Urgent: Starting Today 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR

Urgent: Starting Today 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR As we’ve communicated, starting today, 11/18/2024, you won’t have access to beneficiary eligibility information on the IVR. This includes all [...]

Prepare and Submit an MSP Conditional Claim

Table of Contents Background Step 1: Determine if You Can Submit a Conditional Claim Step 2: Prepare a Conditional Claim Conditional Billing Code Table Step 3: Check for a Matching MSP Record for the Beneficiary in the Common [...]

Attention Home Health Agencies Receiving C7010 Billing Error

Attention Home Health Agencies Receiving C7010 Billing Error Over the past several months one of the top RTP reason codes for home health claims is C7010 – overlap with a hospice election period. The following information will help you avoid [...]

Use Our Provider Self-Service Tools To Spend Less Time on the Phone

Use Our Provider Self-Service Tools To Spend Less Time on the Phone Did you know our PCC experiences high call volumes at the beginning and the ending of each month? To avoid experiencing prolonged hold times, you can use our provider [...]

Avoid Return to Provider and Claim Rejections-Enhancing the Beneficiary Eligibility Verification Process

Avoid Return to Provider and Claim Rejections-Enhancing the Beneficiary Eligibility Verification Process Table of Contents Reason Codes T5052, N5052, U5210, U5220 and U5200 - Preventing RTP and Rejection Claims Why Is Beneficiary [...]

Home Health Top Claim Errors

Do you see the same rejections and returned to providers (RTPs) over and over? Do you know how to correct the most common errors and more importantly how to avoid them in the future? In this session we’ll review the most common reason codes [...]

Missing/Incomplete/Invalid Patient Identifier Remark Code N382

Missing/Incomplete/Invalid Patient Identifier Remark Code N382 If you receive a denial on your remittance with remark code ‘N382’ Missing/Incomplete/Invalid Patient Identifier, please use NGSConnex self-service option to verify the MBI number [...]

Hospice Top Claim Errors

Do you see the same rejections and return to providers (RTPs) over and over? Do you know how to correct the most common errors and more importantly how to avoid them in the future? In this session we’ll review the most common reason codes [...]

Physical/Occupational Therapy Billing

Join us as we review billing guidelines for physical and occupational therapy. We'll review when to apply the KX modifier and the importance of appropriate medical documentation. National Government Services has a Local Coverage Determination [...]

Interactive Voice Response Touch-Tone Instructions

Interactive Voice Response Touch-Tone Instructions Alpha-Numeric Touch-Tone Entries Use this function to enter elements that contain both alpha and numeric characters. Each button on a telephone keypad has a corresponding set of letters. Each [...]

MLN Connects® Newsletter: November 21, 2024

MLN Connects® Newsletter: November 21, 2024 News Medicare-Funded Physician Residency Positions CMS Roundup (November 15, 2024) Hepatitis B Vaccine: Billing Requirement Update Effective January 1 Hospitals: Use Renewed Beneficiary Notices [...]

Physicians: Are You Ordering DMEPOS for Your Patients?

Physicians: Are You Ordering DMEPOS for Your Patients? Physicians provide the foundation for correctly billing services and/or supplies to Medicare. DMEPOS suppliers rely on prescribing providers to substantiate the need for services and/or [...]

Practitioners: Are You Ordering Knee Orthoses for Your Patients?

Practitioners: Are You Ordering Knee Orthoses for Your Patients? The DME MACs are providing helpful guidance to assist suppliers in providing a knee orthosis to your patient. Medicare must be able to verify that there is medical record [...]

Clinicians: Are You Ordering Diabetic Shoes for Your Patients?

Clinicians: Are You Ordering Diabetic Shoes for Your Patients? The following section outlines roles of various practitioners that are involved in the decision-making and provision process for diabetic shoes: Certifying physician: The [...]

Physicians Ordering Oxygen and Oxygen Equipment - Quick Tips

Physicians Ordering Oxygen and Oxygen Equipment - Quick Tips The following is a quick reference guide for physicians and nonphysician practitioners concerning Medicare’s coverage of oxygen and oxygen equipment. For Medicare to consider [...]

Clinicians: Are You Ordering Oxygen for Your Patient?

Clinicians: Are You Ordering Oxygen for Your Patient? Home use of oxygen and oxygen equipment is eligible for Medicare reimbursement only when a beneficiary meets all of the requirements set out in the CMS IOM, Publication 100-03, Medicare [...]

Practitioners: Are You Ordering Ankle-Foot/Knee-Ankle-Foot Orthoses for Your Patients?

