LCD and Article Updates May/June 2024

LCD and Article Updates May/June 2024 Billing and Coding Articles L37485 Prostate Rectal Spacers This policy is retired and is no longer in effect for services rendered on or after 5/1/2024. A52863 Billing and Coding: Pain Management - [...]

Recovery Audit Contractor Reminders

Recovery Audit Contractor Reminders Did you know that Performant is now the RAC for all of National Government Services Part A and Part B lines of business in Jurisdiction 6 and Jurisdiction K? As part of the audit process, Performant may [...]

MLN Connects® Newsletter: May 30, 2024

MLN Connects® Newsletter: May 30, 2024 News Hospice Interdisciplinary Team: Addition of Marriage and Family Therapists & Mental Health Counselors Revised Part B Inflation Rebate Guidance: Using the 340B Modifier — Reminder MLN [...]

National Government Services: Raising Awareness about Care Management

National Government Services: Raising Awareness about Care Management According to the CDC, six in ten adults in the U.S. have a chronic disease and four in ten adults have two or more. As your Medicare Contractor for Jurisdiction 6 and [...]

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 webinar series on Medicare’s preventative services, "Counseling to Prevent Tobacco Use" and “Telehealth and Tobacco Counseling.” Statistics [...]

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 5/30/2024 through 7/14/2024. These [...]

June 2024

In This Issue National Government Services Articles for Part A and Part B Providers Important Reminders for Your EDI Enrollment Save the Dates! CMS National Provider Enrollment Conference in San Diego: 8/28/2024-8/29/2024 A/B DME MAC [...]

Attention Illinois, Massachusetts and Rhode Island Providers: Senior Medicare Patrol Can Assist Medicare Providers!

Attention Illinois, Massachusetts and Rhode Island Providers: Senior Medicare Patrol Can Assist Medicare Providers! National Government Services is proud to announce a special project to assist our providers with your Medicare patients [...]

Attention Illinois, Massachusetts and Rhode Island Providers: Senior Medicare Patrol Can Assist Medicare Providers!

Supplemental Insurance

Section 2: Medicare Basics Supplemental Insurance Table of Contents Supplemental Insurance Medigap Plans Medigap Plans A–N Low-Income Beneficiaries Qualified Medicare Beneficiary Program Specified Low-Income Medicare [...]

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 11th Sessions!

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 11th Sessions! We’re gearing up for our second in the series of Medicare Part B 2024 Spring/Summer Virtual [...]

SNF PPS Web Pricer

MLN Connects® Newsletter: June 6, 2024

MLN Connects® Newsletter: June 6, 2024 News CMS Roundup (May 31, 2024) Quality Payment Program: 2022 Performance Information on Medicare.gov Compare Tool Skilled Nursing Facility Value-Based Purchasing Program: June Confidential Feedback [...]

Supporting Documentation Information

Supporting Documentation Information

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers on Tuesday, June 4th

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers on Tuesday, June 4th! Our first in our series of Medicare Part B 2024 Spring/Summer Virtual Conference Tuesdays is right around [...]

Home Health Claims Returned to Providers with Reason Code 31755

CMS reactivated RC 31755 effective 1/3/2023 and some HH claims are being RTP due to billing errors. These claims need to be corrected with the information provided in the Provider Action section of this article. Medicare is still receiving [...]

MLN Connects® Newsletter: June 13, 2024

MLN Connects® Newsletter: June 13, 2024 News Medicare Shared Savings Program: Apply for January 1 Start Date by June 17 Men’s Health: Encourage Your Patients to Prioritize Their Health Compliance Hospital Beds & Accessories: [...]

Paper Enrollment Process

Paper Enrollment Process Enrollment via paper is an option, but PECOS is the preferred method to process the application with streamlining features. Paper-based enrollment applications are available. Determine which CMS Paper Form you will [...]

Complete All Topics

Complete All Topics Instructions for completing all PECOS topics: Select the ‘Topic View’ tab and add information in every topic Note: The electronic funds transfer (EFT) topic must be completed by: groups suppliers sole owner group [...]

Upload Supporting Documents

Upload Supporting Documents Instructions for PECOS to upload required supporting documentation: Select the ‘Topic View’ tab Select “Required and/or Supporting Documents” Upload documents Mandatory for all provider/supplier types: [...]

Resolve All Errors and Verify Warnings

Resolve all Errors and Verify Warnings Instructions for resolving all errors and warnings: Select the ‘Errors/Warning Check’ Tab.   Correct all errors identified and verify any warnings.   Related Content Resolving PECOS [...]

Verify and Manage Signature(s)

Verify and Manage Signature(s) Verify signatures on all application(s) submitted including applications that were “Return for Corrections”, by returning to the enrollment box in PECOS. Important: The reassignments are viewed by selecting [...]

Determine your Business Structure

Determine your Business Structure When starting a business, you must decide what form of business entity you wish to establish. The legal structure you choose for your business has more to do with tax, liability and management arrangements. [...]

Individual (Group Member) Reassigning Benefits Only

Individual (Group Member) Reassigning Benefits Only Download CMS-855I: Complete sections 1, 2, 3, 4, 4F, 12, 13 and 15 (B and C). Reassignment means that an individual physician, nonphysician practitioner, or other supplier has granted [...]

Ordering/Referring Provider Only

Ordering/Referring Provider Only Download CMS-855O. Complete sections 1, 2, 3, 4, 5, 6 and 8. Note: Ordering and referring providers are only required to be enrolled in one state. Be sure to include supporting documentation for [...]

