How to Find and Respond to Post Payment Review ADR

How to Find and Respond to Post Payment Review ADR Table of Contents How to Find and Respond to Post Payment Review ADR Responding to Post Payment Review ADR Steps to View and Print ADRs from FISS/DDE Provider Online System Related [...]

How to Prevent Common Skilled Nursing Facility Denials

How to Prevent Common Skilled Nursing Facility Denials This resource was developed to increase awareness and educate SNFs on the top errors found by our Medical Review team. The information includes suggestions to ensure documentation [...]

NGS Medical Review Process

NGS Medical Review Process Medicare contractors, like NGS, operate the medical review program to prevent improper payments and protect the Medicare Trust Fund. Medical reviews involve the collection and clinical review of medical records and [...]

MLN Connects® Newsletter: May 29, 2025

MLN Connects® Newsletter: May 29, 2025 News Inpatient Hospital Admissions: Transferring Medical Review Responsibilities for Short Stay Claims Medicare Shared Savings Program: Apply Now MLN Matters® Articles National Coverage [...]

Medicare Review Contractors

During this webinar, we'll assist Medicare providers with knowing the difference between the Medicare review contractors and understanding their role in the Medicare review process. We'll discuss the Supplemental Medical Review [...]

Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated and Advance Payments for Part A Providers and Part B Suppliers

Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated and Advance Payments for Part A Providers and Part B Suppliers Please see the below for information related to the CHOPD Accelerated and Advance Payments for Part A Providers and [...]

Electronic Health Records

Electronic Health Records Eligible professionals under the Medicare EHR Incentive Program include: Doctor of medicine or osteopathy Doctor of dental surgery or dental medicine Doctor of podiatry Doctor of optometry Chiropractor If [...]

HETS EDI Recertification

Tutorial

Medicare Claims: CMS-1500 or Electronic

Requesting an Exception to Timely Filing

Requesting an Exception to Timely Filing Table of Contents Requesting an Exception to Timely Filing No Appeal Rights for Claims Denied Based on Timely Filing Limit Provider Liability Exceptions that May Allow the Time Limit to be [...]

The National Correct Coding Initiative and Medically Unlikely Edits for Part B Providers

This webinar will assist Part B providers with navigating tables for the National Correct Coding Initiative and the medically unlikely edits. We'll also review the proper modifiers to use to avoid denials. There will be time for your [...]

Eligible Method II Providers

Eligible Method II Providers If a CAH wants to become a Method II biller, email the request to A&R at ngsreimbursement@anthem.com.  Suppliers who can enroll as a Method II Biller Reassignment. Doctor of Medicine (MD) Doctor of [...]

Private Practice Physical/Occupational Therapy Billing

We invite you to join our informative webinar focused on billing guidelines for physical and occupational therapy in private practice. During this webinar, we'll review important topics such as the appropriate use of the KX modifier and the [...]

How to Avoid Duplicate Claims

Duplicate denials continue to be one of the top billing errors. Unnecessary duplicate filing of Medicare claims cost the provider's office valuable time and resources, as well as Medicare's time and money to process them. Please join us [...]

Interactive Voice Response System Changes Coming Soon

Interactive Voice Response System Changes Coming Soon We’re making changes to our IVR system. You’ll still dial the same number, but you’ll hear a new voice. Although the IVR provides instructions throughout the call, we want to point out some [...]

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.

Standard Companion Guide Trading Partner Information

Standard Companion Guide Trading Partner Information Instructions Related to the X12 275 Claims Attachment Version 6020 and HL7 Consolidated Clinical Document Architecture R2.1 Companion Guide Version Number: 9.0 Revised: June 2025 Preface [...]

Inpatient Rehabilitation Facilities: Preparing and Submitting Compliant Claims to Medicare

In this webinar, we will review Medicare's general inpatient billing requirements for Inpatient Rehabilitation Facility including bill types, billing frequency, interim billing, benefits exhaust billing, billing when claims are paid by [...]

