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Verify Bank Account Information

The CY 2023 Medicare Physician Fee Schedule Is Now Available

The CY 2023 Medicare Physician Fee Schedule Is Now Available The CY 2023 MPFS is now available. You can view the new fees using the Fee Schedule Lookup tool page on NGSMedicare.com. Posted 11/14/2022

Proper Steps for Notice of Admission Cancel/Resubmission

Proper Steps for Notice of Admission Cancel/Resubmission The purpose of the NOA is to open a new admission period for a home health beneficiary. There are few circumstances when the home health NOA must be canceled and resubmitted to correct [...]

Sequestration Questions and Answers

Sequestration Questions and Answers If a durable medical equipment capped rental period started before 4/1/2013, are the rental payments for months after 4/1/2013, subject to the 2 percent reduction? Answer: Any claims for rental [...]

Billing for Tape Codes (A4450 and A4452) and Modifiers (AU, AV and AW)

Billing for Tape Codes (A4450 and A4452) and Modifiers (AU, AV and AW) Policy specific informational modifiers can be located in the local medical policies. When submitting claims that require policy specific informational modifiers, [...]

Claim Completion Requirements for Facility Location (Item 32)

Claim Completion Requirements for Facility Location (Item 32) When a supplier submits a claim for DMEPOS provided in a location other than the beneficiary’s home (POS 12), the supplier must enter in Item 32, Facility Location, the name and [...]

Coverage and Correct Coding of Blincyto

Coverage and Correct Coding of BlincytoTM Joint DME MAC Publication On 12/3/2014, the FDA gave accelerated approval for Blinatumomab (BlincytoTM) for the treatment of Philadelphia negative relapsed/refractory acute lymphoblastic leukemia. [...]

2015 HCPCS Code Update

2015 HCPCS Code Update The following list identifies changes to level II HCPCS codes for 2015. Added Codes/Added Modifiers: New codes and modifiers are effective for dates of service on or after 1/1/2015. Discontinued Codes/Deleted [...]

Medical Policies/LCDs

What's New in Home Health Education?

What's New in Home Health Education? Updates are currently being made to home health YouTube tutorials and job aids to ensure that all federal regulation changes are captured. Most recently, we have updated the following educational materials [...]

Proper Billing for LEQVIO®

Proper Billing for LEQVIO® National Government Services has noticed improper billing of units and diagnosis related to HCPCS code J1306. We’ve published Proper Billing for LEQVIO® HCPCS Code J1306 to assist our provider community with billing [...]

Multijurisdictional CAC meeting Notice on Micro-Invasive Glaucoma Surgery

Multijurisdictional CAC meeting Notice on Micro-Invasive Glaucoma Surgery Information has been posted on our website about a multijurisdictional Contractor Advisory Committee Meeting Regarding Micro-invasive Glaucoma Surgery to be held on [...]

Proper Billing for TEZSPIRE™

Proper Billing for TEZSPIRE™ National Government Services has noticed improper billing of units related to HCPCS code J2356. We’ve published Proper Billing for TEZSPIRE™ HCPCS Code J2356 to assist our provider community with billing for this [...]

MLN Connects® Newsletter: November 17, 2022

MLN Connects® Newsletter: November 17, 2022     News Hospital Price Transparency: Download Machine-Readable File Sample Formats & Data Dictionaries Medical Review After the COVID-19 Public Health Emergency: New FAQ [...]

2022 Home Health and Hospice Medicare Administrative Contractors Collaborative Summit

Early Bird Registration is Now Open for the 2022 Home Health and Hospice Medicare Administrative Contractors Collaborative Summit The 2022 HH+H MACs Collaborative Summit: One Program, One Voice is now open for early bird registration. This [...]

Credit Balance Status Lookup

About This Tool This tool can be used to check on the status of your mailed or faxed Credit Balance Report. Any reports submitted through Connex will not appear in this tool. How to Search To perform a search, enter a valid PTAN into the [...]

Anesthesia CPT 00537 Being Underpaid for 2022

The 2022 Anesthesia Base Unit for 00537 was not updated for dates of service starting 1/1/2022 which has caused services being underpaid.

Part A FISS Cancel Adjustment Issue

FISS Maintainer will be creating a file to identify the cancel claim records that posted to the CWF as original claims (those with a CD value of “3” instead of “4”) and will be providing those files to CWF. The CWF Maintainer will run those [...]

