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Posting Date: 11/25/2024
Obtaining Beneficiary Eligibility Information Through NGSConnex
Obtaining Beneficiary Eligibility Information Through NGSConnex As a reminder, our Customer Service Representatives aren’t permitted to share eligibility information because it’s available through NGSConnex. If you need help, we [...]
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Posting Date: 11/25/2024
Reminder: The Self-Service Pulse Has Ended
Reminder: The Self-Service Pulse Has Ended We sincerely thank you for being a loyal reader of our Self-Service Pulse each week. To continue receiving updates on our latest self-service tools and services, please subscribe to our general Email [...]
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Posting Date: 11/25/2024
Virtual Multi-Jurisdictional Town Hall Meeting To Be Held 12/10/2024
Virtual Multi-Jurisdictional Town Hall Meeting To Be Held 12/10/2024 National Government Services, along with Novitas Solutions and First Coast Service Options, CGS Administrators, Noridian Healthcare Solutions, Palmetto GBA and WPS Government [...]
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Posting Date: 02/02/2021
Who May File an Appeal?
Who May File an Appeal? Who May File an Appeal? Appointment of Representative Who May Be a Representative How to Make and Revoke an Appointment Attorney Representatives Required Elements When to Submit the Appointment Validity of an [...]
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Posting Date: 07/13/2021
About Appeals
About Appeals Providers, suppliers and beneficiaries have the right to appeal claim determinations made by National Government Services. The purpose of the appeals process is to ensure the correct adjudication of claims. Appeals activities [...]
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Posting Date: 02/02/2021
MSP Overpayments
MSP Overpayments If you are appealing or correcting a claim that you have received an overpayment on because Medicare paid as the primary insurer and another insurance carrier should be the primary payer, follow the instructions on the [...]
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Posting Date: 02/02/2021
What Documents are Needed
What Documents are Needed? What Documents are Needed? Medical Records to Support an Appeal Anesthesia Biofeedback Blepharoplasty Cardiac Rehabilitation Services Chiropractic Services Concurrent Care Cosmetic [...]
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Posting Date: 02/02/2021
Submit an Appeal Electronically with NGSConnex
Submit an Appeal Electronically with NGSConnex You can submit redetermination or reopening requests electronically through NGSConnex. To determine if your appeal qualifies as a reopening or redetermination, access the About Appeals page. All [...]
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Posting Date: 02/02/2021
Submit an Appeal Electronically via esMD
Submit an Appeal Electronically via esMD CMS developed a mechanism for contractors to receive first level appeals electronically from providers via a secure gateway known as Electronic Submission of Medical Documentation, or esMD. Some [...]
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Posting Date: 02/02/2021
Get Help Submitting a Appeal Hard Copy
Get Help Submitting a Appeal Hard Copy All levels of appeals may be submitted by mail. The only types of appeals submitted to National Government Services are reopening and redetermination requests. For information on other types of appeals, [...]
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Posting Date: 12/15/2021
How to Avoid Costly Appeals
How to Avoid Costly Appeals This table includes helpful information to help avoid costly appeals. Use the initial submission tips and resources to help reduce claim denials and improve revenue cycle workflow issues within your office. [...]
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Posting Date: 05/03/2022
How to Prevent Duplicate Appeal and Clerical Error Reopening Requests in NGSConnex
How to Prevent Duplicate Appeal and Clerical Error Reopening Requests in NGSConnex Do you currently submit your appeal requests and reopening requests through NGSConnex? If so, did you know you are required to verify whether a request was [...]
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Posting Date: 06/06/2023
Medical Review Portal in NGSConnex
Medical Review Portal in NGSConnex If you submit fee-for-service claims to National Government Services and you are a registered NGSConnex account holder, you can respond to Medical Review ADRs and submit supporting documentation [...]
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Posting Date: 06/06/2023
Results Letters
Results Letters After National Government Services reviews the requested claims for your facility/office, you’ll receive a Results Letter with results from that round of TPE review. The Results Letter will contain the number of claims that [...]
