Home Health Certifying Provider Change

Home Health Certifying Provider Change Home health certifying physician or NPP changes can occur anytime for a variety of reasons. Some examples may include practitioner retirement or vacation and patient choice. Regardless of the [...]

Home Health Forms – Which is Required?

Home Health Forms – Which is Required? The Advance Beneficiary Notice/Home Health Change of Care Notice/Notice of Medicare Noncoverage Scenario ABN HHHCN NOMNC Patient met goals under the POC and is being [...]

Home Health Aide Services and the Intermittent or Part-Time Rule

Home Health Aide Services and the Intermittent or  Part-Time Rule Job Aid The CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 7, Section 50.2 states: The reason for the visits by the home health aide must [...]

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 considered if it is received [...]

Psychotherapy Services

Psychotherapy Services Table of Contents Regulations and Targeted Probe and Educate Resources Medicare Regulations CMS TPE Resources NGS Resources Psychotherapy Treatment Plans Required Treatment Plan Components [...]

Psychotherapy Services

Part B Overview of Medicare Dental Coverage

Medicare covers a limited number of dental services. The purpose of this webinar is to familiarize dental providers with Medicare Part B dental coverage. Discussion will include an overview of dental coverage, who can provide dental services, [...]

Utilizing Modifiers for Medicare Part B Dental Services

The purpose of this webinar is to discuss the modifiers that are currently allowed to be appended to inextricably linked dental services. We’ll also review the correct placement and billing guidelines for these modifiers when submitting [...]

The Medicare Appeals Process: What You Need to Know

This informative session will help you navigate Medicare’s appeals process by providing information on what an appeal is, how to determine if a claim can be appealed, who may file an appeal, the appeal levels, timeframes and documentation [...]

MLN Connects® Newsletter: September 5, 2024

MLN Connects® Newsletter: September 5, 2024 News Osteogenesis Stimulators: Prior Authorization Requirements Suspended Hospice Benefit: Expanding Prepayment Review in 4 States Skilled Nursing Facility Advance Beneficiary Notice: Revised [...]

Related Content

Related Content Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 32, Cardiac Rehabilitation (CR) Programs, Intensive Cardiac Rehabilitation (ICR), [...]

Pulmonary Rehabilitation

Pulmonary Rehabilitation Effective 1/1/2010, Medicare Part B pays for PR if specific criteria are met by the Medicare beneficiary, the PR program itself, the setting in which it is administered and the physician administering the program, as [...]

Cardiac Rehabilitation and Intensive Cardiac Rehabilitation

Cardiac Rehabilitation and Intensive Cardiac Rehabilitation Medicare Part B pays for CR and ICR programs and related items/services. Specific criteria must be met by the Medicare beneficiary, the cardiac rehabilitation program itself, the [...]

Care Management: 2024 Health Equity Services

As part of a continued series, NGS is raising awareness on the benefits of care management. During this webinar, we’ll discuss the new care management services that were included for Medicare coverage in 2024, caregiver training, principal [...]

Care Management: Cognitive Assessment

As part of a continued series, we’re raising awareness of the benefits of care management. During this webinar, we’ll focus on cognitive assessment, which is a separate service that may be billed for patients when you have recognized potential [...]

Billing Cardiac Rehabilitation Session and Session Limitations

Billing Cardiac Rehabilitation Session and Session Limitations CR sessions are limited to a maximum of two one-hour sessions per day for up to 36 sessions up to 36 weeks with the option of an additional 36 sessions over an extended [...]

Care Management: Behavioral Health Integration and Psychiatric Collaborative Care Management

As part of a continued series, National Government Services (NGS) is raising awareness on the benefits of care management. During this webinar, we’ll discuss behavioral health integration and psychiatric collaborative care management. This [...]

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 [...]

Care Management: Transitional Care Management Services

As part of a continued series, we’re raising awareness of the benefits of care management. During this webinar, we’ll focus on transitional care management services for Medicare patients. We’ll share resources and review proper billing [...]

