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Posting Date: 09/03/2020
We Can Now Accept Electronic Appeal Requests Using the X12 275 Version 6020 Transaction
We Can Now Accept Electronic Appeal Requests Using the X12 275 Version 6020 Transaction National Government Services will now allow Medicare Part A and Part B providers to submit their claim appeal requests, including medical record [...]
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Posting Date: 11/20/2020
VBID Hospice Benefit Component Information Now Available
VBID Hospice Benefit Component Information Now Available Beginning on January 1, 2021, CMS is testing the inclusion of the Part A Hospice Benefit within the MA benefits package through the Hospice Benefit Component of the Value-Based Insurance [...]
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Posting Date: 12/15/2020
Updates to Nursing and Allied Health Education Medicare Advantage Payment Policies
Updates to Nursing and Allied Health Education Medicare Advantage Payment Policies Change Request 11642 Revised 12/15/2020 Revised 12/1/2020 Posted 8/24/2020
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Posting Date: 09/17/2020
Updated Future Effective LCD and Article
Updated Future Effective LCD and Article Fluid Jet System Treatment for LUTS/BPH (L38367) The Fluid Jet System Treatment for LUTS/BPH is now considered medically reasonable and necessary for 30-150 cc- sized prostates when the Indications of [...]
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Posting Date: 09/17/2020
Updated Future Effective LCD and Article
Updated Future Effective LCD and Article Fluid Jet System Treatment for LUTS/BPH (L38367) The Fluid Jet System Treatment for LUTS/BPH is now considered medically reasonable and necessary for 30-150 cc- sized prostates when the Indications of [...]
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Posting Date: 08/21/2019
Ambulance Fee Schedule and Medicare Transports Booklet
Ambulance Fee Schedule and Medicare Transports Booklet A new Ambulance Fee Schedule and Medicare Transports Booklet is available. Learn about coverage, billing and payment for ground and air ambulance transport benefits. Posted 8/21/2019
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Posting Date: 10/09/2019
Medicare’s 2020 Open Enrollment: October 15–December 7
Medicare’s 2020 Open Enrollment: October 15–December 7 Medicare Patients May Have Questions - A State Health Insurance Assistance Program Can Help What is the State Health Insurance Assistance Program? A SHIP is a free insurance counseling [...]
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Posting Date: 09/27/2019
Local Coverage Determination and Article Revisions September-October 2019
Local Coverage Determination and Article Revisions September‒October 2019 All medical policies and related articles can be found on the NGS Medical Policy Center. Bevacizumab and Biosimilars - Related to LCD L33394 (A52370) Bevacizumab-awwb [...]
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Posting Date: 11/01/2019
Local Coverage Determination and Article Revisions October-November 2019
Local Coverage Determination and Article Revisions October‒November 2019 The medical policies and related articles can be found in our Medical Policy Center. Updates Billing and Coding: Molecular Pathology Procedures (A56199) Added [...]
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Posting Date: 11/25/2019
LCD and Article Revisions: November/December 2019
Local Coverage Determination and Article Revisions November–December 2019 LCDs and Articles Revised in November and December: B-type Natriuretic Peptide (BNP) Testing (L33573) Consistent with Change Request 10901, all coding information, [...]
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Posting Date: 09/13/2019
276 Claim Status Inquiry Near Real-Time Response
276 Claim Status Inquiry Near Real-Time Response We are excited to announce a process change for our Part A providers that will return a 277 Claim Status Inquiry Response in “near real time.” Beginning in October, 2019, we will return the 277 [...]
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Posting Date: 08/14/2019
Medicare Beneficiary Identifier Monthly Tip
Medicare Beneficiary Identifier Monthly Tip Are you receiving claim rejections because of an invalid beneficiary identifier? It could be that you are using the wrong characters on the MBI. The new Medicare number will not include the letters [...]