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Posting Date: 11/25/2024
Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)
Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA) N/A L39863 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39863 A59733 [...]
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Posting Date: 06/06/2023
How to Find and Respond to TPE ADR
How to Find and Respond to TPE ADR Once you receive notification your facility is being placed on medical review, you’ll receive instructions on how to find the ADR. The ADR is a request to submit documentation for review to ensure proper [...]
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Posting Date: 06/06/2023
Methods for Submitting an ADR
Methods for Submitting an ADR Table of Contents Submitting Documentation NGSConnex Mailing an ADR CD/DVD esMD Fax [Return to Top] Submitting Documentation NGSConnex is the preferred method of submission. National [...]
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Posting Date: 06/06/2023
Address Corrections for Providers
Address Corrections for Providers An ADR is sent to the provider’s or physician’s address that is listed in PECOS. This is the last address that was submitted to the MAC’s Provider Enrollment Department and approved by CMS. Questions [...]
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Posting Date: 06/06/2023
Medical Documentation Signature Requirements
Medical Documentation Signature Requirements Table of Contents Medical Documentation Signature Requirements Missing Signature Illegible Signature Signatures for Amendments, Corrections and Delayed Entries Related Content [Return to [...]
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Posting Date: 01/18/2022
Five Levels of Appeals
Levels of Appeals and Time Limits for Filing Table of Contents Five Levels of Appeals: Overview Level One – Redetermination Level Two – Reconsideration (QIC) Level Three – Administrative Law Judge (ALJ) Level Four – Medicare [...]
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Posting Date: 06/06/2023
Additional Developmental Request Letters Overview
Additional Development Request Letters Overview National Government Services may require additional information in order to appropriately process claims submitted to the Medicare Program. These requests for additional information letters are [...]
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Posting Date: 11/25/2024
LCD and Article Updates for November 2024
LCD and Article Updates for November 2024 Local Coverage Determinations and Billing and Coding Articles The following Local Coverage Determinations and Billing and Coding Articles have been finalized and will become effective on the specific [...]
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Posting Date: 05/15/2024
Stay of Enrollment
Stay of Enrollment The individual provider or authorized/delegated official of a group/facility agrees to adhere to all Medicare requirements when enrolling. CMS implemented a preliminary, interim status representing a pause in enrollment [...]
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Posting Date: 05/15/2024
Stay of Enrollment
Stay of Enrollment The individual provider or authorized/delegated official of a group/facility agrees to adhere to all Medicare requirements when enrolling. CMS implemented a preliminary, interim status representing a pause in enrollment [...]
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Posting Date: 11/25/2024
Transesophageal Echocardiography (TEE)
Transesophageal Echocardiography (TEE) ultrasound, esophagus, doppler, color flow, contrast, heart L33579 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33579 A52868 [...]
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Posting Date: 11/25/2024
Health Equity Vaccination Efforts: Achieving the Highest Level of Health and Well-Being for Your Patients
Health Equity Vaccination Efforts: Achieving the Highest Level of Health and Well-Being for Your Patients Health equity is the concept that all people should have a fair and just chance to be as healthy as possible, regardless of their [...]
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Posting Date: 11/26/2024
Explore Our Exciting Sessions at the 2024 Preventive Services Virtual Conference!
Explore Our Exciting Sessions at the 2024 Preventive Services Virtual Conference! View All Our Sessions and Register Now! As we gear up for the National Government Services Medicare Part B 2024 Preventive Services Virtual Conference, we [...]
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Posting Date: 10/24/2018
Initiate Part B Reopenings or Non-MSP Overpayment Adjustments in NGSConnex
Initiate Part B Reopenings or Non-MSP Overpayment Adjustments in NGSConnex Did you know that you can save time and money by requesting a Part B clerical error reopening electronically via NGSConnex? You will save time because electronic [...]
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Posting Date: 07/01/2024
17729 and 17730 Hospice Claim Edits for Certifying Physicians
17729 and 17730 Hospice Claim Edits for Certifying Physicians Effective for hospice claims with claim ‘From’ dates on or after 6/3/2024, new claim edits have been implemented per CR 13342 to enforce CMS’ rule to deny hospice claims if the name [...]
