing guidelines.

Provider Enrollment: Completing the CMS-855B Paper Application

During this webinar, we'll provide an understanding of how to complete the CMS-855B provider enrollment paper application for a clinic, group, or supplier.

Provider Enrollment Revalidation Overview

During this webinar, learn about important changes in the revalidation process, how to determine Medicare enrollment revalidation due date and information to avoid disruption in Medicare billing.

How to Avoid Duplicate Claims

Duplicate denials continue to be one of the top billing errors. Unnecessary duplicate filing of Medicare claims cost the provider's office valuable time and resources, as well as Medicare's time and money to process them. Please join us for [...]

How to Avoid Duplicate Claims

Duplicate denials continue to be one of the top billing errors. Unnecessary duplicate filing of Medicare claims cost the provider's office valuable time and resources, as well as Medicare's time and money to process them. Please join us for [...]

Provider Enrollment: Completing the CMS-855A Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855A provider enrollment paper application.

Provider Enrollment: Completing the CMS-855B Paper Application

During this webinar, we'll provide an understanding of how to complete the CMS-855B provider enrollment paper application for a clinic, group, or supplier.

Provider Enrollment: Completing the CMS-855I Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855I provider enrollment paper application for a group member, sole proprietor, or sole owner and we’ll also focus on reassigning Medicare benefits.

Telehealth Place of Service 02 and 10 Clarification

Telehealth Place of Service 02 and 10 Clarification National Government Services has been receiving inquiries from providers in regard to POS 02 and POS 10 for telehealth service reporting. We’ve created this article to provide clarification. [...]

CLIA Number Processing Issue

CLIA Number Processing Issue National Government Services has been made aware of an issue with CLIA lab claims processing. CLIA numbers were not loaded through CWF, resulting in claim denials as CLIA did not match any file. We were informed [...]

Maine, Massachusetts, New Hampshire, Rhode Island and Vermont

Maine, Massachusetts, New Hampshire, Rhode Island, Vermont Member Name Professional Title Association Business Name/Address Email Bedard, Brenda Insurance Compliance & Training Supervisor Maine [...]

Monoclonal Antibodies in Treatment of Alzheimer’s Disease - Medicare Advantage Plan Responsibility

Monoclonal Antibodies in Treatment of Alzheimer’s Disease - Medicare Advantage Plan Responsibility NCD 200.3 was issued by CMS in April,2022 and outlines Medicare coverage policy for monoclonal antibodies that target amyloid (or plaque) for [...]

Home Health Documentation

Who Needs to Pay Application Fees

Institutional providers or suppliers must submit an application fee or hardship exception when initially enrolling, revalidating their enrollment or adding a new Medicare practice location. Physicians, nonphysician practitioners, physician [...]

Description of Application Fee

The application fee is imposed on institutional providers and suppliers to cover enrollment costs. The application fee for calendar year 2024 is $709. Related Content Federal Register Notice ‒ information about how the fee was calculated [...]

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 using PECOS: Under "Helpful [...]

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 rejected prior to the screening [...]

Eligible Method II Providers

Eligible Method II Providers If a CAH wants to become a Method II biller, email the request to A&R at ngsreimbursement@anthem.com.  Suppliers who can enroll as a Method II Biller Reassignment. Doctor of Medicine (MD) Doctor of [...]

Home Health Certification Statement

Home Health Certification Statement What is a home health certification statement? It is an attestation that the Medicare beneficiary is eligible for home health services. It is a CMS requirement and condition of payment for a home health [...]

Home Health Documentation Checklist

Wound Care Under the Medicare Home Health Benefit

Wound Care Under the Medicare Home Health Benefit Wound care treatment typically involves three skilled nursing interventions, which may be performed at the same time or separately from each other. The three services are: Performing the [...]

Homebound Status

Homebound Status A Medicare beneficiary must be confined to the home in order to use their Medicare home health benefit. CMS defines homebound status in the CMS IOM Publication 100-02, Medicare Benefit Policy [...]

Home Health Referrals

Home Health Referrals The certifying physician or allowed nonphysician practitioner, and/or the acute/post-acute care facility referring the patient for home care must ensure that the medical record justifies the referral for Medicare home [...]

Home Health Referrals

Home Health Referrals Table of Contents Home Health Referrals Order for Home Health Services Documentation to Support Homebound Status Documentation to Support the Need for Skilled Services Documentation Regarding the Face-to-Face [...]

Home Health Plans of Care: NPs, CNSs and PAs Allowed to Certify

Home Health Plans of Care: Nurse Practitioners, Clinical Nurse Specialists and Physician Assistants Allowed to Certify Section 3708 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. No. 116-136) amended sections [...]

Provider Compliance Tips for Home Health Services (Part A Non DRG)

Eligibility Criteria for Face-to-Face Encounters

Eligibility Criteria for Face-to-Face Encounters National Government Services is reminding home health providers that a face-to-face encounter form is not adequate documentation to support that a face-to-face encounter occurred. [...]

Home Health: The Definition of an Allowed Practitioner

Home Health:  The Definition of an Allowed Practitioner As per MM12615 the “Definition of an Allowed Practitioner” has been revised to read as follows (CR 12615): Medicare Benefit Policy Manual Chapter 7 Section 30.2.1 – Definition of an [...]

Medicare Home Health Benefit

Medicare Part B Drugs and Biologicals

During this webinar, we’ll provide and in-depth overview of Medicare Part B drug and biological coverage guidelines, pricing, reimbursement and proper billing criteria. We’ll also share educational resources to help ensure proper claim submission.