News - NGSMEDICARE

Posting Date: 11/29/2022

January 2023 Release "Dark Days" for the Common Working File Hosts

January 2023 Release "Dark Days" for the Common Working File Hosts For the upcoming January 2023 Release: For Production, CWF will be observing the Gray Day on Thursday, 12/29/2022 and Dark Days start...

Posting Date: 11/23/2022

MLN Connects® Newsletter: November 23, 2022

MLN Connects® Newsletter: November 23, 2022 News Colorectal Cancer Screening Test: Reduced Coinsurance for Related Procedures Begins January 1 Ambulance Fee Schedule: CY 2023 Inflation Factor & Pr...

Posting Date: 11/22/2022

LCD, Billing and Coding Article Updates for November-December 2022

LCD, Billing and Coding Article Updates for November-December 2022 New LCDs and Articles (Effective 11/1/2022) Off-Label Use of Intravenous Immune Globulin (IVIG) – (L39314) This LCD addresses off-lab...

Posting Date: 11/17/2022

MLN Connects® Newsletter: November 17, 2022

MLN Connects® Newsletter: November 17, 2022 News Hospital Price Transparency: Download Machine-Readable File Sample Formats & Data Dictionaries Medical Review After the COVID-19 Public Health Emer...

Posting Date: 11/15/2022

Proper Billing for LEQVIO®

Proper Billing for LEQVIO® National Government Services has noticed improper billing of units and diagnosis related to HCPCS code J1306. We’ve published Proper Billing for LEQVIO® HCPCS Code J1306 to ...

Posting Date: 11/15/2022

Multijurisdictional CAC meeting Notice on Micro-Invasive Glaucoma Surgery

Multijurisdictional CAC meeting Notice on Micro-Invasive Glaucoma Surgery Information has been posted on our website about a multijurisdictional Contractor Advisory Committee Meeting Regarding Micro-i...

Posting Date: 11/15/2022

Proper Billing for TEZSPIRE™

Proper Billing for TEZSPIRE™ National Government Services has noticed improper billing of units related to HCPCS code J2356. We’ve published Proper Billing for TEZSPIRE™ HCPCS Code J2356 to assist our...

Posting Date: 11/14/2022

The CY 2023 Medicare Physician Fee Schedule Is Now Available

The CY 2023 Medicare Physician Fee Schedule Is Now Available The CY 2023 MPFS is now available. You can view the new fees using the Fee Schedule Lookup tool page on NGSMedicare.com. Posted 11/14/2022

Posting Date: 11/14/2022

Proper Steps for Notice of Admission Cancel/Resubmission

Proper Steps for Notice of Admission Cancel/Resubmission The purpose of the NOA is to open a new admission period for a home health beneficiary. There are few circumstances when the home health NOA mu...

Posting Date: 11/10/2022

MLN Connects® Newsletter: November 10, 2022

MLN Connects® Newsletter: November 10, 2022 News Teaching Hospitals: Phase 2 Section 131 Reviews — Submission Deadline November 18 Medicare Participation for CY 2023 CMS Innovation Center’s Strate...

Posting Date: 11/08/2022

Provider Enrollment: Reminder for Open Enrollment and Participation Agreement

Provider Enrollment: Reminder for Open Enrollment and Participation Agreement The 2023 Annual Participation Open Enrollment Period is approaching for another year. While this is an important time (fro...

Posting Date: 11/03/2022

MLN Connects® Newsletter: November 3, 2022

MLN Connects® Newsletter: November 3, 2022 News COVID-19 Vaccine: Novavax Booster Authorized Medicare Part B Immunosuppressive Drug: Get Information on New Benefit Part B Immunosuppressive Drug Bene...

Posting Date: 11/03/2022

Claims Frequently Asked Question

Claims Frequently Asked Question We have added a new FAQ to our website. View answers to a common question about how to bill for services unrelated to a liability, no fault, or workers compensation cl...

Posting Date: 11/03/2022

Announcement About Medicare Participation for Calendar Year 2023

Announcement About Medicare Participation for Calendar Year 2023 The Centers for Medicare & Medicaid Services has posted the Announcement About Medicare Participation for Calendar Year 2023. Posted 11...

