Submitting Revalidation via PECOS

During this webinar, we’ll provide an understanding of how to utilize the Centers for Medicare & Medicaid Services (CMS) Internet-based Provider Enrollment Chain & Ownership System (PECOS) to be comfortable in navigating the system to submit a [...]

Submitting Revalidation via PECOS

During this webinar, we’ll provide an understanding of how to utilize the Centers for Medicare & Medicaid Services (CMS) Internet-based Provider Enrollment Chain & Ownership System (PECOS) to be comfortable in navigating the system to submit a [...]

PECOS: View and Manage Reassignments through Group Enrollment

During this webinar, we’ll provide an understanding of how to view and manage reassignments through the group enrollment in Provider Enrollment, Chain and Ownership System (PECOS), including to add or terminate reassignments. Individual [...]

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.

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.

Registration Now Open for the 2024 Preventive Services Virtual Conference!

Registration Now Open for the 2024 Preventive Services Virtual Conference! We are thrilled to announce that registration is now open for the National Government Services Medicare Part B 2024 Preventive Services Virtual Conference, taking place [...]

MLN Connects® Newsletter: November 7, 2024

MLN Connects® Newsletter: November 7, 2024 Final Rules Physician Fee Schedule CY 2025 Final Rule Hospital Outpatient Prospective Payment System & Ambulatory Surgical Center Payment System CY 2025 Final Rule ESRD Prospective Payment [...]

Introduction to Medicare Part II

Are you new to the Medicare Program? Attend our Introduction to Medicare Part I and II Webinars! Each session will be 1 hour with 15 minutes of Q&A. Part II will focus on: Local Coverage Determinations, Claim Filing Guidelines, Preventive [...]

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.

Billing Medicare Part A When Veteran’s Administration Eligible Medicare Beneficiaries Receive Services in Non-VA Facilities

Billing Medicare Part A When Veteran’s Administration Eligible Medicare Beneficiaries Receive Services in Non-VA Facilities Table of Contents Background Beneficiary Chooses to Use Medicare Beneficiary Chooses to Use VA Benefits VA [...]

Let’s Chat about Medicare Secondary Payer for Part A Providers

This Let’s Chat session will focus on questions our Part A providers have regarding the topic of Medicare Secondary Payer (MSP). Let's Chat sessions are informal opportunities for our providers to chat with our Provider Outreach and [...]

November is Lung Cancer Awareness Month

November is Lung Cancer Awareness Month Lung cancer is the leading cause of cancer death in the United States and worldwide. Although education, research and treatment options for lung cancer have dramatically improved in recent years, lung [...]

LCD Open Meeting Records

Open Meeting Records Jurisdiction 6 and Jurisdiction K Open Meeting Records Meeting Date Audio Transcript 10/24/2024- J6/JK Open Meeting Recording Transcript  7/18/2024 - J6/JK Open Meeting [...]

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.

Introduction to Medicare Contractors

Medicare Administrative Contractors (MACs) are responsible for processing claims, managing policy and payment, and establishing regional policy guidelines. Are you aware that the Centers for Medicare & Medicaid Services (CMS) also uses several [...]

Navigating Medicare Compliance for Federally Qualified Health Centers

Understanding Medicare compliance is crucial for federally qualified health centers (FQHCs) to ensure proper billing and reimbursement under the FQHC Prospective Payment System (FQHC PPS). This comprehensive webinar is designed to provide an [...]

How To Prevent Claim Errors That Could Be Seen as Abusive or Fraudulent

Did you know having an abundance of certain types of claim errors can put providers at risk of fraud and/or abuse audits and investigation? While most of these errors are usually simple mistakes, continued inappropriate billing could lead to [...]

Rural Health Clinics – What You Need to Know!

This session will focus on information to help rural health clinics (RHCs) ensure that they are compliant with Medicare’s rules and regulations and help your facility have a consistent cash flow and avoid claim denials. Topics will include a [...]