Part A Invalid MBI Cross-Reference Issue

National Government Services is informing Part A providers of a claim processing issue causing invalid MBI cross-referencing. This is resulting in multiple, inactivated HICN being associated with the impacted claims.

Setting Your Security Questions

Setting Your Security Questions Setting up Security Questions is part of the required process for establishing an EDI Gateway Self-Service Portal account. Follow these steps to set up your account Security Questions. Access the Trading [...]

Cardiac, Intensive Cardiac and Pulmonary Rehabilitation Services

Cardiac, Intensive Cardiac and Pulmonary Rehabilitation Services We’ve added Cardiac, Intensive Cardiac and Pulmonary Rehabilitation information to the Cardiac Specialty section of our website. These resources provide detailed coverage and [...]

LCD, Billing and Coding Article Updates for November-December 2022

LCD, Billing and Coding Article Updates for November-December 2022 New LCDs and Articles (Effective 11/1/2022) Off-Label Use of Intravenous Immune Globulin (IVIG) – (L39314) This LCD addresses off-label uses for IVIG. We define off-label as [...]

January 2023 Release "Dark Days" for the Common Working File Hosts

January 2023 Release "Dark Days" for the Common Working File Hosts For the upcoming January 2023 Release: For Production, CWF will be observing the Gray Day on Thursday, 12/29/2022 and Dark Days starting Friday, 12/30/2022 through Sunday, [...]

MLN Connects® Newsletter: December 8, 2022

MLN Connects® Newsletter: December 8, 2022     News CMS Proposes Rule to Expand Access to Health Information and Improve the Prior Authorization Process Rural Emergency Hospitals: New Institutional Provider Type Starting [...]

Reminder for Submission of Modifier 22

Reminder for Submission of Modifier 22 National Government Services would like to remind providers of the requirement for modifier 22. The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, [...]

You Can Help Your Patients Quit Tobacco Use - The Great American Smokeout Is Coming!

You Can Help Your Patients Quit Tobacco Use - The Great American Smokeout Is Coming! Join us for our weekly webinar series on Medicare’s preventative service, "Counseling to Prevent Tobacco Use." Statistics show that tobacco use remains the [...]

Other Options <9>

Reason Code Lookup (touchtone 1) When Reason Code Lookup is selected, the IVR will request the five-digit reason code: Clearly speak or enter the reason code. Refer to the Phonetic Alphabet for assistance with speaking alpha characters [...]

Provider Contact Center News

Provider Contact Center News ​​​​​​​ Effective immediately, all inquiries must be handled in our PCC.   Our PCC is responsible for assisting our provider community and are trained to answer your questions. When additional information [...]

MLN Connects® Newsletter: December 22, 2022

MLN Connects® Newsletter: December 22, 2022     News HHS Proposes to Standardize Electronic Health Care Attachments Transactions and Electronic Signature Processes to Improve the Care Experience for Patients and Providers [...]

Prior Authorization HCPCS Code Inquiry Tool

Enrollment Application Fee for 2023

Enrollment Application Fee for 2023 The Provider Enrollment Application Fee for Calendar Year 2023 is published. Visit Determine/Pay Application Fee for details. ​ Posted 12/30/2022

Enrollment Application Fee for 2023

Enrollment Application Fee for 2023 The Provider Enrollment Application Fee for Calendar Year 2023 is published. Visit Determine/Pay Application Fee for details. ​ Posted 12/30/2022

Medicare Diabetes Prevention Program 2023 Payment Amounts are Available

Medicare Diabetes Prevention Program 2023 Payment Amounts are Available We’ve published the 2023 Medicare Diabetes Prevention Program codes and payments. Visit MDPP Codes and Payment Amounts for the HCPCS-G-Code, Description of MDPP Service [...]

Billing and Coding Article Updates for December 2022-January 2023

Billing and Coding Article Updates for December 2022-January 2023 Billing and Coding: Bevacizumab and biosimilars (A52370) Based on Transmittal 11738 (CR 12998) January 2023 I/OCE Specifications Version 24.0, HCPCS code C9142 has been deleted [...]

Frequently Asked Questions Reviewed and Updated

Frequently Asked Questions Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Topics available are: ASCA CAR T-cell Therapy Claims EDI [...]

Provider Letter of Authorization

Provider Letter of Authorization This form is completed by the provider/facility that is authorizing access to a third party billing service to perform FISS/DDE functions on their behalf. What is the Billing Service Name? This is the [...]

