MEDICAL REVIEW: How do I respond to an ADR Not In List?

MEDICAL REVIEW: How do I sign up for the CMS and NGS Listserv messages?

MEDICAL REVIEW: I’m appealing my claim but received a letter to recoup funds from the TPE denial. What do I do about these letters?

MEDICAL REVIEW: I am under TPE review and my claims were denied, who can I speak to about this?

MEDICAL REVIEW: How do I request an appeal on a claim reviewed by the Medical Review Department?

MEDICAL REVIEW: How do I change my address and which address exactly am I changing to ensure receipt of the MR letters and ADRs?

MEDICAL REVIEW: How do I appeal a claim that MR reviewed but went to a T status or R status because of a CWF issue after MR processed?

MEDICAL REVIEW: How can I use NGSConnex to respond to Medical Review additional documentation requests?

MODIFIERS: When should the QW modifier be appended?

MODIFIERS: When should modifier 51 be added to a claim?

MODIFIERS: When is it appropriate to append the AQ modifier?

MODIFIERS: When is modifier 50 used?

MODIFIERS: When do I need to append the 99 modifier?

Where is the written Part B Reopening Form located?

What is timely filing to adjust a claim?

Where are the appeal forms?

Additional Events Links

Resources Education Partnership Request Form Five Steps to Webinar Success Provider Outreach and Education Reminders

Additional Events Links

Resources Education Partnership Request Form Five Steps to Webinar Success Provider Outreach and Education Reminders

What is the receipt date of the claim?

What is the timely filing for an appeal?

What is the refund address?

What is timely filing for a claim?

What is the mailing address for submitting a claim?

What is the denial date?

What is the address to send the QIC appeal?

What is the QIC timely filing limit?

What is my pay-to address?

What is the ICN?

Does Medicare cover a sign language interpreter?

What is my Payer ID?

Provider Outreach and Education Reminders

Telehealth Services

Telehealth Services Table of Contents General Information Originating Site Distant Site List of Covered Medicare Telehealth Services Billing Facility Fee for Originating Site Payment for Professional Fee Place of [...]

Telehealth Extension 2025

Telehealth Extension 2025 A Congressional continuing resolution bill has extended telehealth coverage for services in all U.S. geographic locations through 9/30/2025. Based on this guidance, National Government Services will continue to pay [...]

Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities

Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities The hospital is the entity required to bill POA indicators on all inpatient claims billed to Medicare. However, accurate coding of all diagnosis [...]

NCCI Lookup Tool Top

National Correct Coding Initiative Lookup Tool The NCCI PTP lookup tool is designed to help providers identify when certain codes are subject to the automated code pair edits. When two codes of an edit pair are identified, the major code [...]

LCD Open Meeting Records

Open Meeting Records Jurisdiction 6 and Jurisdiction K Open Meeting Records Meeting Date Audio Transcript 3/13/2025 – J6/JK Open Meeting Recording Transcript  10/24/2024 – J6/JK Open Meeting [...]

PCACE Full Install Text - ALOB

Version 6.6 (Institutional and Professional) PC-ACE users

PCACE Upgrade Text - ALOB

Version 6.6 (Institutional and Professional) PC-ACE users

About PC-ACE

About PC-ACE The National Government Services PC-ACE free billing software is available for NGS J6 and JK providers only. If you are not a J6 or JK provider, the free billing software must be obtained from your MAC. PC-ACE is a stand-alone [...]

PCACE Download Text - ALOB

The installation code to run the full install or the upgrade for PC-ACE is: NGSMAC1 Important Warning: For PC-ACE version 6.6 updated version: please be patient and allow the full install or update complete. It is important that you do not [...]

Exemption Process for the Prior Authorization Program for Certain Hospital Outpatient Department Services

The Centers for Medicare & Medicaid Services (CMS) implemented a prior authorization program for certain hospital outpatient department (OPD) services for date of service (DOS) on or after 7/1/2020 and subsequently added an exemption [...]

Prior Authorization for Certain Hospital Outpatient Department Services – General PA

Join us for this general webinar about Prior Authorization for certain Hospital Outpatient Department (OPD) services. This webinar will have a non-clinical focus with emphasis on general requirements as listed in the OPD Operational Guide.

Let’s Chat: Prior Authorization for Certain Hospital Outpatient Department Services

This Let’s Chat session focuses on Prior Authorization for certain hospital outpatient department (OPD) services and is an informal opportunity for you to chat with our staff about the selected topic. During the session, you may ask us [...]

Provider Enrollment: Initially Enrolling a Dentist in the Medicare Program

During this webinar, we’ll address the Medicare dental specialty codes and provide an overview of how to enroll using Provider Enrollment, Chain and Ownership System (PECOS) as well as using the CMS-855I paper application. This session is [...]

Submitting Revalidation via PECOS

During this webinar, we’ll provide an understanding of how to utilize the Centers for Medicare & Medicaid Services (CMS) Internet-based Provider Enrollment Chain & Ownership System (PECOS) to be comfortable in navigating the system to [...]

Getting Access to PECOS

During this webinar, we’ll discuss how to obtain access to the Internet-based Provider Enrollment Chain & Ownership System (PECOS) and gain connection to provider enrollment record as well as understand other Centers for Medicare & [...]

PECOS: View and Manage Reassignments through Group Enrollment

During this webinar, we’ll provide an understanding of how to view and manage reassignments through the group enrollment in Provider Enrollment, Chain and Ownership System (PECOS), including to add or terminate reassignments. Individual [...]

Provider Enrollment: Completing the CMS-855A Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855A provider enrollment paper application.

PECOS: Manage Signatures and Additional Information Requests

During this webinar, we’ll give direction for the Provider Enrollment, Chain and Ownership System (PECOS) application on understanding how to manage signatures and respond to additional information request from submitted applications.

Provider Enrollment: Completing the CMS-855I Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855I provider enrollment paper application for a group member, sole proprietor or sole owner and we’ll also focus on reassigning Medicare benefits.

Provider Enrollment Revalidation Overview

During this webinar, learn about important changes in the revalidation process, how to determine Medicare enrollment revalidation due date and information to avoid disruption in Medicare billing.

Provider Enrollment: Completing the CMS-855B Paper Application

During this webinar, we'll provide an understanding of how to complete the CMS-855B provider enrollment paper application for a clinic, group or supplier.

Submitting Part B Medicare Secondary Payer Claims

During this Medicare Secondary Payer (MSP) learning session, we'll teach you how to submit your MSP claims with the appropriate loops and segments. We'll review the MSP billing requirements for paper and electronic claims and [...]

Counseling to Prevent Tobacco Use

In an effort to raise awareness and increase utilization of tobacco use counseling, we’ll focus on the effects of nicotine dependence including affected health consequences during this webinar. Medicare coverage, coding, billing and [...]

Counseling to Prevent Tobacco Use

In an effort to raise awareness and increase utilization of tobacco use counseling, we’ll focus on the effects of nicotine dependence including affected health consequences during this webinar. Medicare coverage, coding, billing and [...]

Targeted Probe and Educate

During this webinar, we'll help the Medicare provider community understand the targeted probe and educate program.

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 proper modifiers to use to avoid denials. There will be time for your questions [...]

Medicare Part B Preventive Services: Bone Mass Measurements, Colorectal and Prostate Cancer Screenings

During this webinar, we'll review the coverage, coding and billing guidelines for bone mass measurements, colorectal and prostate cancer screenings.