Overpayment Request

Table of Contents Forms You'll Need Large Scale Overpayments Overpayment Notification Process Timeline for Processing a Demand Letter [Return to Top] Forms You'll Need Forms for non MSP-related are generally done via NGSConnex, but [...]

Nettings/Offsets Across Organization Affiliations

Effective 1/4/2016, CMS implemented a change to begin netting/offsetting provider money across affiliated providers within the same and also across workloads within a single organization. This CMS change brings consistency to all Part B [...]

Set Up an Extended Repayment Schedule

Forms you’ll need J6 Applying for an Extended Repayment Schedule JK Applying for an Extended Repayment Schedule If repaying an overpayment would constitute a “hardship” on the provider, a request for an ERS should be submitted [...]

Request an Immediate Recoupment

Forms You’ll Need These forms apply to providers that are NOT on Automatic Immediate Recoupments. Electronic Submissions JK or J6 Immediate Recoupment Request Form - Electronic/E-mail Paper Submissions Jurisdiction K [...]

Respond to a Demand Letter

Table of Contents Form(s) you’ll need Timeline for Processing a Demand Letter [Return to Top] Form(s) you’ll need Providers on Automatic immediate Recoupments Do nothing as this automation process will automatically be done and [...]

MSP Post-Pay Overpayments

Forms You’ll Need Jurisdiction K CT-MA-ME-NH-NY-RI-VT Medicare Part B MSP Overpayment Request Form Jurisdiction 6 IL-MN-WI Medicare Part B MSP Overpayment Request Form JK or J6 Medicare Secondary Payer Part B Voluntary [...]

Advanced Payments to Providers

A provider may request an accelerated/advance payment where delays in payments by an A/B MAC for covered services rendered to beneficiaries have caused financial difficulties for the provider. An accelerated/advance payment may also be made in [...]

Overpayment Rebuttal Process

You’ll need to know what the rebuttal process is before initiating and know that the outcome of the rebuttal may not change the National Government Services recoupment process. The overpayment rebuttal process is a protocol used when an [...]

Observance of Juneteenth Holiday

Observance of Juneteenth Holiday In observance of Juneteenth, the National Government Services offices will be closed on Thursday, 6/19/2025. This includes the following departments: EDI Help Desk* Provider Contact Center Provider [...]

Targeted Probe and Educate Educational Videos

Targeted Probe and Educate Educational Videos Video Description MAC Medical Review Best Practices: Updating Your Contact Information Did you know providers can now designate a separate [...]

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 [...]

Some Claims Editing for Reason Code U537I, HH Claim Falls Outside of an HH Admission Period for the Same Provider

Note: This issue was originally reported and resolved in April 2025. The issue has returned so we have reopened the alert. The CWF can only hold the 36 most recent periods of care for any beneficiary. CWF also contains the indicator of when [...]

NGSConnex: Part B Redetermination Electronic Notification of Decision Letters

National Government Services will discontinue issuing paper Medicare Part B redetermination requests that are submitted electronically through our portal, NGSConnex. Instead, they will only be accessible to view and print electronically through [...]

Provider Enrollment: Eliminate Development Request for Additional Information

Provider Enrollment: Eliminate Development Request for Additional Information To eliminate requests for additional information and documentation on provider enrollment applications, ensure all necessary actions are complete before submission. [...]

Home Health and Hospice New Provider Orientation

This webinar is designed for new home health and hospice agencies in an effort to provide essential information on: Doing business with National Government Services as your Medicare Administrative Contractor, Self-service tools to help make [...]

Provider Enrollment: Eliminate Development Request for Additional Information

Provider Enrollment: Eliminate Development Request for Additional Information To eliminate requests for additional information and documentation on provider enrollment applications, ensure all necessary actions are complete before submission. [...]

Register Now and Join Us!