LCD and Article Updates for August/September 2024

LCD and Article Updates for August/September 2024 Local Coverage Determinations Facet Joint Interventions for Pain Management L35936 Effective 8/1/2024 - Updated "Coverage Indications, Limitations and/or Medical Necessity" with the [...]

FQHC PPS Basic Billing and Reimbursement

Are you a Federally Qualified Health Center (FQHC) provider that would like to learn about basic billing and reimbursement under the FQHC prospective payment system (PPS)? This webinar will include claim and payment examples for new providers/ [...]

Telligen QIN-QIO Hosting Chronic Kidney Disease Topics with National Kidney Foundation

Telligen QIN-QIO Hosting Chronic Kidney Disease Topics with National Kidney Foundation Chronic kidney disease (CKD) affects more than 1 in 7 U.S. adults—an estimated 37 million Americans. For Americans with diabetes or high blood pressure—the [...]

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.

LCD and Article Updates for September/October 2024

LCD and Article Updates for September/October 2024 A58152 Billing and Coding: Computed Tomography Cerebral Perfusion Analysis (CTP) The following ICD-10-CM diagnosis codes were added to Group 1- ICD-10-CM Codes That Support Medical necessity [...]

Ultrasound Screening for Abdominal Aortic Aneurysm

Preventive Services Guide Ultrasound Screening for Abdominal Aortic Aneurysm An ultrasound screening for AAA is a procedure using sound waves (or such other procedures using alternative technologies, of commensurate accuracy and cost, as [...]

Screening Pelvic Examinations

Preventive Services Guide Screening Pelvic Examination A pelvic examination is a type of gynecologic examination for women. Some of the conditions that health care providers look for during a pelvic examination include infections, fibroids, [...]

Screening for Cervical Cancer with Human Papillomavirus Tests

Preventive Services Guide Screening for Cervical Cancer with Human Papillomavirus Tests Cervical cancer is commonly caused by the HPV. The USPSTF found that regular screening greatly reduces the rate of cervical cancer and the number of [...]

Prostate Cancer Screening

Preventive Services Guide Prostate Cancer Screening Prostate cancer is the second most common cancer in men in the United States, after skin cancer. Older men, African-American men and men who have a family history of prostate cancer have a [...]

Medical Nutrition Therapy

Preventive Services Guide Medical Nutrition Therapy MNT is a dietary intervention that is used to prevent or treat health conditions that are caused by or made worse by unhealthy eating habits. Table of Contents Eligibility Criteria [...]

Intensive Behavioral Therapy for Obesity

Preventive Services Guide Intensive Behavioral Therapy for Obesity In 2003, the United States Preventive Services Task Force found good evidence that BMI “is reliable and valid for identifying adults at increased risk for mortality and [...]

Intensive Behavioral Therapy for Cardiovascular Disease

Preventive Services Guide Intensive Behavioral Therapy for Cardiovascular Disease CVD generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain or stroke. CMS has determined [...]

Human Immunodeficiency Virus Screening

Preventive Services Guide Human Immunodeficiency Virus Screening HIV attacks cells that help the body fight infection making a person vulnerable to other infections. Nearly 1.2 million Americans are now living with HIV infection and about [...]

Hepatitis C Virus Screening

Preventive Services Guide Hepatitis C Virus Screening Hepatitis C is a virus that can damage the liver; it is transmitted through infected blood or body fluids. The most common way people get infected is by sharing needles used to inject [...]

Glaucoma Screening

Preventive Services Guide Glaucoma Screening Glaucoma is a group of eye diseases in which damage to the optic nerve results in loss of eyesight. Medicare beneficiaries over the age of 60 have an increased risk of developing glaucoma. CMS has [...]

Depression Screening

Preventive Services Guide Depression Screening Also Known as Screening for Depression in Adults Coverage Criteria Covered annually At least 11 months must have passed since last depression screening G0444: Annual depression [...]

Counseling to Prevent Tobacco Use

Preventive Services Guide Counseling to Prevent Tobacco Use Smoking is the leading preventable cause of disease, disability and death in the United States. It harms nearly every organ in the body and causes about one in every five deaths. [...]