EDI Enrollment Agreement Form

EDI Enrollment Agreement Form This form is a required document by CMS allowing a provider to exchange electronic transactions with the MAC. This form is effective as long as the provider is exchanging Medicare claims with the MAC, carrier, or [...]

EDI Gateway Self-Service Password Portal

EDI Gateway Self-Service Password Portal As an EDI Trading Partner, you will be able to use the EDI Gateway Self-Service Password Portal located on the EDI web page on our website. This provides a simple and secure web-based process for [...]

Choose Transaction Status

Choose Transaction Status In this section, be sure to select all transactions you would like to be setup with. NGS EDI does not require a separate packet per transaction. Setup or change your setup for sending claims (837) electronically. [...]

Submitting the Packet

Submitting the Packet Once the General Enrollment Information section is complete and submitted, the necessary enrollment forms will be presented. All information previously answered will be auto-populated on each individual EDI form. You will [...]

General Information

General Information If information entered belongs to a Corporate Office, select the “Corporate Office” checkbox. What is the Entity Name? This is the provider name that was submitted on the CMS-855 form when applying to participate with [...]

EDI Registration Form

EDI Registration Form This form is used for batch billing enrollment: Part A/B providers who submit batch transactions to Medicare, such as transmitting 837 claims, receiving 835 electronic remittances and requesting 276/277 claims status [...]

Part A Logon Request Form: Billing Service Using a Letter of Authorization PIN

Part A Logon Request Form  Billing Service Using a Letter of Authorization PIN This option allows a billing service to complete the Part A Logon Request Form after the Letter of Authorization has been completed by the provider/facility [...]

EDI ERA Enrollment Form

EDI ERA Enrollment Form The EDI ERA Enrollment Form is required to be on file for each PTAN/NPI currently setup or requesting to be setup for the first time to receive electronic remittances through NGS. Should I Complete This Form? The [...]

Part A Logon Request Form: Provider/Facility Requesting Access

Part A Logon Request Form Provider/Facility Requesting Access This form is for Part A providers requesting access to the Fiscal Intermediary Standard System (FISS)/Direct Data Entry (DDE) Online System and check patient eligibility. Note: Up [...]

Tracking my Enrollment Packet and Checking Status

Tracking my Enrollment Packet and Checking Status Once your packet is submitted (See the section on Submitting the Packet), a confirmation message is displayed on the screen with the assigned Packet ID (PID) number. The PID will be sent to the [...]

Tobacco Cessation - An On Demand YouTube Video

Tobacco Cessation - An On Demand YouTube Video We know our providers are busy! Have you or a colleague been unavailable during what you thought would be a beneficial live webinar? The NGS POE team created a free Tobacco Cessation “On-Demand” [...]

Home Health Change of Care Notice (CMS-10280)

Hospice Hot Topic: The Medicare Hospice Beneficiary Election Statement

Hospice Hot Topic: The Medicare Hospice Beneficiary Election Statement It is imperative that hospice providers understand the federal Medicare requirements and mandatory medical record documentation to support coverage. For instance, the local [...]

Billing and Reimbursement for Noncontact Real-Time Fluorescence Wound Imaging (CPT 0598T and CPT 0599T)

Billing and Reimbursement for Noncontact Real-Time Fluorescence Wound Imaging (CPT 0598T and CPT 0599T) National Government Services has updated its reimbursement policy on CPT codes 0598T and 0599T (Noncontact Real-Time Fluorescence Wound [...]

Contractor Advisory Committee Meeting 3/16/2023: Hyaluronans

Contractor Advisory Committee Meeting 3/16/2023: Hyaluronans National Government Services will host a CAC Meeting via teleconference on 3/16/2023, from 1:00–4:00 p.m. ET. Discussions will focus on the treatment of patients with Hyaluronans for [...]

Prior Authorization Outpatient Department Self-Service Inquiry Tools

Prior Authorization Outpatient Department Self-Service Inquiry Tools National Government Services continues to see PARs submitted for non-prior authorization HCPCS codes as well as requests submitted on behalf of providers on exemption.  [...]

View Outstanding Overpayments

View Outstanding Overpayments The View Outstanding Overpayments selection will provide a list of current outstanding overpayments for the provider account selected. In this section you have the opportunity to view/print an overpayment demand [...]

View Provider Earnings to Date

View Provider Earnings to Date Select the Financials button on the home page. In the Select a Provider panel, click the Select button next to the applicable provider account.  Select Provider Earnings to Date from the [...]

Overlap/Dispute Process