Register Now and Join Us! June 3-5, 2025 There's still time to register for the 2025 Spring Part B Virtual Conference. Immerse yourself in expert-led sessions designed to transform compliance understanding into action.   Posted 5/13/2025

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 & [...]

Complying with Medicare Signature Requirements

Complying with Medicare Signature Requirements Medicare Compliance: Verify signature requirements have been met before you submit your medical records to prevent CERT errors. Review the CERT Alert article Signature [...]

Hospice Billing Coffee Break

Provider Outreach and Education is hosting a 30-minute coffee break to help answer your troublesome hospice billing questions. This is a great opportunity to discuss areas of billing more in depth and review helpful guides and resources. Keep [...]

Medicare Part B Preventive Services: Intensive Behavioral Therapy for Obesity and Depression Screening

During this webinar, we'll review the Medicare coverage, coding and billing guidelines for intensive behavioral therapy for obesity and screening for depression in adults.

Ambulance Medical Necessity

Ambulance Medical Necessity According to the Centers for Medicare & Medicaid Services’ (CMS) Internet Only Manual (IOM) 100-02, Medicare Benefit Policy Manual, Chapter 10, Ambulance Services; (400 KB) 10.2 - Necessity and Reasonableness [...]

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 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.

Federally Qualified Health Center Basic Billing and Reimbursement

Are you a federally qualified health center (FQHC) provider eager to deepen your understanding of billing and reimbursement under FQHC prospective payment system (PPS)? Whether you're new to the role or just need a refresher, this webinar [...]

CO-22

Avoiding/Correcting This Error During patient registration it’s important for office staff to identify whether a beneficiary’s claims should be covered by other insurance before, or in addition to, Medicare. Providers shall use our [...]

CO-109

Avoiding/Correcting This Error Palmetto GBA is the Medicare Administrative Contractor for processing claims of railroad retirees, regardless of their location. Providers and suppliers must verify patients' Medicare entitlement before [...]

CO-16

Avoiding/Correcting This Error This denial message is specific to chiropractic claims with CPT/HCPCS codes that are not billable by Medicare enrolled chiropractors. Medicare Part B coverage for chiropractic care is limited to spinal [...]

CO-16

Avoiding/Correcting This Error The MBI is necessary for all claims submitted to MAC. Claims without a correct MBI are rejected, requiring providers to verify and resubmit them. To avoid this, use the Eligibility Lookup in NGSConnex before [...]

CO-16

Avoiding/Correcting This Error This rejection is the result of submitting a CPT/HCPCS code without a required modifier. You are required to research the proper modifier to report with the CPT/HCPCS code then submit a new claim. Please use [...]

OA-18

Avoiding/Correcting This Error A duplicate claim submission occurs when a provider resubmits a claim either on paper or electronically for a single encounter and the service is provided by the same provider to the: same beneficiary; for the [...]

CO-16

Avoiding/Correcting This Error The billing provider's information on the claim is missing or invalid. To avoid this error, ensure the following details are accurate and included: the billing provider's NPI, name, address, ZIP code and phone [...]

CO-109

Avoiding/Correcting This Error This denial is received when your Medicare patient is enrolled in an MA plan, instead of “traditional fee-for-service” Medicare. MA plans are health plans offered by private companies approved by Medicare [...]

CO-16

Avoiding/Correcting This Error Certain services require the name and NPI of the ordering or referring physician, depending on the service type. Definitions: Referring Physician: Requests an item or service for a Medicare beneficiary. [...]

Podiatry Services - Routine Foot Care and Debridement of Nails

While the Medicare Program generally excludes routine foot care services from coverage, there are specific indications or exceptions under which there are program benefits. Medicare payment may be made for routine foot care when the patient has [...]

Home Health Billing Coffee Break

Provider Outreach and Education is hosting a 30-minute coffee break to help answer your troublesome billing questions. This is a great opportunity to discuss areas of billing more in depth and review helpful guides and resources. Keep in mind [...]