Identify the Proper Order of Payers for a Beneficiary's Services

Table of Contents Background Step 1: Check for Open Medicare Secondary Payer Records for the Beneficiary in the Common Working File Step 2: Collect MSP Information from the Beneficiary  Step 3: Compare the MSP Information you [...]

Using Medicare Resources

Did you know all providers who submit claims to the Medicare Program are required to be familiar and comply with the most current Medicare billing and coverage guidelines? Where do you turn to learn about Medicare? You can find a variety of [...]

Fundamentals of Medicare - Medicare Program Exclusions

Section 2: Medicare Basics Medicare Program Exclusions No payment can be made under Medicare Part A or Medicare Part B for certain items and services. The list below includes the general Medicare program exclusions. For details regarding [...]

The Hospice Benefit

Section 2: Medicare Basics The Hospice Benefit Table of Contents The Hospice Benefit Requirements for Coverage Hospice Benefit Days and Costs Hospice Services Noncovered Hospice Services [Return to Top] The Hospice Benefit [...]

Home Health Care Benefit

Section 2: Medicare Basics Home Health Care Benefit Table of contents Home Health Care Benefit Responsibilities of Hospitals Discharging Medicare Beneficiaries Home Health Prospective Payment System Responsibilities of Providers [...]

Inpatient Hospital Care

Section 2: Medicare Basics Inpatient Hospital Care Table of Contents Inpatient Hospital Care Inpatient Benefit Days and Cost-Sharing Full Days—Renewable Coinsurance Days—Renewable Lifetime Reserve Days—Nonrenewing Inpatient [...]

Skilled Nursing Facility Inpatient Care

Section 2: Medicare Basics Skilled Nursing Facility Inpatient Care Table of Contents Skilled Nursing Facility Inpatient Care Requirements for Coverage Technical Requirements Medical Requirements Inpatient SNF/Swing Bed Benefit [...]

Medicare Part B Medical Insurance

Section 2: Medicare Basics Medicare Part B—Medical Insurance Table of Contents Medicare Part B—Medical Insurance Part B Costs Medicare Deductible, Coinsurance and Premium Rates Covered Part B Services Covered Physicians’ Services [...]

Medicare Part A

Section 2: Medicare Basics Medicare Part A Table of Contents Medicare Part A Benefit Periods—Medicare Part A Ending a Benefit Period Benefit Period Examples [Return to Top] Medicare Part A Medicare Part A is referred to as Hospital [...]

The Medicare Card

Section 2: Medicare Basics The Medicare Card Once a person is enrolled in Medicare, they are issued a card that indicates they are covered by Medicare. The Medicare card is red, white and blue in color. It is issued (and can be reissued) [...]

The Social Security Administration and Medicare Enrollment

Section 2: Medicare Basics The Social Security Administration and Medicare Enrollment The SSA office has the responsibility for handling Medicare enrollment and managing premium billing and payment. Premiums may be deducted from a [...]

Fundamentals of Medicare: Participating Providers

Section 1: Introduction Participating Providers Providers receiving Medicare reimbursement are known as “participating providers.” To become a participating provider, a provider must be in compliance with applicable provisions of Title VI of [...]

Fundamentals of Medicare: State Responsibilities

Section 1: Introduction State Responsibilities Facilities desiring to participate in either the Medicare or Medicaid programs must meet participation conditions for certification. State agencies certify to the DHHS whether providers satisfy, [...]

Federal Government Administration

Section 1: Introduction Table of Contents Federal Government Administration Who Is CMS? CMS' Goals Program Objectives Access to Quality Care Services to Beneficiaries Program Administration CMS Structure CMS [...]

Introduction

Section 1: Introduction Introduction Disclaimer National Government Services produced this material as an informational reference for providers furnishing services in our contract jurisdiction. NGS employees, agents and staff make no [...]

Understanding Medicare Fraud and Abuse

Join this session to learn about fraud and abuse affecting providers and your Medicare patients that will increase your awareness of integrity issues and prevent potential fraudulent and abusive practices against the Medicare Program.

