Correct Coding of Molecular Testing Panels (Revised)

Correct Coding of Molecular Testing Panels (Revised) The submission of claims using individual gene CPT codes, when gene panels are ordered, is considered incorrect coding. Correct coding requires that when a panel code is ordered, it should [...]

Fraud and Abuse Right Hand HHH

UPIC Contact Information UPIC Western Qlarant Integrity Solutions, LLC Qlarant Website States: Alaska, Arizona, American Samoa, California, Guam, Hawaii, Idaho, Montana, Nevada, North Dakota, Northern Marianas Islands, Oregon, South Dakota, [...]

Fraud and Abuse Right Hand Part A

UPIC Contact Information UPIC Western Qlarant Integrity Solutions, LLC Qlarant Website States: Alaska, Arizona, American Samoa, California, Guam, Hawaii, Idaho, Montana, Nevada, North Dakota, Northern Marianas Islands, Oregon, South Dakota, [...]

Fraud and Abuse Right Hand Part B

UPIC Contact Information UPIC Western Qlarant Integrity Solutions, LLC Qlarant Website States: Alaska, Arizona, American Samoa, California, Guam, Hawaii, Idaho, Montana, Nevada, North Dakota, Northern Marianas Islands, Oregon, South Dakota, [...]

Fraud and Abuse Right Hand FQHC

UPIC Contact Information UPIC Western Qlarant Integrity Solutions, LLC Qlarant Website States: Alaska, Arizona, American Samoa, California, Guam, Hawaii, Idaho, Montana, Nevada, North Dakota, Northern Marianas Islands, Oregon, South Dakota, [...]

Clinical Literature

Multi-Jurisdictional Contractor Advisory Committee (CAC)/Subject Matter Expert Meeting March 10, 2022 Topic: SIJ Interventions and Procedures References for SIJ Injections and Procedures Diagnostics Buchanan P, Vodapally S, Lee DW, et [...]

Psychiatric and Psychology Services

Psychiatric and Psychology Services Psychiatric Evaluations The psychiatric diagnostic evaluation is an integrated psychosocial assessment, including history, mental status and recommendations. The evaluation may include communication with [...]

Revised LCD Comments Address - Updated

Revised LCD Comments Address - Updated Due to a technical issue with the LCD Comments mailbox for National Government Services, emailed comments have not been received by NGS. Please use this alternative address to submit all comments on [...]

National Government Services Proposed LCDs for Comment 9/29/2022-11/12/2022

National Government Services Proposed LCDs for Comment 9/29/2022-11/12/2022 The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from [...]

LCD Reconsideration Process

New LCD Request Process

MLN Connects® Newsletter: February 8, 2024

MLN Connects® Newsletter: February 8, 2024 News Medicare Shared Savings Program: Application Deadlines for a January 1, 2025, Start Date New Dental Specialty Codes for Medicare Hospices & Skilled Nursing Facilities: Report All [...]

National Government Services Proposed LCDs for Comment

National Government Services Proposed LCDs for Comment The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 2/8/2024 through 3/23/2024. These [...]

Reminder: Jurisdiction 6 and Jurisdiction K Providers Using Medicare Part B MSP Overpayment Request Form for Non-MSP

Reminder: Jurisdiction 6 and Jurisdiction K Providers Using Medicare Part B MSP Overpayment Request Form for Non-MSP Use the Medicare Part B MSP Overpayment Request Form for the following situations, not for non-MSP overpayments: 07–MSP [...]

National Government Services Will Be Open On President's Day

National Government Services Will Be Open On President's Day National Government Services will be open on President's Day, Monday, 2/19/2024. The PCC will be open and available to take your calls. Posted 2/14/2024

MLN Connects® Newsletter: February 15, 2024

MLN Connects® Newsletter: February 15, 2024 News CMS Roundup (Feb 9, 2024) Marriage and Family Therapists & Mental Health Counselors: New Specialty Codes for Medicare Medicare Physician Fee Schedule Database: April Update MLN [...]

Centers for Medicare & Medicaid Services Office of Legislation

Health Benefits of Quitting Smoking

Health Benefits of Quitting Smoking Help your Patients Kick the Habit! Smoking leads to multiple diseases and potentially death, but this is preventable – anyone at any age can benefit from quitting smoking. Medicare covers tobacco cessation [...]