Posting Date: 11/02/2022

MLN Connects® Newsletter: OPPS/ASC and PFS Final Payment Rules

MLN Connects® Newsletter: OPPS/ASC and PFS Final Payment Rules Final Rules Final Rules HHS Continues Biden-Harris Administration Progress in Promoting Health Equity in Rural Care Access Through Outp...

Posting Date: 11/01/2022

MLN Connects® Newsletter: Final Rules

MLN Connects® Newsletter: Final Rules Final Rules Calendar Year (CY) 2023 Home Health Prospective Payment System Rate Update and Home Infusion Therapy Services Requirements CY 2023 End-Stage Renal Dis...

Posting Date: 11/01/2022

Coming Soon ‒ The CY 2023 Medicare Physician Fee Schedule

Coming Soon ‒ The CY 2023 Medicare Physician Fee Schedule The CY 2023 MPFS will soon be available on the Fee Schedule Lookup tool located on NGSMedicare.com, after the CY 2023 physician fee schedule r...

Posting Date: 10/27/2022

Notice of Local Coverage Determination Retirement

Notice of Local Coverage Determination Retirement Based on comments received at our Open Meeting on 10/20/2022, National Government Services has decided to retire the Proposed LCD DL38262 Salvage High...

Posting Date: 10/27/2022

MLN Connects® Newsletter: October 27, 2022

MLN Connects® Newsletter: October 27, 2022 News COVID-19 Updated Booster Vaccines Covered Without Cost-Sharing for Eligible Children Ages 5–11 Oversight of Nation’s Poorest-Performing Nursing Homes In...

Posting Date: 10/27/2022

November is Lung Cancer Awareness Month

November is Lung Cancer Awareness Month Did you know that cigarette smoking is the number one risk factor for lung cancer? In the United States, cigarette smoking is linked to about 80% - 90% of lung ...

Posting Date: 10/25/2022

Pneumococcal Vaccine Frequently Asked Questions

Pneumococcal Vaccine Frequently Asked Questions We’ve added new frequently asked questions to our website. View answers to common questions about Pneumococcal Vaccine to ensure you have the informatio...

Posting Date: 10/25/2022

October and November 2022 Billing and Coding and Medical Policy Article Updates

October and November 2022 Billing and Coding and Medical Policy Article Updates Retired article: Billing and Coding: Complex Drug Administration Coding (A58620) Revised articles: Billing and Coding: M...

Posting Date: 10/21/2022

Revised LCD Comments Address - Updated

Revised LCD Comments Address - Updated Due to a technical issue with the LCD Comments mailbox for National Government Services, emailed comments have not been received by NGS. Please use this alternat...

Posting Date: 10/20/2022

Medicare Coverage of Over-the-Counter COVID-19 Tests

Medicare Coverage of Over-the-Counter COVID-19 Tests Beginning 4/4/2022 and continuing through 5/11/2023, people with Medicare Part B, including those enrolled in a MA plan, are eligible to receive up...

Posting Date: 10/20/2022

Physicians/Practitioners! Are You Ordering Oxygen for Your Patients?

Physicians/Practitioners! Are You Ordering Oxygen for Your Patients? This is your opportunity to hear directly from the Medicare contractors regarding documentation required for coverage criteria to b...

Posting Date: 10/20/2022

MLN Connects® Newsletter: October 20, 2022

MLN Connects® Newsletter: October 20, 2022 News Skilled Nursing Facility Provider Preview Reports: Review by November 14 Help Your Patients Make Informed Health Care Decisions Ambulance Fee Schedule: ...

Posting Date: 10/19/2022

You Can Help Your Patients Quit Tobacco Use - The Great American Smokeout Is Coming!

You Can Help Your Patients Quit Tobacco Use - The Great American Smokeout Is Coming! Join us for our weekly webinar series on Medicare’s preventative service, "Counseling to Prevent Tobacco Use." Stat...

Posting Date: 10/19/2022

A/B and DME Collaborative Glucose Monitors and Supplies

A/B and DME Collaborative Glucose Monitors and Supplies View the A/B and DME Collaborative Glucose Monitors and Supplies YouTube Video for coverage criteria, documentation requirements and resources f...

