Removal of HCPCS Code

Removal of HCPCS Code Prior Authorization Update Effective immediately, for claims with dates of service on or after 1/7/2022, the Centers for Medicare & Medicaid Services is removing current procedural terminology code 67911 (correction [...]

Appropriate Use Criteria

MLN Connects® Newsletter for Thursday, September 29, 2022

MLN Connects® Newsletter for Thursday, September 29, 2022​​​​​​​ News Resources & Flexibilities to Assist with Public Health Emergency in Puerto Rico Resources & Flexibilities to Assist with Public Health Emergency in Florida [...]

Diabetes Awareness

Drugs and Biologicals

Sleep Studies

Timely Filing

Medically Unlikely Edits

Free Medicare Home Health YouTube Videos

Free Medicare Home Health YouTube Videos National Government Services has a plethora of educational Medicare Home Health YouTube videos regarding billing and documentation. These videos are free, short in length and very informative. They [...]

Free Medicare Hospice YouTube Videos

Free Medicare Hospice YouTube Videos National Government Services has an array of educational Medicare Hospice YouTube videos regarding billing and documentation. These videos are free, short in length and very informative. They contain [...]

Home Health Benefit

Coding and Edits

Do You Only Order or Certify Services? Use Revised Enrollment Form CMS-855O by January 1

Do You Only Order or Certify Services? Use Revised Enrollment Form CMS-855O by January 1 The revised Enrollment for Eligible Ordering/Certifying Physicians and Other Eligible Professionals (Form CMS-855O) is required beginning 1/1/2023. We’ll [...]

MLN Connects® Newsletter for Thursday, October 6, 2022

MLN Connects® Newsletter for Thursday, October 6, 2022​​​​​​​ News Resources & Flexibilities to Assist with Public Health Emergency in South Carolina Implementation of Inflation Reduction Act Provision Addressing Medicare Payments [...]

Billing Medicare for a Denial - Condition Code 21

Billing Medicare for a Denial - Condition Code 21 Medicare will not pay for services excluded by statute. For claims submitted to Medicare, these excluded services that are not a Medicare benefit may be: Not submitted to Medicare at all [...]

Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System

Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System This notice is to remind providers on the correct process for deleting a revenue code line in FISS DDE. If providers have claim [...]

Billing

Lung Cancer Screening

Drugs and Biologicals

Pain Management

Introducing our new Medicare Topic: Tobacco Cessation

Introducing our new Medicare Topic: Tobacco Cessation Visit our new designated Tobacco Cessation Medicare Topic for everything health care providers need to know about Medicare coverage for tobacco cessation counseling including coverage [...]

Tobacco Cessation

Frequently Asked Questions

MLN Connects® Newsletter: October 13, 2022

MLN Connects® Newsletter: October 13, 2022 News Protect Your Patients in October: Give Them a Flu Shot and COVID-19 Vaccine Vacating Differential Payment Rate for 340B-Acquired Drugs in 2022 Outpatient Prospective Payment System Final [...]

Drugs and Biologicals Frequently Asked Questions

Drugs and Biologicals Frequently Asked Questions We’ve added new frequently asked questions to our website. View answers to common questions about Drugs and Biologicals to ensure you have the information needed to properly submit claims for [...]

The Home Health and Hospice Targeted Probe and Educate Process

The Home Health and Hospice Targeted Probe and Educate Process Medical Review conducts TPE on claims from all providers under the Medicare Program. Protect your revenue by gaining more knowledge regarding TPE audits. Providers targeted for [...]

Provider Outreach and Education Events

Provider Outreach and Education Events Our Provider Outreach and Education team offers a wealth of educational sessions for a variety of Medicare topics throughout the year. Because there are so many choices, we’ve improved the Search [...]

A/B and DME Collaborative Glucose Monitors and Supplies

A/B and DME Collaborative Glucose Monitors and Supplies View the A/B and DME Collaborative Glucose Monitors and Supplies YouTube Video for coverage criteria, documentation requirements and resources for glucose monitors and supplies. Posted [...]

MLN Connects® Newsletter: October 20, 2022

MLN Connects® Newsletter: October 20, 2022 News Skilled Nursing Facility Provider Preview Reports: Review by November 14 Help Your Patients Make Informed Health Care Decisions Ambulance Fee Schedule: CY 2023 Ambulance Inflation Factor [...]

HHS-690 Assurance of Compliance

CMS-1539 Medicare/Medicaid Certification and Transmittal

CMS-1561 Health Insurance Benefit Agreement

Pneumococcal Vaccine

Pneumococcal Vaccine Frequently Asked Questions

Pneumococcal Vaccine Frequently Asked Questions We’ve added new frequently asked questions to our website. View answers to common questions about Pneumococcal Vaccine to ensure you have the information needed to properly submit claims for [...]

