Non-Appealable Situations with Medicare Advantage Plans - Make Sure Your Staff is Aware

Non-Appealable Situations with Medicare Advantage Plans - Make Sure Your Staff is Aware When a Medicare Beneficiary enrolls in a MA Plan, that MA plan takes the place of Traditional Medicare benefits. National Government Services is [...]

Common Denials Guide for Diabetes Self-Management Training and Medical Nutrition Therapy

Common Denials Guide for Diabetes Self-Management Training and Medical Nutrition Therapy National Government Services, MAC for Jurisdiction K and Jurisdiction 6, continues to provide you with resources to help reduce the burden of claim [...]

Use National Government Services Self-Service Tools to Maximize your Workload

Use National Government Services Self-Service Tools to Maximize your Workload Our PCC telephone lines are busiest at the beginning and end of each month, and this creates long wait times for providers trying to resolve claim payments, denials, [...]

Prepare and Submit a Medicare Tertiary Claim

Table of Contents Prepare and Submit a Medicare Tertiary Claim Step 1: Determine When a Claim(s) Must be Submitted to Medicare Step 2: Check for MSP Insurer Information in Medicare’s Records Step 3: Prepare and Submit Medicare Tertiary [...]

Provider Enrollment Appeals Cover Sheet

Checking Medicare Eligibility

Checking Medicare Eligibility To determine the last date a patient received tobacco cessation counseling, providers can check patient eligibility through these online tools and services: Table of Contents NGSConnex HIPAA Eligibility [...]

Reopening versus Redetermination

Reopening versus Redetermination Table of contents Reopening versus Redetermination Reopening Telephone Reopening Unit Redeterminations [Return to Top] Reopening versus Redetermination Understanding your next steps are very [...]

Reducing Unprocessable Claim Rejections

When claims are submitted with invalid, incomplete or incorrect information, our claims processing system will detect these errors and will reject claims as unprocessable. Our goal is to assist our providers in submitting claims correctly the [...]

Common Working File Incorrectly Rejecting for Edit 538H

National Government Services is informing Part A and Part B providers of an error in CWF in the Eligibility Database, incorrectly identifying some beneficiaries as incarcerated and rejecting new claims for Edit 538H. This may also generate [...]

Submitting Electronic Medical Records via CD or Thumb Drive

Submitting Electronic Medical Records via CD or Thumb Drive 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 [...]

PECOS Application Status Tool

The status of your application is indicated by the step that is highlighted. If an application fee is required, an additional step will be added and the system will generate five steps. Your application was successfully [...]

U5210

Avoiding/Correcting This Error Each beneficiary should be screened for eligibility. Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS Provider [...]

U5200

Avoiding/Correcting This Error Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS Provider Online System, HETS or NGSConnex to verify beneficiary [...]

C7010

Avoiding/Correcting This Error If services are unrelated to hospice stay, resubmit with condition code 07 (treatment of nonterminal illness for hospice patient). Verify hospice enrollment prior to claim submission by reviewing the CWF, HETS [...]

U5200

Avoiding/Correcting This Error Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS/DDE Provider Online System, HETS or NGSConnex to verify [...]

Mastering Critical Access Hospital Billing and Compliance

Are you new to critical access hospital (CAH) billing or need a refresher? Join us for an in-depth webinar designed specifically for billing professionals looking to enhance their knowledge of CAHs. This session will cover the fundamentals of [...]

Pricing <5>

table, td, th table { border-collapse: collapse; width: 50%; } Pricing <5> When Pricing is selected, the IVR will When Pricing is selected, the IVR will play the following: "To obtain pricing information, visit NGSMedicare.com and [...]

Documentation Submission Responsibilities

Documentation Submission Responsibilities When medical records are requested, the billing provider is responsible to obtain sufficient documentation to support the medical necessity of the service(s) billed. If the documentation is [...]

Part B Claims Impacted by CWF CLIA File Issue

The CWF Host has recognized an issue in the CLIA file and has successfully reloaded the corrected CLIA file.

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 Provider [...]

[UPDATE] Hospice Claims Rejected with Reason Code 17729

Claim rejections for TOB 081X and 082X with RC 17729 have occurred due to a file error. These claims did comply with CMS-required entry of the correct certifying physician in the “Attending” field, which did match the PECOS Enrolled [...]

