Understanding Participating, Nonparticipating and Opt Out Status

Understanding Participating, Nonparticipating and Opt Out Status Principles Participating Status Nonparticipating Status Opt Out Status Explanation When a physician/practitioner enrolls as a new provider in [...]

Medicare Provider/Supplier Specialty Codes

Medicare Provider/Supplier Specialty Codes Here is the list of Medicare provider/supplier specialty codes you can use as a reference during the enrollment process. Code Description 01 General practice 02 [...]

Medicare Provider/Supplier Provider Type Codes

Medicare Provider/Supplier Provider Type Codes Below is the list of Medicare provider/supplier type codes you can use as a reference during the enrollment process and claims processing. Code Description 20 [...]

CMS-855B Completion Tips for Ownership Interest and/or Managing Control Information

CMS-855B Completion Tips for Ownership Interest and/or Managing Control Information Table of Contents Section 5 – Ownership interest and/or managing control information Instructions for Completing Section 5 Section 5A - [...]

Supporting Documentation Required for Enrollment Revalidations

Supporting Documentation Required for Enrollment Revalidations Submit all required documentation based on your revalidation scenario: Written confirmation from the IRS confirming your legal business name and EIN (e.g., IRS CP-575) The [...]

Approval or Denial

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

Acknowledgement Email

Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: NGS-PE-Communications@elevancehealth.com containing the NGS case number for tracking [...]

CMS-855I Completion Tips for Physicians and NPPs in Private Practice (Sole Owner or Sole Proprietor) Revalidation Application

CMS-855I Completion Tips for Physicians and NPPs in Private Practice (Sole Owner or Sole Proprietor) Revalidation Application Follow the instructions printed on the CMS-855I application and refer to this list of sections required for [...]

Description of Revalidation

Description of Revalidation Section 6401(a) of the Affordable Care Act requires that all enrolled providers or suppliers revalidate their Medicare enrollment information under new enrollment screening criteria. To maintain Medicare billing [...]

Revalidation Request Mailed

Revalidation Request Mailed We will mail the revalidation notices to identified providers and suppliers currently enrolled in the Medicare Program. The revalidation notice will be sent two to three months prior to due date. Each provider or [...]

How Will You Know it is Time to Revalidate

How Will You Know it is Time to Revalidate We will contact each provider or supplier when it is time to revalidate their enrollment information by sending a revalidation notice with a revalidation due date.   We will send the [...]

How to Search on the Medicare Revalidation List Tool for Due Date

How to Search on the Medicare Revalidation List Tool for Due Date Table of Contents How to Search on the Medicare Revalidation List Tool for Due Date Find a Provider By NPI By Name Associated Datasets [Return to Top] How [...]

Cognitive Assessment

Cognitive Assessment Table of Contents Billing Codes Billing Information Documentation Related Content [Return to Top] Billing Codes 99483: 60 minute face-to-face [Return to Top] Billing Information Cognitive assessment [...]

Paper Enrollment Process

Paper Enrollment Process Paper-based enrollment applications are available. Submitting your enrollment via paper is an option, but PECOS is the preferred method to process the application with streamlining features. Determine which CMS-855 [...]

Clinics/Group Practices and Other Suppliers

Clinics/Group Practices and Other Suppliers Download CMS-855B. Complete Sections: 1, 2, 3, 4, 5, 6, 8, 12, 13, 15B and D (if applicable) Attachment 1 for Ambulance Suppliers Attachment 2 for IDTFs Attachment 3 for OTP Notes [...]

Introducing PECOS 2.0 

Introducing PECOS 2.0 PECOS 2.0 will make the Medicare enrollment and revalidation processes faster and more efficient. For more information, visit Introducing PECOS 2.0. Revised 7/31/2024

Reviewing the PECOS Enrollment Practice Location Area for OPPS Providers Claim Submission

Reviewing the PECOS Enrollment Practice Location Area for OPPS Providers Claim Submission All off-campus OPPS locations must be identified on the enrollment record. If a hospital OPPS claim is submitted with a practice service location that [...]

Advanced Care Planning

Advanced Care Planning Table of Contents Billing Codes Billing Information Documentation Related Content [Return to Top] Billing Codes 99497: 30 minutes 99498: each additional 30 minutes [Return to Top] Billing Information [...]

Behavioral Health Integration

Behavioral Health Integration Table of Contents BHI Overview Eligible Conditions Part B Billing/Coding BHI Services New Coding and Payment for BHI Conditions Billed by Clinical Psychologists and Clinical Social Workers Initiating [...]

Chronic Care Management

Chronic Care Management Table of Contents Billing Codes Billing and Documentation Care management for chronic conditions Related Content [Return to Top] Billing Codes 99490: Provide at least 20 minutes of clinical staff time [...]

Principal Care Management

Principal Care Management Table of Contents Billing Codes Documentation Related Content [Return to Top] Billing Codes 99424: PCM services for a single high-risk disease first 30 minutes provided personally by a physician or [...]

Psychiatric Collaborative Care Model

Psychiatric Collaborative Care Model The psychiatric CoCM was introduced in 2018 and Medicare began making separate payments using CPT codes 99492, 99493 and 99494. Effective 1/1/2021, G2214 was added to Psychiatric CoCM to cover shorter [...]