Medicare Portable X-Ray Survey Reminder

Medicare Portable X-Ray Survey Reminder MACs, under the direction of the CMS, are conducting a national cost analysis survey to assess the transportation components of portable X-ray services, specifically HCPCS codes R0070 and R0075. This [...]

View a General Inquiry

View a General Inquiry Table of Contents View a General Inquiry Attachments [Return to Top] View a General Inquiry National Government Services, Inc. will respond to your inquiry via NGSConnex within 45-business days of the date your [...]

Other Audit Contractor ADRs

Other Audit Contractor Additional Development Requests Origins Facts Identification Comprehensive Error Rate Testing (CERT) Office of Inspector General (OIG) Recovery Auditor Contractors (RAC) [...]

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction 6 HH+H Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Home Health Services - Medical Necessity ICD-10 Z47-Z47.89 N/A 55H3V – The documentation did [...]

Holding MSP Claims Receiving CWF Edit 6802

Certain MSP claims are incorrectly rejected against CWF edit 6802. On 4/24/2025, CMS directed MACs to hold all MSP claims editing with 6802 while CWF works to correct the issue.

NGSConnex: Local Security Officer Overview, Access and Navigation

This webinar is geared toward all lines of business for those who will be a Local Security Officer (LSO) in the NGSConnex portal. Come join us and see how NGSConnex can make your life a little easier. We will review the responsibilities of an [...]

MLN Connects® Newsletter: June 18, 2025

MLN Connects® Newsletter: June 18, 2025 News 2023 Doctors & Clinicians Preview Period Open Until June 25 Hospital Price Transparency: Respond to Accuracy & Completeness RFI by July 21 Medicare Part B Discarded Drug Program: Get [...]

Steps to Claim Corrections

This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

Proper Part B Claim Submissions

This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments or denials. We will guide you through the CMS-1500 claim form and the electronic equivalent loops [...]

Reducing Unprocessable Claims

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 [...]

Home Health Certifying Provider Change

Home Health Certifying Provider Change Home health certifying physician or NPP changes can occur anytime for a variety of reasons. Some examples may include practitioner retirement or vacation and patient choice. Regardless of the [...]

Home Health Referrals

Home Health Referrals Table of Contents Home Health Referrals Order for Home Health Services Documentation to Support Homebound Status Documentation to Support the Need for Skilled Services Documentation Regarding the Face-to-Face [...]

Home Health Forms – Which is Required?

Home Health Forms – Which is Required? The Advance Beneficiary Notice/Home Health Change of Care Notice/Notice of Medicare Noncoverage Scenario ABN HHHCN NOMNC Patient met goals under the POC and is being [...]

Eligibility Criteria for Face-to-Face Encounters

Eligibility Criteria for Face-to-Face Encounters National Government Services is reminding home health providers that a face-to-face encounter form is not adequate documentation to support that a face-to-face encounter occurred. [...]

Wound Care Under the Medicare Home Health Benefit

Wound Care Under the Medicare Home Health Benefit Wound care treatment typically involves three skilled nursing interventions, which may be performed at the same time or separately from each other. The three services are: Performing the [...]

Home Health Plans of Care: NPs, CNSs and PAs Allowed to Certify

Home Health Plans of Care: Nurse Practitioners, Clinical Nurse Specialists and Physician Assistants Allowed to Certify Section 3708 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. No. 116-136) amended sections [...]

Homebound Status

Homebound Status A Medicare beneficiary must be confined to the home in order to use their Medicare home health benefit. CMS defines homebound status in the CMS IOM Publication 100-02, Medicare Benefit Policy [...]

Home Health: The Definition of an Allowed Practitioner

Home Health:  The Definition of an Allowed Practitioner As per MM12615 the “Definition of an Allowed Practitioner” has been revised to read as follows (CR 12615): Medicare Benefit Policy Manual Chapter 7 Section 30.2.1 – Definition of an [...]

Fee Schedule Assistance

Fee Schedule Assistance Connecticut Illinois Locality/Area and County Information Maine, Massachusetts, New Hampshire, Rhode Island, Vermont Locality/Area and County Information New York Locality/Area and County Information Locate and [...]