Correct or Adjust a Claim Due to an MSP-Related Issue

Table of Contents Background Step 1: Identify the Fiscal Intermediary Shared System Direct Data Entry Status Location of the Claim and the Reason for the Claim Correction or Change Status Location TB9997 (Returned to Provider Claims) [...]

Prepare and Submit a Medicare Secondary Payer Claim

Table of Contents Background Step 1: Determine If You Must Submit an MSP Claim Step 2: Prepare an MSP Claim MSP Billing Code Table Step 3: Check for a Matching MSP Record for the Beneficiary in the Common Working File Step [...]

Verify Bank Account Information

National Government Services receives numerous electronic funds transfer banking rejections each year due to frozen or closed bank accounts. To prevent interruption in Medicare payment, billing providers verify an active bank account is [...]

Revalidation Application Checklist

Revalidation Application Checklist Use the Revalidation Application Checklist to assist when revalidating your enrollment information. The general checklist will allow you to understand requirements while the PECOS and CMS-855 paper [...]

Announcement About Medicare Participation for Calendar Year 2024

Announcement About Medicare Participation for Calendar Year 2024 The Centers for Medicare & Medicaid Services has posted the Announcement About Medicare Participation for Calendar Year 2024. Posted 11/14/2023

Register Now for the 2024 Preventive Services Virtual Conference!

Register Now for the 2024 Preventive Services Virtual Conference! Dive deep into critical preventive services topics! All Part B Providers! Register now for the National Government Services Medicare Part B 2024 Preventive Services Virtual [...]

Introduction to Medicare Part I

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 I will focus on: Jurisdictions, NGS Website/Medicare Education, Medicare Enrollment [...]

November 2024

In This Issue National Government Services Articles for Part A and Part B Providers Local Coverage Determination Open Meeting Reminder – Beginning 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR NGSConnex: Overview, [...]

CERT Program Information

CERT Program Information What Is the CERT Program? The CMS implemented the CERT program to measure improper payments in the Medicare FFS program. CERT selects a stratified random sample of claims submitted to Part A/B MACs and DME MACs [...]

CERT Tools

CERT Tools   Centers for Medicare & Medicaid Services CERT Page  CERT C3HUB provider website CERT Reports Revised 11/13/2024

CERT Tools

CERT Tools Centers for Medicare & Medicaid Services CERT Page  CERT C3HUB provider website CERT Reports  Revised 11/13/2024

Correcting Reason Code 37253

Correcting Reason Code 37253 To ensure home health claim information aligns with OASIS data, the iQIES OASIS claim data match is essential. If no matching assessment is found in iQIES when a claim is submitted, it will be returned with reason [...]

Let’s Get Familiar with National Correct Coding Initiatives Procedures

The Centers for Medicare & Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) program to promote national correct coding. Incorrect coding often leads to improper payment and increases the paid claims error rate. If [...]

Understanding Your Medicare Secondary Payer Responsibilities

All Medicare providers have responsibilities related to Medicare being the secondary payer including identifying payers primary to Medicare (per the Medicare Secondary Payer provisions, such as Employer Group Health Plans, No-Fault, WC, etc.), [...]

The “How To” in Avoiding Documentation-Related Claim Denials

Have you received claim denials for missing or incomplete documentation? Does your facility have difficulty responding timely to our additional development requests (ADRs)? Join us for a session that will focus on tips to prevent and [...]

Complying with the Comprehensive Error Rate Testing Program

Do you know who the Comprehensive Error Rate Testing (CERT) contractor is? Have you been notified of CERT record requests and/or received CERT claim errors? The Centers for Medicare & Medicaid Services (CMS) established the CERT program to [...]

November 21st is The Great American Smokeout

November 21st is The Great American Smokeout You Can Help Your Patients Quit Smoking Smoking is one of the leading causes of heart disease and stroke. At least 70% of cigarette smokers see a clinician annually and many want to quit. Each [...]

MLN Connects® Newsletter: November 14, 2024

MLN Connects® Newsletter: November 14, 2024 News 2025 Medicare Parts A & B Premiums and Deductibles Medicare Participation for CY 2025 Ambulance Fee Schedule: CY 2025 Final Policies Prior Authorization Review Timeframe Change [...]

IVR Conversion Table

Conversion Chart for Patient Names Conversion Chart for Beneficiary HICN/MBI/PTAN/DCN Letter Conversion Letter Conversion A 2 A *21 B 2 B *22 C 2 C *23 [...]