Fundamentals of Medicare

One Week Until Beneficiary Eligibility Information Leaves the IVR

One Week Until Beneficiary Eligibility Information Leaves the IVR  As we’ve communicated, beginning 11/18/2024, beneficiary eligibility information will not be offered on the IVR. This includes all beneficiary eligibility information that [...]

Checking Eligibility and Knowing Your Point of Contact

Checking Eligibility and Knowing your Point of Contact Table of Contents Checking Eligibility and Knowing your Point of Contact How to Verify Patient Eligibility Related Content Listed below are the different patient eligibility and [...]

Go Paperless Today - Protect Your Bottom Line

Go Paperless Today ‒ Protect Your Bottom Line Every day is a great day to choose electronic solutions rather than paper. Make today the day you go electronic. If you are sending paper to National Government Services, change that now. You can [...]

Medicare Home Health Collaboration with Other Provider Types

Medicare Home Health Collaboration with Other Provider Types Table of Contents The Medicare Home Health Benefit Therapy Providers and the Home Health Benefit Durable Medical Equipment Suppliers and the Home Health Benefit Hospice and the [...]

HCPCS 90658 Claim Hold

Claim hold for CPT 90658 (influenza vaccine)

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 [...]

CO-22

Avoiding/Correcting This Error During patient registration it’s important for office staff to identify whether a beneficiary’s claims should be covered by other insurance before, or in addition to, Medicare. Providers shall use [...]

PR-31

Avoiding/Correcting This Error Services were denied for one or more of the following reasons: The name or Medicare number was incorrect or missing. The date of death precedes the date of service. Expenses were incurred prior to coverage. [...]

PR-31

Avoiding/Correcting This Error Services were denied for one or more of the following reasons: The name or Medicare number was incorrect or missing. The date of death precedes the date of service. Expenses were incurred prior to coverage. [...]

CO-109

Avoiding/Correcting This Error This denial is received when your Medicare patient is enrolled in a MA plan, instead of “traditional fee-for-service” Medicare. MA plans are health plans offered by private companies approved by Medicare that [...]

CO-109

Avoiding/Correcting This Error This denial is received when your Medicare patient is enrolled in a MA plan, instead of “traditional fee-for-service” Medicare. MA plans are health plans offered by private companies approved by Medicare that [...]

CO-22

Avoiding/Correcting This Error During patient registration, it’s important for office staff to identify whether a beneficiary’s claims should be covered by other insurance before, or in addition to, Medicare. Providers shall [...]

Determine if Medicare is Primary or Secondary for a Beneficiary's Services

Table of Contents Determine if Medicare is Primary or Secondary for a Beneficiary's Services Step 1: Collect MSP Information from the Beneficiary During an MSP Screening Process Step 2: Check for Open MSP Records for a Beneficiary in [...]

Prepare and Submit an MSP Claim

Table of Contents Step 1: Determine if an MSP Claim Must be Submitted to Medicare Step 2: Check Medicare’s Eligibility Files via NGSConnex to Determine if There's Other Insurance Primary to Medicare Step 3: Prepare the MSP (Partial-Payment [...]

APPEALS: I received a remittance advice with the message “this care may be covered by another payer per coordination of benefits.” Is this an appealable claim?

Medicare Part A Rebuttal Form

Medicare Part B Rebuttal Form

Provider Enrollment Appeals Cover Sheet

Skin Substitutes

Skin Substitutes CMS provides pricing for some wound care products; however, there are many that do not have established pricing. When a skin substitute/wound care product does not have established pricing, the pricing for the item will be [...]

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 Provider Enrollment, Chain and Ownership System (PECOS) as well as using the CMS-855I paper application. This session is [...]

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 Provider Enrollment, Chain and Ownership System (PECOS) as well as using the CMS-855I paper application. This session is [...]

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 [...]

Submitting Electronic Medical Records

Submitting Electronic Medical Records National Government Services can accept medical records submitted on a CD or thumb drive however, submitting via our free, secure, web-based portal NGSConnex is preferred and far more advantageous for [...]

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.