Colorectal Cancer Screening

Preventive Services Guide Colorectal Cancer Screening Screenings are performed to diagnose colorectal cancer or to determine a beneficiary’s risk for developing colorectal cancer. Colorectal cancer screening may consist of several different [...]

Cardiovascular Disease Screening Tests

Preventive Services Guide Cardiovascular Disease Screening Tests Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. Table of [...]

Annual Wellness Visit Screening

Preventive Services Guide Annual Wellness Visit Screening Table of Contents Annual Wellness Visit Screening Coverage Criteria Two Types of AWV Elements Elements of Initial AWV Personalized Prevention Plan Services – [...]

General Information

General Information In certain circumstances, National Government Services or other contractors working under the CMS may need to request additional information with regard to claims submitted to the Medicare Program. The requests for [...]

Other Audit Contractor ADRs

Other Audit Contractor Additional Development Requests An ADR may be requested from one of the contractors listed below. If you receive correspondence from any one of these contractors, please follow the instructions within their letter. [...]

Claim ADRs

Claim Additional Development Requests National Government Services will not be able to process your claim without additional documentation. The following are the most common situations when NGS would require additional documentation to process [...]

Ways to Respond to ADRs

Ways to Respond to ADRs Table of Contents Ways to Respond to ADRs Utilizing Paperwork Segment and esMD Electronic Submission of Medical Documentation NGSConnex Portal Fax U.S. Mail, FedEx, UPS [Return to Top] Ways to Respond to ADRs [...]

Resources

Resources CMS Medicare Dental Coverage Change Request (CR) 13181 Medicare Policy Updates for Dental Services as Finalized in the Calendar Year (CY) 2023 Physician Fee Schedule (MPFS) Final Rule Change Request (CR) 13190 Educational [...]

Overpayments Due to Contractor Audit Reviews

Overpayments Due to Contractor Audit Reviews If you do not agree with any CMS contractor audits determination and you are a provider practicing in JK (CT, MA, ME, NH, NY, RI, VT) or J6 (IL, MN, WI), you may use the Medicare appeals process [...]

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.

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 [...]

Medical Review Targeted Probe and Educate ADRs

Medical Review Targeted Probe and Educate Additional Development Requests Medical Review NGS Medical Review Department will be performing service specific post-payment reviews for a random selection of claims billed to Medicare Part A and B. [...]

Part B Overview of Medicare Dental Coverage

Medicare covers a limited number of dental services. The purpose of this webinar is to familiarize dental providers with Medicare Part B dental coverage. Discussion will include an overview of dental coverage, who can provide dental services, [...]

Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line

Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line Attention: Provider Enrollment and Credentialing Departments Revalidate before your due date to avoid a “Stay of Enrollment” or claim rejections which may [...]

Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line

Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line Attention: Provider Enrollment and Credentialing Departments Revalidate before your due date to avoid a “Stay of Enrollment” or claim rejections which may [...]

Alcohol Misuse and Counseling

Preventive Services Guide Alcohol Misuse and Counseling Table of Contents Alcohol Misuse and Counseling Two-Part Benefit Cost Sharing Reimbursement Nonparticipating Providers Common Claim Denial Reasons Related Content [Return [...]

Screening Pap Tests

Preventive Services Guide Screening Pap Tests Cervical cytology, also called a Pap test, looks for abnormal changes in cells in the cervix, which is part of a woman’s reproductive organs. Screening for cervical cancer via a Pap test is very [...]

Hospice Claim Reporting Requirements for Attending and Certifying Physicians

Hospice Claim Reporting Requirements for Attending and Certifying Physicians ​​​​Under CMS' current guidelines, the hospice medical director or the hospice physician and the attending physician (if the beneficiary has one), must initially [...]

PC-ACE

Local Coverage Determination Open Meeting Announcement

Local Coverage Determination Open Meeting Announcement Table of Contents Jurisdiction 6/Jurisdiction K Part A/Part B MAC Requests to Present Registered Presenters (Slide Presentations Only) Observers Comments on Proposed LCDs [...]