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Posting Date: 07/25/2019
Changes to National Government Services Local Coverage Determination Process
Changes to National Government Services Local Coverage Determination Process In accordance with Section 4009 of H.R. 34-21st Century Cures Act (Public Law No: 114-255), CMS is updating the “Medicare Program Integrity Manual” with detailed [...]
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Posting Date: 07/19/2019
Attention PIP Hospitals – Delay in Periodic Interim Payment (PIP) Payments
Attention PIP Hospitals – Delay in Periodic Interim Payment (PIP) Payments We have been informed that the biweekly PIP/Pass-Through payment cycle did not initiate as scheduled last night. Therefore, the biweekly payments will be delayed by one [...]
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Posting Date: 06/10/2019
Reminder: ZIP Code Needed on Claims with Flu Vaccine Codes
Reminder: ZIP Code Needed on Claims with Flu Vaccine Codes Medicare Part B requires the location where the service(s) are rendered to be included on the claim for every service payable under the MPFS. In Box 32 on the CMS-1500 claim form, [...]
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Posting Date: 06/13/2019
MLN Connects® for Thursday, June 13, 2019
MLN Connects® for Thursday, June 13, 2019 MLN Connects® for Thursday, June 13, 2019 View this edition as a PDF News DMEPOS Competitive Bidding - Round 2021: Register Now Medicare Shared Savings Program: Submit Notice of Intent to [...]
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Posting Date: 06/11/2019
EDI Front End Rejection Code Lookup Tool
EDI Front End Rejection Code Lookup Tool The EDI Front End Rejection Code Lookup Tool is a simple to use tool that provides a clear and understandable description of edit codes returned on the 277 Claims Acknowledgement (277CA). Using this [...]
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Posting Date: 10/10/2019
Center for Medicare and Medicaid Innovation Payments
Center for Medicare and Medicaid Innovation Payments Section 1115A of the Social Security Act established the CMMI within the CMS to test innovative payment techniques and service delivery models. This payment model is outside the normal [...]
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Posting Date: 08/23/2019
Local Coverage Determination and Article revisions August‒September 2019
Local Coverage Determination and Article revisions August‒September 2019 Please note that consistent with Change Request 10901, all coding information, national coverage provisions and Associated Information (Documentation Requirements, [...]
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Posting Date: 09/11/2019
Important Update for Skilled Nursing Facilities - CMS Updated the SNF PDPM Web Page
Important Update for Skilled Nursing Facilities - CMS Updated the SNF PDPM Web page The SNF PPS PDPM was implemented on 10/1/2019 to replace the Resource Utilization Group, Version IV (RUG-IV) for the SNF PPS. SNF PDPM will improve [...]
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Posting Date: 07/02/2019
Genetic Testing Fraud Scam Directed at Medicare Beneficiaries
Genetic Testing Fraud Scam Directed at Medicare Beneficiaries The U.S. Department of Health and Human Services Office of Inspector General is alerting the public about a fraud scheme involving genetic testing. Please review the Fraud Alert: [...]
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Posting Date: 12/16/2019
Ensure Referral Forms Include the MBI
Ensure Referral Forms Include the MBI Providers have expressed concern regarding referral forms that do not include the new Medicare number, the MBI, they receive from providers who have referred a Medicare beneficiary to them for services. [...]
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Posting Date: 06/14/2019
July 2019 Release Dark Days for the Common Working File Host
July 2019 Release Dark Days for the Common Working File Host For the upcoming July 2019 Release, CWF will be observing dark days starting Friday, 6/28/2019, through Sunday, 6/30/2019 to accommodate the anticipated duration of this activity and [...]
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Posting Date: 06/13/2019
July 2019 Fiscal Intermediary Standard System Direct Data Entry Screen Changes
July 2019 Fiscal Intermediary Standard System Direct Data Entry Screen Changes The following updates will be made to existing screens and implemented on 7/1/2019. MAP1716 Claim page (6) – INIT DRG field will be displayed this is a 4-byte [...]
