HETS EDI Recertification

MLN® Booklet: Medicare Billing: CMS-1500 & 837P

Enrollment Application Forms

Enrollment Application Forms You have two options for submitting your Part B Enrollment application to Medicare. You can choose to submit: Electronic application through PECOS, or CMS paper application forms Also view Understanding [...]

Provider Contact Center

Provider Contact Center Table of Contents Want to talk to us? Make the Most of Your Call Customer Care Representative Assistance Interactive Voice Response System NGSConnex Online Inquiry System Freedom of Information Act (FOIA) [...]

Provider Contact Center

Provider Contact Center Table of Contents Want to talk to us? Make the Most of Your Call Customer Care Representative Assistance Interactive Voice Response System NGSConnex Online Inquiry System Freedom of Information Act (FOIA) [...]

Provider Contact Center

Provider Contact Center Table of Contents Want to talk to us? Make the Most of Your Call Customer Care Representative Assistance Interactive Voice Response System NGSConnex Online Inquiry System Freedom of Information Act (FOIA) [...]

Medical Necessity and the Advance Beneficiary Notice

Register for this webinar and learn how to properly administer the Advance Beneficiary Notice of Noncoverage (ABN) within the office setting. If you are a physician, nonphysician practitioner or office staff member and interested in learning [...]

Smoking Cessation Tools and Resources - You Can Help Your Patients Quit Tobacco Use

Smoking Cessation Tools and Resources - You Can Help Your Patients Quit Tobacco Use Smokefree.gov Centers for Disease Control and Prevention: Tips from Former Smokers campaign Centers for Disease Control and Prevention: Office on Smoking [...]

Medicare Physician Fee Schedule Database

Medicare offers several tools to help providers bill their services. Many questions you have can be answered by learning how to access and use the Medicare Physician Fee Schedule Database. We hope you'll join us for an overview of this database.

Using NGSConnex to Prevent Eligibility Denials and Rejections

During this webinar, we'll examine common eligibility denials and rejections for National Government Services Part B claims and provide strategies from NGSConnex to prevent them in future submissions. There will be time following the [...]

Steps to Claim Corrections

This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

Proper Part B Claim Submissions

This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments or denials. We will guide you through the CMS-1500 claim form and the electronic equivalent loops [...]

U537I

Avoiding/Correcting This Error All dates of service reported on a period of care claim must be on or after the date of admission. Verify the from and through dates billed and all line-item dates of service to ensure the dates are within the [...]

Being Compliant by Avoiding Claim Denials, Reopenings and Redeterminations

National Government Services is committed to reducing provider burden associated with Medicare claim denials, reopenings and appeals. Don’t wait until you receive the claim denials that will increase your time, effort, and cost to have the [...]

Laboratory Part B Billing

During this webinar, we'll review the Centers for Medicare & Medicaid Services billing requirements for laboratory and pathology services and includes appropriate modifier usage when submitting claims for laboratory/pathology services. [...]

Reducing Unprocessable Claims

When claims are submitted with invalid, incomplete or incorrect information, our claims processing system will detect these errors and will reject claims as unprocessable. Our goal is to assist our providers in submitting claims correctly the [...]

Repetitive Scheduled Non-Emergent Ambulance Transports Prior Authorization

Attention All Independent Ambulance Suppliers! If you are providing repetitive, scheduled, non-emergent ambulance transports (RSNAT), you'll want to attend this webinar. Join us to learn everything you need to know about the RSNAT program.

Medically Unlikely Edits

Medically Unlikely Edits An MUE is the maximum number of UOS allowable under most circumstances for a single HCPCS/CPT code billed by a provider for a particular date of service for a single beneficiary. All claims submitted by physicians [...]

Unprocessable Claim Rejections and Corrections

Unprocessable Claim Rejections and Corrections Unprocessable claims are medical claims that cannot be processed by Medicare Part B National Government Services, because they contain incomplete, missing or invalid information. Incomplete [...]

FY 2027 Hospital Wage Index Development Timetable Final

National Correct Coding Initiative

National Correct Coding Initiative CMS developed the NCCI to promote national correct coding methodologies and eliminate improper coding of Medicare Part B claims. Coding policies are based on coding conventions defined in the AMA’s CPT [...]

FY 2027 PUF Release

FY 2027 PUF Release Availability and Revisions to Wage Index PUF On Friday, 5/23/2025, CMS released the preliminary FY 2027 Worksheet S-3, Parts II and III wage index PUF. The FY 2027 IPPS wage index will be calculated based on Federal [...]

Patient Driven Payment Model

Patient Driven Payment Model Table of Contents Assessment Schedule Administrative Presumption Lookback Period (Observation Period) Examples General PDPM Resources [Return to Top] Assessment Schedule Learn more about the [...]

NGS Medical Review Process

NGS Medical Review Process Medicare contractors, like National Government Services, operate the medical review program to prevent improper payments and protect the Medicare Trust Fund. Medical reviews involve the collection and clinical review [...]

Skilled Nursing Facility Town Hall Question and Answers

Skilled Nursing Facility Town Hall Questions and Answers Are daily notes required for skilled rehabilitation? Answer: Daily notes for rehabilitation are not required, however, they do support that therapy performed was skilled and [...]

Required Documentation

Required Documentation Table of Contents Required Documentation The medical record should contain patient specific information detailing Certification and Recertification Requirements Signature Requirement for Certifications and [...]

Skilled Services

Skilled Services Table of Contents Skilled Services Skilled Nursing Examples of skilled nursing Skilled Therapy Skilled Respiratory Nonskilled Service Examples Examples of personal care services General Skilled [...]

Coverage Requirements

Coverage Requirements Eligibility, preadmission, and 30-day transfer are components of coverage requirements for Skilled Nursing Facilities. There are several components to each of the coverage requirements; please utilize the links below to [...]