Practitioners: Are You Ordering Ankle-Foot/Knee-Ankle-Foot Orthoses for Your Patients? The DME MACs are providing helpful guidance to assist suppliers in providing a lower limb orthosis to your patient. Medicare must be able to verify that [...]

Practitioners: Are You Ordering Spinal Orthoses for Your Patient?

Practitioners: Are You Ordering Spinal Orthoses for Your Patients? The DME MACs are providing helpful guidance to assist the supplier in providing a spinal orthosis to your patient. Medicare must be able to verify there is supporting medical [...]

Clinicians: Are You Ordering PAP Devices and Related Accessories for Your Patients?

Clinicians: Are You Ordering PAP Devices and Related Accessories for Your Patients? Medicare can make payment for PAP devices and related accessories when the patient’s medical record shows the patient has OSA and meets medical documentation, [...]

Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)

Durable Medical Equipment, Prosthetics, Orthotics and Supplies To help providers and suppliers gain a better understanding of the roles of billing, coverage, documentation requirements and medical necessity when providing DMEPOS to Medicare [...]

Practitioners: Are You Ordering Nebulizers and Inhalation Medication for Your Patient?

Practitioners: Are You Ordering Nebulizers and Inhalation Medication for Your Patient? Medicare will consider coverage of a nebulizer, compressor and related accessories when the patient’s medical record verifies that the patient has a [...]

Physicians: Are You Ordering Glucose Monitors and Supplies for Your Patients?

Physicians: Are You Ordering Glucose Monitors and Supplies for Your Patients? The CERT program has noted claim errors for glucose monitors. The following information is provided to assist you in reducing these types of errors. Medicare will [...]

Physicians: Are You Ordering Surgical Dressings for Your Patient?

Physicians: Are You Ordering Surgical Dressings for Your Patient? In order for a DME supplier to provide surgical dressings to your patients, there are actions you can take to make sure that all the required supporting medical record [...]

Hospital Billing for Beneficiaries Enrolled in Option Code C Medicare Advantage Organization Plans

Hospital Billing for Beneficiaries Enrolled in Option Code C Medicare Advantage Organization Plans  A Medicare beneficiary can choose to enroll in an option code C MAO plan. If they do, that plan replaces their original Medicare. Original [...]

Start Your Morning with a Podcast - Navigating Medicare: Part A Insights for Providers

Start Your Morning with a Podcast - Navigating Medicare: Part A Insights for Providers Did you know we have a podcast channel on both Spotify and Apple Podcasts that are just for our providers? On your way to work each day, listen to these [...]

JK: Medicare Paid Hospital Providers Twice for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient IPPS Hospital Stays

Medicare Paid Hospital Providers Twice for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient IPPS Hospital Stays Table of Contents Provider Action Payment Window Policy and Under Arrangement Policy [...]

Hospitals Must Correctly Assign Severe Malnutrition Diagnosis Codes to Inpatient Claims

Hospitals Must Correctly Assign Severe Malnutrition Diagnosis Codes to Inpatient Claims Table of Contents Hospitals Must Correctly Assign Severe Malnutrition Diagnosis Codes to Inpatient Claims Hospital Action(s) Related Content [...]

Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities

Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities The hospital is the entity required to bill POA indicators on all inpatient claims billed to Medicare. However, accurate coding of all diagnosis [...]

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.

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.

Request a Redetermination

Request a Redetermination The first level of appeal is carried out by the affiliated contractor/MAC. Time limit to initiate = 120 days from date of receipt of the initial determination notice Time limit to complete the review = 60 days [...]

Submit a Reconsideration

Submit a Reconsideration The second level of appeal is the reconsideration request and is carried out by the QIC. Time limit to initiate = 180 days from date of receipt of redetermination decision Time limit to complete the review = 60 [...]

Medicare Appeals Council Review

Medicare Appeals Council Review The fourth level of appeal is carried out by the MAC; this may also be referred to as the Department Appeals Board or DAB. Time limit to initiate = 60 days from date of receipt of ALJ decision Time limit to [...]

Reopenings for Minor Errors and Omissions

Reopenings for Minor Errors and Omissions Providers may request a reopening of the original claims processing decision by contacting the TRU. The TRU can be used when you wish to revise the initial determination of a specific service or [...]

Reopening Request Timeframes

Reopening Request Timeframes According to the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 34, Section 10.6.2, Timeframes for Party Requested Reopenings: A party may request a contractor reopen and revise its initial [...]

ALJ Hearing

ALJ Hearing The third level of appeal is an ALJ hearing. Time limit to initiate = 60 days from the date of receipt of reconsideration (QIC decision) Time limit to complete the review = 90 days Amount in controversy = The amount that must [...]