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Posting Date: 05/31/2019
July 2019 EDI Front-End Quarterly Release
July 2019 EDI Front-End Quarterly Release Please be advised that while the CMS-mandated quarterly release for July 2019 will be installed the weekend of 6/30/2019, the code set updates included with this release will not be effective in the [...]
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Posting Date: 12/10/2019
January 2020 Release "Dark Days" for the Common Working File Hosts
January 2020 Release "Dark Days" for the Common Working File Hosts For the upcoming January 2020 Release: New Year’s Day holiday – observed Wednesday, January 1st – No cycles (onlines available). CWF will be observing dark days starting [...]
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Posting Date: 10/01/2019
Center for Medicare and Medicaid Innovation Remittance Remark
Center for Medicare and Medicaid Innovation Remittance Remark Attention providers: If you are receiving a remark stating "CMMI" payment on your remittance this is regarding a QPP payment. Please direct any questions regarding QPP to [...]
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Posting Date: 10/01/2019
October is National Breast Cancer Awareness Month
October is National Breast Cancer Awareness Month Breast Cancer Screening and Mammography Breast cancer is one of the most common kinds of cancer in women. According to the U.S. Department of Health and Human Services, about one in eight [...]
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Posting Date: 08/07/2019
Important News from CGS, Jurisdiction B DME MAC: Prior Authorization Condition of Payment for Certain Power Mobility Devices
Important News from CGS, Jurisdiction B DME MAC: Prior Authorization Condition of Payment for Certain Power Mobility Devices If you have Medicare patients who are seeking prior authorization of a power mobility devices, please review the CGS [...]
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Posting Date: 10/18/2019
Coding for Sinuva™ Claims
Coding for Sinuva™ Claims This notice is a coding instruction, and not an indication of coverage. FDA labels should be consulted for indications and usage. Claims submitted to National Government Services for endoscopic placement of Sinuva™ [...]
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Posting Date: 12/02/2019
MLN Connects® Special Edition for Monday, December 2, 2019
MLN Connects® Special Edition for Monday, December 2, 2019 HHAs: Get Help Registering for iQIES by December 23 Avoid payment delays. You need access to the upgraded Internet Quality Improvement and Evaluation System (iQIES) to submit [...]
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Posting Date: 06/06/2019
MLN Connects® Special Edition - Thursday, June 6, 2019
MLN Connects® Special Edition - Thursday, June 6, 2019 CMS Seeks Public Input on Patients over Paperwork Initiative to Further Reduce Administrative, Regulatory Burden to Lower Healthcare Costs On June 6, CMS issued a Request for Information [...]
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Posting Date: 09/30/2019
MLN Connects® Special Edition - Monday, September 30, 2019
MLN Connects® Special Edition - Monday, September 30, 2019 New HCPCS Code J0642 for Levoleucovorin Injection For dates of service on or after October 1, use HCPCS code J0642 for levoleucovorin injection products marketed under the brand name [...]
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Posting Date: 11/14/2019
MLN Connects® for Thursday, November 14, 2019
MLN Connects® for Thursday, November 14, 2019 New Medicare Card: If an MBI Changes MLN Connects® for Thursday, November 14, 2019 View this edition as a PDF News New Medicare Card: If an MBI Changes Medicare Shared Savings [...]
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Posting Date: 05/28/2019
Local Coverage Determination and Article Revisions: May–June 2019
Local Coverage Determination and Article Revisions: May–June 2019 All medical policies and related articles can be found on the NGS Medical Policy Center. Intravenous Immune Globulin (IVIG) - Related to LCD L33394 (A52446) Corrected product [...]
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Posting Date: 06/26/2019
Local Coverage Determination and Article Revisions: June–July 2019
Local Coverage Determination and Article Revisions: June–July 2019 All medical policies and related articles can be found on the NGS Medical Policy Center. LCD Revisions for June 2019 Psychiatric Partial Hospitalization Programs [...]