How to Prevent Common Skilled Nursing Facility Denials

How to Prevent Common Skilled Nursing Facility Denials This resource was developed to increase awareness and educate SNFs on the top errors found by our Medical Review team. The information includes suggestions to ensure documentation [...]

How to Find and Respond to Post Payment Review ADR

How to Find and Respond to Post Payment Review ADR Table of Contents How to Find and Respond to Post Payment Review ADR Responding to Post Payment Review ADR Steps to View and Print ADRs from FISS/DDE Provider Online System Related [...]

NGS Medical Review Process

NGS Medical Review Process Medicare contractors, like NGS, operate the medical review program to prevent improper payments and protect the Medicare Trust Fund. Medical reviews involve the collection and clinical review of medical records and [...]

Skilled Nursing Facility Educational Center

Skilled Nursing Facility Educational Center As part of the effort to lower the SNF improper payment rate, CMS has initiated a five claim Skilled Nursing Facility Probe & Educate allowing for outreach to all Medicare billing SNFs in the [...]

Medicare Review Contractors

During this webinar, we'll assist Medicare providers with knowing the difference between the Medicare review contractors and understanding their role in the Medicare review process. We'll discuss the Supplemental Medical Review [...]

Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated and Advance Payments for Part A Providers and Part B Suppliers

Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated and Advance Payments for Part A Providers and Part B Suppliers Please see the below for information related to the CHOPD Accelerated and Advance Payments for Part A Providers and [...]

MLN Connects® Newsletter: May 29, 2025

MLN Connects® Newsletter: May 29, 2025 News Inpatient Hospital Admissions: Transferring Medical Review Responsibilities for Short Stay Claims Medicare Shared Savings Program: Apply Now MLN Matters® Articles National Coverage [...]

Requesting an Exception to Timely Filing

Requesting an Exception to Timely Filing Table of Contents Requesting an Exception to Timely Filing No Appeal Rights for Claims Denied Based on Timely Filing Limit Provider Liability Exceptions that May Allow the Time Limit to be [...]

Tutorial

Medicare Claims: CMS-1500 or Electronic

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.

Modifier 22 Supporting Documentation for Part B claims

Modifier 22 Supporting Documentation for Part B claims The Centers for Medicare & Medicaid Services, Internet-Only-Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 40.2.10 Unusual Circumstances states: [...]

How to Prevent Common Skilled Nursing Facility Denials

How to Prevent Common Skilled Nursing Facility Denials This article was developed to increase awareness and educate SNFs on the top errors found by our Medical Review team. The information below includes suggestions to ensure documentation [...]

Best Practices for a Successful Targeted Probe and Educate Review

Best Practices for a Successful Targeted Probe and Educate Review Table of Contents Getting Started With TPE Notification Letter During the Review Process Post-Probe/Review Results Letter Prepare for Post-Probe Education [Return to [...]

Best Practices for a Successful Targeted Probe and Educate Review

Best Practices for a Successful Targeted Probe and Educate Review Table of Contents Getting Started With TPE Notification Letter During the Review Process Post-Probe/Review Results Letter Prepare for Post-Probe Education [Return to [...]

Overview of Evaluation and Management Services

Due to the overwhelming response for this session, we’re offering this as a repeat of the 6/3 virtual conference webinar. We've seen major changes to the evaluation and management code set over the last few years. In 2021, the AMA [...]

Appeals Calculator Levels of Appeal Table

Five Levels of Appeals: Overview Levels Level One Level Two Level Three Level Four Level Five Type of Appeal Redetermination Reconsideration (QIC) Administrative Law Judge (ALJ) Medicare Appeals [...]

Daily Treatment Notes Requirement for Inpatient SNF Services

Therapy Treatment Note Requirement for Inpatient SNF Services The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-2, Medicare Benefit Policy Manual, Chapter 15 is the primary source for therapy [...]

Targeted Probe and Educate Review Topics

Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to supply medical [...]

Medical Review: Targeted Probe and Educate Review Topics

Medical Review: Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to [...]

Targeted Probe and Educate Educational Videos

Targeted Probe and Educate Educational Videos   Video Description Targeted Probe and Educate Learn more about the TPE Program.   Additional educational information can be found on our Events page [...]

Targeted Probe and Educate Review Topics

Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to supply medical [...]

Targeted Probe and Educate Review Topics

Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to supply medical [...]

Home Health Billing Part One: The Notice of Admission

Provider Outreach and Education is hosting a two-part home health billing series. Part one will focus on what you need to know before billing, verifying eligibility, and the required fields to properly submit The Notice of Admission. This [...]

Home Health Billing Part Two: The Period of Care Claim

Part two of this home health billing series focuses on the period of care claim, how reimbursement is determined under the Patient Driven Groupings Model, and review of the key billing requirements for claim billing. This session is a great [...]

Resources

MLN® Fact Sheet: Medicare Overpayments CMS Internet-Only Manual Publication 100-06, Medicare Financial Management Manual, Chapter 3 - Overpayments Reviewed 6/4/2025

Complete a Voluntary Refund

Table of Contents Forms Used for Providers NOT on Automatic Immediate Recoupments and Check(s) Are Attached to This Form(s) Option 1: Completing the Voluntary Refund Form High Volume Spreadsheet Instructions Option 2: Large [...]

Bankruptcy Notifications

Notify us if you file bankruptcy. If you have filed a bankruptcy petition or are involved in a bankruptcy proceeding, National Government Services requests that you notify us immediately so that we can properly coordinate with the CMS and the [...]

How Should I Respond?

An overpayment may be identified and self-reported by a provider via clerfical error reopening or an overpayment, may be discovered by Medicare contractors as part of the claim and reimbursement review process. The key to reporting and repaying [...]