Federal Court Review

Federal Court Review The fifth level of appeal is carried out by the Federal District Court (U.S. District Court). Time limit to initiate = 60 days from date of receipt of Medicare Appeals Council decision Amount in Controversy = The [...]

All Part B Providers – Register Now!

All Part B Providers – Register Now! Don't miss your chance to attend! Don't miss your chance to attend the National Government Services Medicare Part B 2024 Preventive Services Virtual Conference! Registration is happening now, and seats are [...]

Targeted Probe and Educate

During this webinar, we'll help the Medicare provider community understand the targeted probe and educate program.

Telehealth Services

Telehealth Services Table of Contents General Information Originating Site Distant Site List of Covered Medicare Telehealth Services Billing Facility Fee for Originating Site Payment for Professional Fee Place of [...]

Medicare Telehealth Changes for 2022

Medicare Telehealth Changes for 2022 The CY 2022 MPFS Final Rule indicated that Section 123 of the CAA removed the geographic restrictions and added the home of the beneficiary as a permissible originating site for telehealth services [...]

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 [...]

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 [...]

NGSConnex: Overview, Access, Navigation and Eligibility Look Up

This webinar is geared toward all lines of business. Come join us and see how NGSConnex can make your life a little easier. We’ll review what NGSConnex has to offer, including registration, access, navigation and beneficiary eligibility look [...]

NGSConnex: Overview, Access, Navigation and Eligibility Look Up

This webinar is geared toward all lines of business. Come join us and see how NGSConnex can make your life a little easier. We’ll review what NGSConnex has to offer, including registration, access, navigation and beneficiary eligibility look [...]

NGSConnex: Overview, Access, Navigation and Eligibility Look Up

This webinar is geared toward all lines of business. Come join us and see how NGSConnex can make your life a little easier. We’ll review what NGSConnex has to offer, including registration, access, navigation and beneficiary eligibility look [...]

NGSConnex: Overview, Access, Navigation and Eligibility Look Up

This webinar is geared toward all lines of business. Come join us and see how NGSConnex can make your life a little easier. We’ll review what NGSConnex has to offer, including registration, access, navigation and beneficiary eligibility look [...]

NGSConnex: Overview, Access, Navigation and Eligibility Look Up

This webinar is geared toward all lines of business. Come join us and see how NGSConnex can make your life a little easier. We’ll review what NGSConnex has to offer, including registration, access, navigation and beneficiary eligibility look [...]

NGSConnex: Overview, Access, Navigation and Eligibility Look Up

This webinar is geared toward all lines of business. Come join us and see how NGSConnex can make your life a little easier. We’ll review what NGSConnex has to offer, including registration, access, navigation and beneficiary eligibility look [...]

NGSConnex: Overview, Access, Navigation and Eligibility Look Up

This webinar is geared toward all lines of business. Come join us and see how NGSConnex can make your life a little easier. We’ll review what NGSConnex has to offer, including registration, access, navigation and beneficiary eligibility look [...]

Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)

Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate

Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate Table of Contents Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate Background: Standard Payment vs. [...]

Medicare Telehealth Changes for 2024/2025

Medicare Telehealth Changes for 2024/2025 Table of Contents Major Medicare Telehealth Flexibilities Not Affected by the End of the PHE Reporting Home Address Expiration of PHE Flexibilities for Direct Supervision Requirements Teaching [...]

Prolonged Preventive Services

Preventive Services Guide Prolonged Preventive Services Effective for claims with dates of service on or after 1/1/2018, prolonged preventive services will be payable by Medicare when billed as an add-on to an applicable preventive service [...]

Initiate Eligibility Lookup

Initiate Eligibility Lookup Click the Eligibility Lookup button from the NGSConnex homepage.   In the Select a Provider panel, click the Select button next to the applicable provider account.   In the Select a [...]

Long-Term Care Hospital

8/26/2024

Self-Service Pulse: What You Need To Know This Week As your MAC, National Government Services wants to provide you with a comprehensive source containing the most current information available for our self-service tools. Medicare BLAST [...]

Learning Medicare Secondary Payer Interactively

It’s all about Part B Medicare Secondary Payer (MSP) provisions and providers knowing their responsibilities for obtaining all insurance data from beneficiaries. During this MSP learning session, we'll make it easy for you to understand how MSP [...]

Physicians: Are You Ordering External Breast Prostheses for Your Patient?

Physicians: Are You Ordering External Breast Prostheses and Supplies for Your Patient? Following this guidance will help your patients and the Medicare Program by verifying there is medical documentation to support the provision of external [...]