Medicare University Right Content

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Procedure Code 99211 Job Aid

Procedure Code 99211 Job Aid Table of Contents Definition for 99211 Definition for Established Patient Face-to-Face Encounter Requirements Presence of Physician Requirements Evaluation and Management Services Provider-Patient [...]

Resources for Medicare Providers of Service

Resources for Medicare Providers of Service Access to all resources and tools offered to our Medicare provider and supplier communities  

Hospice Documentation Checklist

General Inpatient Check Off List

Incident to Office Guidelines

“Incident to” Office Guidelines The CMS rules for billing office services as “incident to” a physician’s services are summarized within this document. Of note, the concept does not apply to services performed in the hospital environment, which [...]

August 2024

In This Issue National Government Services Articles for Part A and Part B Providers LCD and Article Updates for June/July 2024 [Cancelled] Multijurisdictional Contractor Advisory Committee Meeting Notice on Superficial Radiation Therapy [...]

Part B Top Claim Errors Updated

Part B Top Claim Errors Updated Using data analysis, we update the Top Claim Errors on a quarterly basis and provide: the error reason code; a description of the error; the error type; details that include steps you can take to [...]

Introducing the All-New Medicare University!

  Introducing the All-New Medicare University! We encourage you to visit the new Medicare University and explore these exciting enhancements. Simply follow the directions below to check it out. Logging in for the First Time Medicare [...]

MLN Connects® Newsletter: August 1, 2024

MLN Connects® Newsletter: August 1, 2024 Final Payment Rules Skilled Nursing Facility FY 2025 Final Rule Inpatient Rehabilitation Facility FY 2025 Final Rule Inpatient Psychiatric Facility FY 2025 Final Rule Hospice FY 2025 Final Rule [...]

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 [...]

Acknowledgement Email

Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: NGS-PE-Communications@elevancehealth.com containing the NGS case number for tracking [...]

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 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. CMS has implemented [...]

Requests for Additional Information

Request 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 [...]

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 Part B Provider [...]

Approval or Denial

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

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. [...]

Physicians and Nonphysician Practitioners that Reassign All Benefits

Physicians and Nonphysician Practitioners that Reassign All Benefits Download CMS-855I. Complete Sections: 1, 2, 3, 4, 4F, 12, 13 and 15B Note: Submit national board certification and diploma for nonphysician practitioners. If adding [...]

Unnecessary Adjustments for Part B Claims

Unnecessary Adjustments for Part B Claims A recent transition process at the Medicare Part B system maintainer has resulted in unnecessary and inappropriate Part B claim adjustments, impacting all MACs nationwide. This issue started to occur [...]

Incident to Quick Reference Chart

Incident to Quick Reference Chart Location PT Status Scenario Who Bills Comments Office New patient NPP sees patient - MD not present in office suite NPP bills for the service under the NPP NPI NPP [...]

“Incident to” Services

“Incident to” Services This article has been specially designed for our providers who perform services “Incident to” the services of a physician/NPP. Table of Contents The “Incident to” Provision of Medicare Your Office Hospital or [...]

Supplemental Security Income Ratio Realignment for Cost Reporting Periods Starting Before 10/1/2013

Supplemental Security Income Ratio Realignment for Cost Reporting Periods Starting Before 10/1/2013 On 6/9/2023, in response to the Supreme Court’s ruling in Azar v. Allina Health Services, 139 S. Ct. 1804 (2019), the CMS issued a final rule [...]

Education Partnership Request Form

Education Partnership Request Form

Education Partnership Request Form

Education Partnership Request Form

MLN Connects® Newsletter: August 8, 2024

MLN Connects® Newsletter: August 8, 2024 Final Payment Rule Hospital Inpatient Prospective Payment System & Long-Term Care Hospital Prospective Payment System FY 2025 Final Rule News Transitional Coverage for Emerging Technologies [...]

Removal of Facet HCPCS Codes

Removal of Facet HCPCS Codes Prior Authorization Outpatient Department Update  Effective 8/16/2024, the CMS is removing two current procedural terminology codes from the OPD Facet Joint Injection list of codes: 64492 – Facet joint [...]

Medical Policy Contact Information

Medical Policy Contact Information Please Note: General inquiries related to Medicare coverage policies, including clinical issues, drugs, radiopharmaceuticals, local and national coverage determinations, billing and reimbursement must be [...]

Medical Policy Contact Information

Medical Policy Contact Information Please Note: General inquiries related to Medicare coverage policies, drugs, radiopharmaceuticals, local and national coverage determinations, billing and reimbursement must be directed to the Provider [...]

Medical Policy Contact Information

Medical Policy Contact Information Please Note: General inquiries related to Medicare coverage policies, including clinical issues, drugs, radiopharmaceuticals, local and national coverage determinations, billing and reimbursement must be [...]

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations) If you disagree with Medicare’s claim determination, you may Appeal. However, please follow these important tips before you submit a first level of appeal [...]

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations) If you disagree with Medicare’s claim determination, you may Appeal. However, please follow these important tips before you submit a first level of appeal [...]