Critical Care and Medicare Billing Compliance

While critical care codes did not change with the 2021 or 2023 AMA CPT updates, there are a lot of guidelines for billing these services. During this webinar, we'll discuss critical care coding, what is and is not critical care, how to [...]

Telehealth & Remote Patient Monitoring Updates

Telehealth & Remote Patient Monitoring Updates The CMS MLN Booklet® Telehealth & Remote Patient Monitoring has been updated with important information effective 10/1/2025. Posted 5/8/2025

The Medicare Appeals Process: What You Need to Know

This informative session will help you navigate Medicare’s appeals process by providing information on what an appeal is, how to determine if a claim can be appealed, who may file an appeal, the appeal levels, timeframes and documentation [...]

Paperwork Segment – PWK

Paperwork Segment – PWK PWK is a segment in the 837 electronic claim transaction. It links an electronic claim with the supporting documentation submitted by the provider. PWK indicators on the electronic claim notify NGS that documentation [...]

Paperwork Segment – PWK

Paperwork Segment – PWK The paperwork segment of an electronic claim submission is commonly known as PWK. PWK can be used when an electronically submitted claim requires additional documentation for purposes of claim processing. View our [...]

Local Coverage Determination Open Meeting Announcement

Local Coverage Determination Open Meeting Announcement Table of Contents Jurisdiction 6/Jurisdiction K Part A/Part B MAC Requests to Present Registered Presenters (Slide Presentations Only) Observers Comments on Proposed LCDs [...]

MLN Connects® Newsletter: May 13, 2025

MLN Connects® Newsletter: May 13, 2025 News CMS Seeks Public Input on Improving Technology to Empower Medicare Beneficiaries Posted 5/13/2025

MLN Connects® Newsletter: May 15, 2025

MLN Connects® Newsletter: May 15, 2025 News CMS Releases Draft Guidance for the Third Cycle of Medicare Drug Price Negotiation Program to Lower Drug Prices for American Patients Opioid Treatment Programs: CY 2025 Updates Laboratories: [...]

Private Practice Physical/Occupational Therapy Billing

We invite you to join our informative webinar focused on billing guidelines for physical and occupational therapy in private practice. During this webinar, we'll review important topics such as the appropriate use of the KX modifier and the [...]

How to Avoid Duplicate Claims

Duplicate denials continue to be one of the top billing errors. Unnecessary duplicate filing of Medicare claims cost the provider's office valuable time and resources, as well as Medicare's time and money to process them. Please join us [...]

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.

Medicare Compliance With the Incident To Provision

Do you have nonphysician practitioners that are, or could be, providing services incident to the physicians in the practice? Are you following the Centers for Medicare & Medicaid Services (CMS) regulations for this program? Staying [...]

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.

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 [...]

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.

Critical Access Hospitals: Preparing and Submitting Compliant Inpatient Claims to Medicare

In this webinar, critical access hospitals (CAHs) will learn how to properly prepare inpatient claims for submission to Medicare. We will review Medicare inpatient hospital benefit days, the Medicare benefit period, the applicable fields of [...]

Medicare Part B Targeted Probe and Educate Process

Are you familiar with targeted probe and educate? Perhaps you've heard of it but are not sure what it entails. Either way, consider attending this webinar as we cover this important topic. We'll discuss everything you need to know so if [...]

EDI Enrollment processing update

EDI Enrollment processing update National Government Services, EDI Enrollment Department will require all information submitted for EDI access to be valid and accurate. Exceptions will no longer be made when validating and processing requests [...]

Provider Transaction Access Number Request Form

Observance of Memorial Day 2025

Observance of Memorial Day 2025 In observance of Memorial Day 2025, our offices will be closed Friday, 5/23/2025 and Monday, 5/26/2025. Note: EDI claim files transmitted after 4:00 p.m. CT/5:00 p.m. ET on 5/22/2025 will have a claim receipt [...]