How to Become a Medicare-Enrolled OTP Supplier

How to Become a Medicare-Enrolled OTP Supplier OTPs with current, valid and full certification by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accredited by a SAMHSA-approved accrediting body; including the DEA [...]

Learn Over Lunch – NGSConnex Inquiries

Effective 5/27/2025, National Government Services will no longer accept inquiries submitted through the postal service to any of our P.O. Boxes or faxed to any of our fax lines. Are you prepared? Join this session to learn how to efficiently [...]

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 will also review proper modifiers to use to avoid denials. There will be time following the [...]

Overpayments Due to Contractor Audit Reviews

Overpayments Due to Contractor Audit Reviews If you do not agree with any CMS contractor audits determination and you are a provider practicing in JK (CT, MA, ME, NH, NY, RI, VT) or J6 (IL, MN, WI), you may use the Medicare appeals process [...]

CMS Links

Accreditation of Advanced Diagnostic Imaging Suppliers All Fee-For-Service Providers Ambulatory Surgical Centers (ASC) Center Beneficiary Notices Initiative (BNI)  Care Management including: Advanced Care Planning Behavioral [...]

MLN Connects® Newsletter: May 22, 2025

MLN Connects® Newsletter: May 22, 2025 News Discarded Drugs: Get Updated Lists Medicare Provider Payment & Utilization Public Use Files: Annual Update Medicare Fee-for-Service Geographic Variation Public Use Files & Interactive [...]

The 2025 Spring Part B Virtual Conference Begins in One Week!

The 2025 Spring Part B Virtual Conference Begins in One Week! The 2025 Spring Part B Virtual Conference begins in one week! This is your last chance to register and join us on June 3–5, 2025! Don’t miss out on this must-attend event!   [...]

MLN Connects® Newsletter: May 22, 2025

MLN Connects® Newsletter: May 22, 2025 Departments of Labor, Health and Human Services, Treasury Announce Move to Strengthen Healthcare Price Transparency Trump administration issues request for information, guidance to expand access to real [...]

Medically Unlikely Edits

Claim ADRs

Claim Additional Development Requests Types include: Origins Facts Identification NOC and unlisted codes. Modifiers: AS, 22, 52, 53, 62, 66, 80, 81, 82. PWK initiated and records are not [...]

CMS Medically Unlikely Edits

Medically Unlikely Edits and Related Billing Clarifications

Medically Unlikely Edits and Related Billing Clarifications 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. [...]

Medical Review Targeted Probe and Educate ADRs

Medical Review Targeted Probe and Educate Additional Development Requests Origins Facts Identification CMS’ TPE program is provider specific education that will focus on improving issues without allowing other [...]

General Information

General Information National Government Services or other CMS contractors may need to request additional information for Medicare claims to assess compliance with Medicare rules. These requests are ADRs. An ADR is a notification/letter [...]

Related Resources

Related Resources MLN® Educational Tool: How to Use the Medicare National Correct Coding Initiative (NCCI) Tools Medicare National Correct Coding Initiative (NCCI) Edits Medicare NCCI Medically Unlikely Edits (MUEs) National Correct [...]

The National Correct Coding Initiative Lookup Tool

The National Correct Coding Initiative Lookup Tool The National Correct Coding Initiative Lookup Tool is designed to help providers identify when certain codes are subject to the automated code pair edits. Search for coding pairs by entering a [...]

Ways to Respond to ADRs

Ways to Respond to ADRs When you are ready to submit, refer to the ADR for the specific submission methods available. NGS offers multiple ways for providers to submit their documentation in response to an ADR. CMS audit contractors notate in [...]

Relocation of the Medically Unlikely Edit Webpage Information

Relocation of the Medically Unlikely Edit Webpage Information National Government Services would like to inform you of an important change regarding the placement of the MUE section on our website. The MUE information has been relocated and is [...]

National Correct Coding Initiative and Medically Unlikely Edits

Quarterly Version Update Changes

Quarterly Version Update Changes CMS posts changes to each of its NCCI PTP published edit files on a quarterly basis. This includes additions, deletions and modifier indicator quarterly changes to PTP column one/column two correct coding edits [...]

Procedure to Procedure Edits

Procedure to Procedure Edits The NCCI contains one table of edits for physicians/practitioners and one table of edits for outpatient hospital services. Hospital PTP edits apply to types of bills subject to the outpatient code editor for the [...]

Add-on Codes

Add-on Codes Add-on codes are specific types of HCPCS/CPT codes intended to describe services that can only be reported in conjunction with a primary procedure. They represent additional work performed during the primary procedure and [...]

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.

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 [...]

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) [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 Hospital Wage Index Development Timetable Final

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 [...]

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 [...]

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 [...]

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 [...]

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 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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

Electronic Health Records

Electronic Health Records Eligible professionals under the Medicare EHR Incentive Program include: Doctor of medicine or osteopathy Doctor of dental surgery or dental medicine Doctor of podiatry Doctor of optometry Chiropractor If [...]

HETS EDI Recertification

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 [...]

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 [...]