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Posting Date: 12/02/2024
Off-label Use of Rituximab and Rituximab Biosimilars
Off-label Use of Rituximab and Rituximab Biosimilars L39297 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39297 A59101 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=59101 A59213 [...]
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Posting Date: 12/02/2024
Get Help Completing My Enrollment Application
Since your organization can apply for Medicare enrollment in two ways, online through the PECOS system and on paper, it is important to know where to go to learn about the expected processes and guidelines. There are two main areas where you [...]
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Posting Date: 12/02/2024
Get Help Completing My Enrollment Application
Since your organization can apply for Medicare enrollment in two ways, online through the PECOS system and on paper, it is important to know where to go to learn about the expected processes and guidelines. There are two main areas where you [...]
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Posting Date: 12/02/2024
Get Help Completing My Enrollment Application
Since your organization can apply for Medicare enrollment in two ways, online through the PECOS system and on paper, it is important to know where to go to learn about the expected processes and guidelines. There are two main areas where you [...]
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Posting Date: 12/22/2023
Call Center Planned Outage Status
Call Center Planned Outage Offline Friday, 12/13/2024
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Posting Date: 07/01/2024
The Utilization of the KX Modifier on Dental Claims
The Utilization of the KX Modifier on Dental Claims National Government Services wants to bring to your attention the usage of the KX modifier for the submission of Medicare claims for dental services that are inextricably linked to covered [...]
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Posting Date: 10/19/2021
How to Determine if the Provider is Active and Get the Provider Enrolled in Medicare Part B
How to Determine if the Provider is Active and Get the Provider Enrolled in Medicare Part B Table of Contents Determine if the Provider Has an Active Enrollment How to Enroll the Provider in Medicare Part B [Return to Top] Determine [...]
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Posting Date: 12/02/2024
How to Determine if the Provider is Active and Get the Provider Enrolled in Medicare Part B
Table of Contents Determine If the Provider Has an Active Enrollment How to Enroll the Provider in Medicare Part B Determine If the Provider Has an Active Enrollment Navigate to the Medicare Fee-For-Service Public Provider Enrollment [...]
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Posting Date: 12/02/2024
Reminder: Obtaining Beneficiary Eligibility Information Through NGSConnex
Reminder: Obtaining Beneficiary Eligibility Information Through NGSConnex As a reminder, our Customer Service Representatives aren’t permitted to share eligibility information because it’s available through NGSConnex. If you need help, [...]
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Posting Date: 12/02/2024
The CY 2025 Medicare Physician Fee Schedule Is Now Available
The CY 2025 Medicare Physician Fee Schedule Is Now Available The CY 2025 MPFS is now available. You can view the new fees using the Fee Schedule Lookup tool page on NGSMedicare.com. Posted 12/2/2024
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Posting Date: 12/02/2024
Announcement About Medicare Participation for Calendar Year 2025
Announcement About Medicare Participation for Calendar Year 2025 The Centers for Medicare & Medicaid Services has posted the Announcement About Medicare Participation for Calendar Year 2025. Posted 12/2/2024
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Posting Date: 12/02/2024
Provider Enrollment: Reminder for Open Enrollment and Participation Agreement
Provider Enrollment: Reminder for Open Enrollment and Participation Agreement The 2025 Annual Participation Open Enrollment Period is approaching for another year. While this is an important time (from mid-November to December 31) for [...]
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Posting Date: 11/26/2024
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 [...]
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Posting Date: 11/27/2024
MLN Connects® Newsletter: November 27, 2024
MLN Connects® Newsletter: November 27, 2024 News Opioid Treatment Programs: CY 2025 Updates HIV Screening & Prevention Claims, Pricers, & Codes Home Health Prospective Payment System Grouper: January Update Clotting Factor: [...]
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Posting Date: 12/03/2024
Report a Change of Ownership, Acquisition/Merger or Consolidation
Table of Contents Step 1: Determine You Are in the Right Place Step 2: Understand Type of CHOW Change of Ownership Acquisition/Merger Consolidation CHOW Reminders Step 3: Make Changes via Enrollment Application Change of [...]