Using the IVR

Table of Contents MBI Phonetic Alphabet Now Available Tips MBI Phonetic Alphabet IVR Conversion Tool [Return to Top] MBI Phonetic Alphabet Now Available To assist you when speaking the MBI, we have implemented the MBI phonetic [...]

When to Use the Provider Contact Center Versus Self-Service Tools

When to Use the Provider Contact Center Versus Self-Service Tools The CMS requires contractors to provide self-service and electronic communication technologies as efficient, cost effective means of disseminating Medicare provider information, [...]

Hospital Acquired Conditions and Present on Admission Resource for Physicians

Hospital Acquired Conditions and Present on Admission Resource for Physicians Did you know that documentation about your patient’s inpatient stay is vital for accurate submission of an inpatient hospital claim to Medicare? This resource [...]

Part B Claims Denied with Error 524B

An error in CWF processing has not yet been fully corrected. The error is occurring when Demo Codes A5 (Making Care Primary-MCP) or A6 (Guiding an Improved Dementia Experience-GUIDE) are on the claim and the HIC on the claim has an active MSP [...]

Fast Track Access

Fast Track Access You will be prompted for the fast-track access when you use a feature that requires provider authentication (NPI, PTAN, TIN). Features: Claim Status, Checks, Offsets, Pricing, Appeals You can obtain a code after you [...]

Electronic Funds Transfer

EFT allows for claim payments to be electronically transferred to your bank in place of a hard copy check mailed to the facility. Medicare payments due a provider or supplier of services may be sent to a bank (or similar financial institution) [...]

Eligibility

Eligibility information is no longer available via the IVR. To obtain Eligibility information login to NGSConnex and select Eligibility Lookup. If you haven’t already registered for NGSConnex, you can obtain detailed step-by-step instructions [...]

General Information <8>

General Information <8> When General Information is selected, the IVR will present the caller with a submenu. Voice Touch-Tone Entry IVR Supplies Phone Numbers 1 Commonly requested telephone numbers [...]

Deactivation of Billing Privileges/Suspension of Payment

Reasons for Deactivation of Medicare Billing Privileges/Suspension of Payment (not all inclusive) Inactivity Failure to complete revalidation within required time frame Unreported provider address and/or bank information Inactivity [...]

Deactivation of Billing Privileges/Suspension of Payment

Reasons for Deactivation of Medicare Billing Privileges/Suspension of Payment (not all inclusive) Inactivity Failure to complete revalidation within required time frame Unreported provider address and/or bank information Inactivity [...]

Deactivation of Billing Privileges/Suspension of Payment

Reasons for Deactivation of Medicare Billing Privileges/Suspension of Payment (not all inclusive) Inactivity Failure to complete revalidation within required time frame Unreported provider address and/or bank information [Return to [...]

Prevent Revalidation Processing Delays

When National Government Services receives a revalidation application, we often determine additional information is needed to process the application. In those cases, a request for additional information is sent which is commonly referred to as [...]

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 to Search on the Medicare Revalidation List Tool for Due Date [...]

Revalidate My Enrollment

Table of Contents Step 1: Determine You Are in the Right Place What’s ahead for your next Medicare enrollment revalidation? How will you know if you are due for revalidation? Step 2: Complete the Medicare Application Step 3: [...]

Revalidate My Enrollment

Step 1: Determine You Are in the Right Place Medicare provider enrollment revalidation is part of the Patient Protection and Affordable Care Act, Section 6401(a), which established a requirement for all enrolled providers/suppliers to [...]

Inpatient Psychiatric Certification/Recertification/Delayed Certification

Inpatient Psychiatric Certification/Recertification/Delayed Certification Physicians are required to certify the medical necessity of inpatient services. This is required on admission and if the service is needed for an extended period of [...]

Physician Documentation Requirements for Certification of Home Health Care

Physician Documentation Requirements for Certification of Home Health Care Medicare has changed the physician documentation requirements for certification of home health care for dates of service effective 1/1/2015. While clinicians still need [...]

Physician Orders to Admit to Inpatient Hospital or for Observation Services

Physician Orders to Admit to Inpatient Hospital or for Observation Services Lack of a formal order for inpatient admission or observation services results in an increase of the CERT error rate for National Government Services. CERT auditors [...]

Process for Requesting Medical Records

Process for Requesting Medical Records Additional Documentation Requests INITIAL ADR letters for CERT are sent to the address on file with the NSC for DMEPOS suppliers, or the MAC for the provider/supplier that billed/submitted the [...]