Are the radiofrequency ablations allowed now until 3/20/2023, or are already noncovered?

What is the frequency requirement for the pneumococcal vaccine?

What is the administration code for the pneumococcal vaccine?

Is the pneumococcal vaccine subject to coinsurance and deductible?

Does Medicare pay for counseling and education of the pneumococcal vaccine?

If I administer two different vaccinations during the same visit, e.g., influenza and pneumococcal, can I bill for two separate administrations?

Can a mass immunizer combine pneumococcal with other vaccines on one roster bill?

What are the allowance limits for the cost of the pneumococcal vaccine?

Is an order required to administer the pneumococcal vaccine?

CMS-855I: How do I complete a reassignment?

CMS-855I: Who needs to sign the CMS-855I for a reassignment?

APPLICATION STATUS: Where can I find the status of a submitted application?

PECOS: Manage Signatures and Additional Information Requests

During this webinar, we’ll give direction for the Provider Enrollment, Chain and Ownership System (PECOS) application on understanding how to manage signatures and respond to additional information request from submitted applications.

Medicare Part B Top Claim Denials

During this webinar, we’ll review the current top ten claim denials which are identified by internal claim data and provide guidance for correcting them, and solutions to prevent them from occurring on future claims. There will be time for your [...]

Split/Shared and Incident To Services

Split/Shared and Incident To Services Please define the substantive portion of a split (or shared) visit in 2024? Answer: The following factors apply in 2024 in determining the substantive portion of a split (or shared) visit:   [...]

CLAIMS: How do I indicate on a Medicare claim that the services are NOT related to a liability, no fault (including medical payment) or Workers’ Compensation accident, injury or illness MSP record in the CWF?

CLAIMS: I received a denial stating that the documentation submitted did not support the medical necessity of laboratory services. Can you tell me what I can submit to support these services?

DDE: Is there some place on FISS/DDE that shows how many physical therapy (PT) or occupational therapy (OT) visits the beneficiary has had?

PC-ACE: Is there a resource I can use to assist me with Medicare Secondary Payer (MSP) claims when using PC-ACE?

DDE: I tried to access my claim through the FISS/DDE system and it will not let me pull it up. What is the problem?

DDE: I have a claim which was fully denied and I am attempting to use the automated denial adjustment process, but the FISS/DDE system is not allowing me to adjust my claim. Why am I not able to bring up my claim and submit the adjustment?

DDE: My name changed and I need to change the name associated to my log on ID. How do I do that?

DDE: How do I get my log on ID password reset?

DDE: Can a provider view additional development requests (ADRs) via the FISS/DDE?

Complex and Chronic Care - HCPCS Code G2211

Complex and Chronic Care - HCPCS Code G2211 Please define appropriate usage and billing for HCPCS code G2211. Answer: CMS has approved G2211 for 2024 as an add-on code for complex and/or continuous office and outpatient E/M services [...]

Documentation

Documentation What are the basic documentation requirements for a service submitted to Medicare for payment? Answer: For all services submitted to Medicare, the medical record (whether electronic or paper) must clearly define the provider [...]

Reminder – Beginning 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR

Reminder – Beginning 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR To help protect Medicare beneficiaries against fraud, CMS is instructing all MACs to remove beneficiary eligibility information from our IVR [...]

APPLICATION FEE: What is the amount of the application fee?

DETERMINATION LETTER: How can I get a copy of the determination (approval/denial) letter for a submitted application?

PECOS: In PECOS, how do I know if the authorized/delegated official or individual provider signed the application?

PECOS: In PECOS, how do I submit an application?

PECOS: I received an email to sign an application; how do I do this?

PECOS: In PECOS, how do you find an enrollment to submit an application?

COVID-19 Vaccine and Monoclonal Antibody

COVID-19 Vaccine and Monoclonal Antibody With the end of the PHE, as of 5/11/2023, this information no longer applies. We will keep the information available for PHE-related services that occurred prior to the expiration date that have not yet [...]

Claim Billing Guidance

Claim Billing Guidance With the end of the PHE, as of 5/11/2023, this information no longer applies. We will keep the information available for PHE-related services that occurred prior to the expiration date that have not yet been billed. [...]

COVID-19

COVID-19 The 2019 Novel Coronavirus (COVID-19) was declared a PHE on 3/13/2020 and it was officially expired on 5/11/2023. Please visit CMS' Current emergencies web page for complete details on the PHE. Email Updates To keep you informed [...]

Inpatient Hospital Issued Notices

Inpatient Hospital Issued Notices Applies to: All hospitals Medicare beneficiaries and hospitals have certain rights and protections related to financial liability and appeals under the Medicare Program. These financial liability and appeal [...]

Medicare Part A and B Billing for the COVID-19 Vaccine and Monoclonal Antibody

Medicare Part A and B Billing for the COVID-19 Vaccine and Monoclonal Antibody Table of Contents Medicare Part A and B Billing for the COVID-19 Vaccine and Monoclonal Antibody Roster Billing How to Submit a Centralized Bill Medicare [...]

Medicare Coverage of Over-the-Counter COVID-19 Tests

Medicare Coverage of Over-the-Counter COVID-19 Tests The OTC COVID-19 test demonstration ended on 5/11/2023. Starting on 5/12/2023, Medicare no longer covers or pays for OTC COVID-19 tests for those with Medicare Part B benefits. Beginning [...]

REVALIDATION: Do I need to revalidate if it has not been five years since my last revalidation?

REVALIDATION: How do I know I need to revalidate?

REVALIDATION: Where is the revalidation notification letter sent?

SIGNATURES: Who signs the CMS applications and forms for an entity? (ex. 855A, 855B, 20134, 460, 588)

SIGNATURES: Who signs the CMS applications and forms for an entity? (ex. 855A, 855B, 20134, 460, 588)

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, [...]

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 [...]

Prior Authorization of Repetitive Scheduled Non-Emergent Ambulance Transport

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 [...]

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 [...]

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 [...]

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 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 [...]

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 [...]