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Posting Date: 07/12/2019
MLN Connects® Special Edition - Thursday, July 11, 2019
MLN Connects® Special Edition - Thursday, July 11, 2019 HHAs: CY 2020 and 2021 New Home Infusion Therapy Benefit and Payment and Policy Changes On July 11, CMS issued a proposed rule [CMS-1711-P] that proposes routine updates to the home [...]
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Posting Date: 11/26/2019
MLN Connects® Special Edition Article for Tuesday, November 26, 2019
MLN Connects® Special Edition for Tuesday, November 26, 2019 HHAs: Avoid Payment Delays, Register for iQIES by December 23 Act now. Home Health Agencies (HHAs) need access to the upgraded Internet Quality Improvement and Evaluation System [...]
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Posting Date: 12/26/2019
MLN Connects® Special Edition for Thursday, December 26, 2019
MLN Connects® Special Edition for Thursday, December 26, 2019 Feedback on Scope of Practice The Centers for Medicare & Medicaid Services (CMS) is seeking additional input and recommendations regarding elimination of specific Medicare [...]
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Posting Date: 05/23/2019
MLN Connects® for Thursday, May 23, 2019
MLN Connects® for Thursday, May 23, 2019 MLN Connects® for Thursday, May 23, 2019 View this edition as a PDF News No Shortcuts to Safer Opioids Prescribing: CDC Commentary CMS Takes Action to Lower Prescription Drug Prices and [...]
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Posting Date: 05/09/2019
MLN Connects® for Thursday, May 9, 2019
MLN Connects® for Thursday, May 9, 2019 MLN Connects® for Thursday, May 9, 2019 View this edition as a PDF News DMEPOS Competitive Bidding: Registration and Bid Window for Round 2021 Comprehensive Strategy to Foster Innovation for [...]
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Posting Date: 05/02/2019
MLN Connects® for Thursday, May 2, 2019
MLN Connects® for Thursday, May 2, 2019 MLN Connects® for Thursday, May 2, 2019 View this edition as a PDF News New Medicare Card: Transition Period Ends in 8 Months Addressing Social Determinants of Health Will Help Achieve [...]
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Posting Date: 07/18/2019
MLN Connects® for Thursday, July 18, 2019
MLN Connects® for Thursday, July 18, 2019 MLN Connects® for Thursday, July 18, 2019 View this edition as a PDF News Is Your Vendor/Clearinghouse Submitting Your Claims with the MBI? DMEPOS Competitive Bidding: Round 2021 Bid [...]
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Posting Date: 07/11/2019
MLN Connects® for Thursday, July 11, 2019
MLN Connects® for Thursday, July 11, 2019 MLN Connects® for Thursday, July 11, 2019 View this edition as a PDF News New Medicare Card: Transition Period Ends in Less Than 6 Months HHS To Transform Care Delivery for Patients with [...]
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Posting Date: 06/27/2019
MLN Connects® for Thursday, June 27, 2019
MLN Connects® for Thursday, June 27, 2019 MLN Connects® for Thursday, June 27, 2019 View this edition as a PDF News Medicare Shared Savings Program: Submit Notice of Intent to Apply by June 28 MIPS Data Validation and Audit for [...]
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Posting Date: 06/20/2019
MLN Connects® for Thursday, June 20, 2019
MLN Connects® for Thursday, June 20, 2019 MLN Connects® for Thursday, June 20, 2019 View this edition as a PDF News New Medicare Card: 75% of Claims Submitted with MBI IRF: Voluntary Appeals Settlement Options CMS Proposes to [...]
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Posting Date: 06/06/2019
MLN Connects® for Thursday, June 6, 2019
MLN Connects® for Thursday, June 6, 2019 MLN Connects® for Thursday, June 6, 2019 View this edition as a PDF News Medicare Shared Savings Program: Submit Notice of Intent to Apply Beginning June 11 Promoting Interoperability Program: [...]