Change to Roster Claims Information Entry in the Fiscal Intermediary Standard System Direct Data Entry

Change to Roster Claims Information Entry in the FISS DDE Effective 1/28/2013, the FISS maintainer has made a change to the way roster claims are entered. After entering the required information into the FISS DDE, providers will have to hit [...]

Common Working File (CWF) Host Dark Days for April 2024 Release

Common Working File (CWF) Host Dark Days for April 2024 Release For the upcoming April 2024 Release: For Production, CWF will be observing the Gray Day on Thursday, 3/28/2024 and Dark Days starting Friday, 3/29/2024 through Sunday, 3/31/2024 [...]

Proper Billing for Patient Supplied Drugs

Proper Billing for Patient Supplied Drugs Drugs, including biologicals, must represent an expense to the physician or legal entity billing for the services or supplies. In some instances, the patient purchases the drug or, the physician [...]

Evaluation and Management Frequently Asked Questions

Evaluation and Management Frequently Asked Questions We’ve expanded our E/M FAQs for the Complex and Chronic Care – HCPCS code G2211 category to include answers to common questions we’ve received about this add-on code. Visit this page for the [...]

MLN Connects® Newsletter: February 22, 2024

MLN Connects® Newsletter: February 22, 2024 News CMS Issues Additional Guidance on Program to Allow People with Medicare to Pay Out-of-Pocket Prescription Drug Costs in Monthly Payments Compliance Medical Services Authorized by the [...]

Correct or Reopen a Claim Due to an MSP-Related Issue

Table of Contents Correct or Reopen a Claim Due to an MSP-Related Issue Identify the Finalized Status of the Claim and Take the Appropriate Action Depending on the Type of Denial/Correction That Needs to be Made Step 1 Claim Denied as [...]

Medicare Part B Overpayments

Medicare Part B Overpayments We developed the Medicare Part B Overpayments Tip Sheet to provide instructions for reporting various overpayment situations. Topics include responding to a demand letter, viewing outstanding overpayments, [...]

Overpayments Right Hand

Resources Medicare Part B Overpayments Tip Sheet Form(s) you'll need: Financial Contact Submissions All Forms

Overpayments Right Hand

Resources Medicare Part B Overpayments Tip Sheet Form(s) you'll need: Financial Contact Submissions All Forms

Ambulance Duplicate Claim Denials

Sample TPE Notification Letter

Sample TPE Notification Letter Mail Date Provider Name Provider Address City, State, Zip Casefolder ID: Casefolder ID Provider Number PTAN: PTAN (Provider Transaction Access Number) Provider Number NPI: NPI (National Provider Identifier) [...]

Sample TPE Notification Letter

Sample TPE Notification Letter Mail Date Provider Name Provider Address City, State, Zip Casefolder ID: Casefolder ID Provider Number PTAN: PTAN (Provider Transaction Access Number) Provider Number NPI: NPI (National [...]

Medicare Preventive Services

Medicare Preventive Services Medicare covers many preventive services to help keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep your patients from getting certain [...]

LCD and Billing and Coding Article Updates for February/March 2024

LCD and Billing and Coding Article Updates for February/March 2024 Local Coverage Determinations Biomarker Testing for Prostate Cancer Diagnosis (L37733) This LCD has been retired and will no longer be in effect for services performed after [...]

Date of Service on CMS-1500 Billing

Date of Service on CMS-1500 Billing Overview Radiology Services Surgical and Anatomical Pathology Chronic Care Management Care Plan Oversight Home Health Certification and Recertification Physician End-Stage Renal Disease Services [...]

Change Healthcare Security Incident

Change Healthcare Security Incident The CMS and National Government Services are aware that Change Healthcare recently suffered a cyber-attack. Change Healthcare is a clearinghouse vendor that connects providers with insurance payers and has [...]

MLN Connects® Newsletter: February 29, 2024

MLN Connects® Newsletter: February 29, 2024 Events ICD-10 Coordination & Maintenance Committee Meeting — March 19–20 MLN Matters® Articles Appropriate Use Criteria for Advanced Diagnostic Imaging: CY 2024 Update Clinical [...]

Tobacco Counseling via Telehealth

Tobacco Counseling via Telehealth Tobacco use is the leading cause of preventable disease, disability and death in the United States. Each year, nearly half a million Americans die prematurely of smoking or exposure to secondhand smoke. [...]