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Posting Date: 12/03/2024
Behavioral Health Telehealth In-Person Requirements
Behavioral Health Telehealth In-Person Requirements National Government Services has been receiving questions regarding the behavioral health telehealth requirement that the initial telehealth service include an in person visit within the [...]
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Posting Date: 12/03/2024
Rural Tobacco Disparity
Rural Tobacco Disparity Tobacco use and exposure to SHS are major causes of preventable disease, disability and mortality in the United States and are responsible for approximately 480,000 deaths annually; another 16 million people are living [...]
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Posting Date: 12/02/2024
December 2024
In This Issue National Government Services Articles for Part A and Part B Providers Two Weeks to Prepare to Use NGSConnex for Beneficiary Eligibility Information A/B DME MAC Collaborative Lower Limb Orthoses Webinar November is Lung [...]
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Posting Date: 11/25/2024
Termination of the Hospice Benefit Component of the VBID Model on 12/31/2024
Termination of the Hospice Benefit Component of the VBID Model on 12/31/2024 After carefully considering recent feedback about the increasing operational challenges of the Hospice Benefit Component and limited and decreasing participation [...]
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Posting Date: 11/21/2024
Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)
Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q) This stringent claim editing process helps ensure that Medicare does not make payments for services rendered to beneficiaries who are not eligible due to being [...]
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Posting Date: 12/04/2024
Intensive Behavioral Therapy for Obesity and Screening for Depression and Alcohol Misuse Screening
During this webinar, we''ll review the Medicare coverage, coding and billing guidelines for intensive behavioral therapy for obesity and screening for depression in adults.
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Posting Date: 12/04/2024
Medicare Diabetes Prevention Program
Stop diabetes before it begins. Join us and learn about the Medicare diabetes program to help people with Medicare stay healthy and prevent diabetes.
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Posting Date: 12/04/2024
Screening for Cardiovascular Disease and Abdominal Aortic Aneurysm
During this webinar, we'll review the coverage, coding, and billing guidelines for cardiovascular disease (CVD) screening blood tests, intensive behavioral therapy for CVD, and ultrasound screening for abdominal aortic aneurysm preventive services.
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Posting Date: 12/04/2024
Initial Preventive Physical Examination and Annual Wellness Visit
Ensure that your patients obtain the wellness examinations they are eligible for by knowing the differences between the initial preventive physical examination and annual wellness visit. During this webinar, we'll review the coverage, coding [...]
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Posting Date: 12/04/2024
2024 Health Equity Services
With the addition of health equity services in 2024, we are raising awareness on the benefits available for Medicare beneficiaries. During this webinar, we’ll discuss the new care management services that were included for Medicare coverage in [...]
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Posting Date: 12/04/2024
Top Part B Claim Errors for Preventive Services
Join us for a discussion of the top Part B claim denials for preventive services. We'll share the denial reasons, how to correct the denials, and solutions to prevent them from occurring on future claim submissions.
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Posting Date: 12/04/2024
Diabetes Self-Management Training, Diabetes Screening Tests, and Medical Nutrition Therapy
During this webinar, we'll review the coverage, coding and billing guidelines for diabetes screening tests, diabetes self-management training, and medical nutrition therapy.
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Posting Date: 12/04/2024
Bone Mass Measurements, Colorectal and Prostate Cancer Screenings
During this webinar, we'll review the coverage, coding and billing guidelines for bone mass measurements, colorectal and prostate cancer screenings.
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Posting Date: 12/04/2024
Counseling to Prevent Tobacco Use and Lung Cancer Screening
During this webinar, we'll review the coverage, coding and billing guidelines for the Medicare preventive services benefits of counseling to prevent tobacco use.
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Posting Date: 12/04/2024
Flu, COVID-19 and PPV Vaccines
During this webinar, we'll review the coverage, coding and billing guidelines for influenza, pneumococcal and COVID-19 vaccine administration and billing.
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