CERT Text Part B

Need to Appeal a CERT Denial? Log onto our secure NGSConnex online Web application and quickly file an appeal. Submitting an appeal electronically saves postage, print and mail costs and is easy to do through NGSConnex.com. If you do not [...]

Attention All Medicare Providers: Are You Using an Outsource Company?

Attention All Medicare Providers: Are You Using an Outsource Company? Do you use an outsource company for your Medicare billing and account receivables? Do you know who is using your data? Do you know how they are using your data? How much is [...]

Prior Authorization Exemption: 56900 Denials Alert

Prior Authorization Exemption: 56900 Denials Alert NGS PA department has denied claims due to non-responses related to the postpayment ADR review for the Exemption process. Providers may submit the necessary documentation to the NGS PA [...]

October and November 2022 Billing and Coding and Medical Policy Article Updates

October and November 2022 Billing and Coding and Medical Policy Article Updates Retired article: Billing and Coding: Complex Drug Administration Coding (A58620) Revised articles: Billing and Coding: Molecular Pathology Procedures [...]

Notice of Local Coverage Determination Retirement

Notice of Local Coverage Determination Retirement Based on comments received at our Open Meeting on 10/20/2022, National Government Services has decided to retire the Proposed LCD DL38262 Salvage High-intensity Focused Ultrasound (HIFU) [...]

MLN Connects® Newsletter: October 27, 2022

MLN Connects® Newsletter: October 27, 2022 News COVID-19 Updated Booster Vaccines Covered Without Cost-Sharing for Eligible Children Ages 5–11 Oversight of Nation’s Poorest-Performing Nursing Homes Initial Nursing Facility Evaluation [...]

November is Lung Cancer Awareness Month

November is Lung Cancer Awareness Month Did you know that cigarette smoking is the number one risk factor for lung cancer? In the United States, cigarette smoking is linked to about 80% - 90% of lung cancer deaths. Lung cancer is the third [...]

340B-Acquired Drugs Payment Differential Cancellation

Previously applied differential payment rates for 340B-acquired drugs are no longer valid as of 9/28/2022, as per a ruling by the United States District Court for the District of Columbia. As a result, the CMS will revert to paying the default [...]

Comprehensive Error Rate Testing

MLN Connects® Newsletter: Final Rules

MLN Connects® Newsletter: Final Rules Final Rules Calendar Year (CY) 2023 Home Health Prospective Payment System Rate Update and Home Infusion Therapy Services Requirements ​​​​​​​ CY 2023 End-Stage Renal Disease (ESRD) Prospective [...]

Coming Soon ‒ The CY 2023 Medicare Physician Fee Schedule

Coming Soon ‒ The CY 2023 Medicare Physician Fee Schedule The CY 2023 MPFS will soon be available on the Fee Schedule Lookup tool located on NGSMedicare.com, after the CY 2023 physician fee schedule regulation is put on display. Once the Fee [...]

Assistant at Surgery Billing Documentation Reminder

Assistant at Surgery Billing Documentation Reminder Claims for assistant at surgery with a zero (0) indicator in the MPFSDB must have information to support and identify the assistant and also support the medical necessity of his/her [...]

MLN Connects® Newsletter: November 3, 2022

MLN Connects® Newsletter: November 3, 2022   News COVID-19 Vaccine: Novavax Booster Authorized Medicare Part B Immunosuppressive Drug: Get Information on New Benefit Part B Immunosuppressive Drug Benefit: Check Medicare Eligibility [...]

Claims Frequently Asked Question

Claims Frequently Asked Question We have added a new FAQ to our website. View answers to a common question about how to bill for services unrelated to a liability, no fault, or workers compensation claim to ensure you have the information [...]

Announcement About Medicare Participation for Calendar Year 2023

Announcement About Medicare Participation for Calendar Year 2023 The Centers for Medicare & Medicaid Services has posted the Announcement About Medicare Participation for Calendar Year 2023. Posted 11/3/2022

Revalidate Provider Enrollment

This section gives you access and education about revalidating your enrollment.

Electronic Funds Transfer

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Go Electronic

This section gives you access/education about first time Enrollment.

Rebuttal

This section gives you access/education about first time Enrollment.

Appeals

This section gives you access/education about first time Enrollment.

NGSConnex Feedback

NGSConnex Feedback After you log into NGSConnex, each page contains a Feedback button. If you experience issues while using NGSConnex, please use the Feedback to let us know.  Your feedback allows us to begin essential research and [...]

MLN Connects® Newsletter: November 10, 2022

MLN Connects® Newsletter: November 10, 2022     News Teaching Hospitals: Phase 2 Section 131 Reviews — Submission Deadline November 18 Medicare Participation for CY 2023 CMS Innovation Center’s Strategy to Support [...]

Transplant Services

Verify Bank Account Information

Verify Bank Account Information