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Posting Date: 05/30/2019
MLN Connects® for Thursday, May 30, 2019
MLN Connects® for Thursday, May 30, 2019 MLN Connects® for Thursday, May 30, 2019 View this edition as a PDF News New Medicare Card Flyer for Your Patients Programs of All-Inclusive Care for the Elderly Final Rule Hospice [...]
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Posting Date: 06/06/2019
National Government Services Proposed Local Coverage Determinations for Comment
National Government Services Proposed Local Coverage Determinations for Comment The following proposed LCDs are open for comment from 6/6/2019‒7/20/2019 and are listed on the Local Coverage Determination Open Meeting Announcement agenda: [...]
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Posting Date: 09/25/2019
Sleep Study Scoring and Testing Physician Letter
Sleep Study Scoring and Testing Physician Letter CGS and Noridian, the DME MAC for J6 and JK respectively, have issued a new Dear Physician letter in regard to sleep study scoring and testing. The letters were issued by these contractors as [...]
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Posting Date: 08/01/2019
External Counterpulsation Billing (G0166)
External Counterpulsation Billing (G0166) National Government Services has discovered providers are billing invalid places of services for G0166 (External Counterpulsation, per treatment session) as per The Centers for Medicare & Medicaid [...]
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Posting Date: 08/28/2019
September is Prostate Cancer Awareness Month
September is Prostate Cancer Awareness Month Prostate cancer is the most common non skin cancer among men in the United States. It is a disease that in which malignant cancer cells form in the tissues of the prostate. Prostate cancer is [...]
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Posting Date: 06/10/2019
Opt Out Affidavits Database
Opt Out Affidavits Database Need to verify if a provider has opted out of Medicare? A resource for a list of opt out providers is located on the Medicare Opt Out Affidavits Database, verify status with effective date range. Instructions for [...]
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Posting Date: 08/14/2019
October 2019 Release Dark Days for the Common Working File Hosts
October 2019 Release Dark Days for the Common Working File Hosts For the upcoming October 2019 Release, CWF will be observing dark days starting Friday, 10/4/2019 through Sunday, 10/6/2019 to accommodate the anticipated duration of this [...]
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Posting Date: 09/13/2019
October 2019 Fiscal Intermediary Standard System Direct Data Entry Screen Changes
October 2019 Fiscal Intermediary Standard System Direct Data Entry Screen Changes The following updates will be made to existing screens and implemented on 10/1/2019. Entry added for new Bone Density HCPCS 0508T eligibility dates to MAP175M. [...]
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Posting Date: 06/18/2019
New Version of PC-ACE: July 2019
New Version of PC-ACE: July 2019 PC-ACE Version 4.3 contains several CMS mandates and product enhancements including but not limited to the items listed below. CR11132 ‒ Update to Mammography Editing CR11192 ‒ April 2019 Integrated [...]
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Posting Date: 09/27/2019
New Version of PC-ACE: October 2019
New Version of PC-ACE: October 2019 PC-ACE Version 4.4 contains several CMS mandates and product enhancements including but not limited to the items listed below. CR11321 - Implement Operating Rules - Phase III Electronic Remittance Advice [...]
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Posting Date: 06/18/2019
New Version of PC Print: July 2019
New Version of PC Print: July 2019 PC Print version 7.1.0 will soon be available on our website. This version contains the following enhancement: Change Request 11204 contains the RARC and CARC published by WPC through March 2019 [...]
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Posting Date: 09/27/2019
New Version of PC Print: October 2019
New Version of PC Print: October 2019 PC Print version 7.1.1 will soon be available on our website. This version contains the following enhancements: CR11252 contains the RARC and CARC published by WPC through July 2019 [...]
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Posting Date: 06/18/2019
Travel Allowance for Laboratory Services
Travel Allowance for Laboratory Services We have seen an increase in incorrect billing for laboratory service travel allowances. Please see below helpful HCPCS billing information and a link to the CMS IOM on appropriate billing for [...]
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