Adding a New Reassignment of Benefits Using the CMS-855I

Adding a New Reassignment of Benefits Using the CMS-855I Download CMS-855I version (5/23): Complete sections 1A and B, 2A, 3, 4F (add, terminate, change reassignment), 13, and 15B and 15C IMPORTANT: If an individual is new to the [...]

Electronic Funds Transfer Agreement

Electronic Funds Transfer Agreement Download and complete the CMS-588 EFT Authorization Agreement. Physicians and nonphysician practitioners who are reassigning all of their payments to another entity are not required to submit the CMS-588. [...]

Medicare Participating Physician or Supplier Agreement

Medicare Participating Physician or Supplier Agreement Download and complete CMS-460 Medicare Participating Physician or Supplier Agreement. Note: CMS-460 must have a signature and date of participant or authorized representative of [...]

1-800-MEDICARE Authorization to Disclose Personal Health Information

Prior Authorization Request for Outpatient Services: Implanted Spinal Neurostimulators

Prior Authorization Request for Outpatient Services: Cervical Fusion

Creating application in PECOS

Creating Application in PECOS Instructions to create an application in PECOS: Login to PECOS My Associates Create Initial Enrollment Application Note: There will be a series of questions to determine application descriptions tailored to [...]

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 18th Sessions!

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 18th Sessions! Our third in the series of Medicare Part B 2024 Spring/Summer Virtual Conference Tuesday’s [...]

Acknowledgement Email

Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: CustomerService-DoNotReply@cms.hhs.gov containing the PECOS web tracking number. [...]

Requests for Additional information

Requests for Additional information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Site Visits

Site Visits Site visits may be required and will be unannounced; the contractor representatives must disclose to the provider appropriate identifying credentials and explain the purpose of the visit. CMS has implemented a site visit [...]

Requests for Additional Information

Requests for Additional Information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Requests for Additional Information

Requests for Additional Information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Individual Medicare Enrollment Private Practice (Sole Proprietor) via SSN

Individual Medicare Enrollment Private Practice (Sole Proprietor) via SSN Download CMS-855I. Complete sections 1, 2, 3, 4, 6, 8, 12, 13 and 15B. Note: Be sure to complete sections 4, 4A, 4A3, 4B, 4C, 4D and 4E. If reassigning benefits [...]

Individual Medicare Enrollment Private Practice (Sole Proprietor) via EIN

Individual Medicare Enrollment Private Practice (Sole Proprietor) via EIN Download CMS-855I: Complete sections: 1, 2, 3, 4, 6, 8, 12, 13 and 15B. Notes: Be sure to complete section 4, 4A, 4A3 (enter employer identification number) 4B, [...]

Individual Medicare Enrollment Sole Owner of a Corporation via Tax ID

Individual Medicare Enrollment Sole Owner of a Corporation via Tax ID Download CMS-855I: Complete sections 1, 2, 3, 4, 6, 8, 12, 13 and 15. Notes: Corporation structures: examples are PA, PC, LLC, PLLC, Inc., etc. Be sure to complete [...]

Physician Assistant

Physician Assistant Download CMS-855I Complete sections 1, 2, 3, 4, 4F, 12, 13 and 15B Note: Submit the required supporting documents including the NCCPA and diploma. Reviewed 6/13/2024

Supporting Documents

Supporting Documents Attach required supporting documentation for individuals or organizations. Submit all applicable documents: CMS-588 EFT Authorization Agreement and voided check or bank confirmation letter IRS document confirming your [...]

Medicare Information in Other Languages

Medicare Information in Other Languages Download Medicare & You in Spanish, 中文/Chinese, TIẾNG VIỆT/Vietnamese or 한국어/Korean. Español/Spanish  中文/Chinese  한국어/Korean  TIẾNG VIỆT/Vietnamese   Reviewed 6/13/2024

Sign and Submit the Application(s)

Sign and Submit the Application(s) In order to send your application, after resolving all errors, you must select “Begin Submission” which is available from any of the tabs (Topic View, Fast Track View, Error/Warning Check). Instructions for [...]

Site Visits

Site Visits Site visits may be required for certain providers and will be unannounced; the contractor representatives must disclose to the provider appropriate identifying credentials and explain the purpose of the visit. The CMS has [...]

PECOS Self-Service Application Status

PECOS Self-Service Application Status You may run simple search queries to retrieve and view the status of your PECOS application. Individual ‒ View the enrollment application status of an individual provider in an organization or private [...]

Check Provider Enrollment Application Status

Check Provider Enrollment Application Status You may run simple search queries to retrieve and view the status of your CMS-855 application via two options. Case number/web tracker id NPI and TIN combination Related Content Check [...]

Interactive Voice Response System

Interactive Voice Response System You may check the status of your provider enrollment application (PECOS or paper) submissions via the IVR by: Case number/web tracker id or NPI and TIN combination Related Content Interactive Voice [...]

Approval or Denial

Approval or Denial Approval Once your application is approved, you will receive an emailed, faxed or mailed Medicare letter with PTAN. Review this letter to ensure that everything is accurate and if you have any questions, please contact the [...]

Approval or Denial

Approval or Denial Approval Once your application is approved, you will receive an emailed, faxed or mailed Medicare letter with PTAN. Review this letter to ensure that everything is accurate and if you have any questions, please contact the [...]

Requests for Additional Information

Requests for Additional Information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Sign and Submit the Application(s)

Credit Balance Reminder: Submissions For Quarter Ending 6/30/2024 Start Soon!

Credit Balance Reminder: Submissions For Quarter Ending 6/30/2024 Start Soon! CBR submissions can be submitted starting on 7/1/2024 and are due within 30 days to be considered timely. Remember, even if no monies are owed to Medicare for this [...]