Posting Date: 10/18/2022

Provider Outreach and Education Events

Provider Outreach and Education Events Our Provider Outreach and Education team offers a wealth of educational sessions for a variety of Medicare topics throughout the year. Because there are so many ...

Posting Date: 10/17/2022

The Home Health and Hospice Targeted Probe and Educate Process

The Home Health and Hospice Targeted Probe and Educate Process Medical Review conducts TPE on claims from all providers under the Medicare Program. Protect your revenue by gaining more knowledge regar...

Posting Date: 10/14/2022

Cardiac, Intensive Cardiac and Pulmonary Rehabilitation Services

Cardiac, Intensive Cardiac and Pulmonary Rehabilitation Services We’ve added Cardiac, Intensive Cardiac and Pulmonary Rehabilitation information to the Cardiac Specialty section of our website. These ...

Posting Date: 10/13/2022

MLN Connects® Newsletter: October 13, 2022

MLN Connects® Newsletter: October 13, 2022 News Protect Your Patients in October: Give Them a Flu Shot and COVID-19 Vaccine Vacating Differential Payment Rate for 340B-Acquired Drugs in 2022 Outpatien...

Posting Date: 10/12/2022

Introducing our new Medicare Topic: Tobacco Cessation

Introducing our new Medicare Topic: Tobacco Cessation Visit our new designated Tobacco Cessation Medicare Topic for everything health care providers need to know about Medicare coverage for tobacco ce...

Posting Date: 10/12/2022

Drugs and Biologicals Frequently Asked Questions

Drugs and Biologicals Frequently Asked Questions We’ve added new frequently asked questions to our website. View answers to common questions about Drugs and Biologicals to ensure you have the informat...

Posting Date: 10/10/2022

The Great American Smokeout is Coming!

The Great American Smokeout is Coming! As a health care professional who provides care to patients with Medicare, you can help protect the health of your patients by encouraging them to take advantage...

Posting Date: 10/06/2022

MLN Connects® Newsletter for Thursday, October 6, 2022

MLN Connects® Newsletter for Thursday, October 6, 2022 News Resources & Flexibilities to Assist with Public Health Emergency in South Carolina Implementation of Inflation Reduction Act Provision Addre...

Posting Date: 10/06/2022

Notification of the 2023 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review

Notification of the 2023 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review The amount that must remain in controve...

Posting Date: 10/05/2022

Do You Only Order or Certify Services? Use Revised Enrollment Form CMS-855O by January 1

Do You Only Order or Certify Services? Use Revised Enrollment Form CMS-855O by January 1 The revised Enrollment for Eligible Ordering/Certifying Physicians and Other Eligible Professionals (Form CMS-8...

Posting Date: 10/04/2022

Free Medicare Home Health YouTube Videos

Free Medicare Home Health YouTube Videos National Government Services has a plethora of educational Medicare Home Health YouTube videos regarding billing and documentation. These videos are free, shor...

Posting Date: 10/04/2022

Free Medicare Hospice YouTube Videos

Free Medicare Hospice YouTube Videos National Government Services has an array of educational Medicare Hospice YouTube videos regarding billing and documentation. These videos are free, short in lengt...

Posting Date: 10/03/2022

Your Feedback In Action – NGSConnex Improvements

Your Feedback In Action – NGSConnex Improvements We listen to you and are excited to share Your Feedback in Action! You told us that the NGSConnex Printable Views for Eligibility and Remittance Advice...

Posting Date: 09/29/2022

MLN Connects® Newsletter for Thursday, September 29, 2022

MLN Connects® Newsletter for Thursday, September 29, 2022 News Resources & Flexibilities to Assist with Public Health Emergency in Puerto Rico Resources & Flexibilities to Assist with Public Health Em...

Posting Date: 09/29/2022

National Government Services Proposed LCDs for Comment 9/29/2022-11/12/2022

National Government Services Proposed LCDs for Comment 9/29/2022-11/12/2022 The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal co...

Posting Date: 09/26/2022

Billing and Coding and Medical Policy Article Updates September/October 2022

Billing and Coding and Medical Policy Article Updates September/October 2022 Billing and Coding: Bevacizumab and biosimilars (A52370) Based on Transmittal 11594, (CR 12885) October 2022 Update of the ...

Posting Date: 09/22/2022

MLN Connects® Newsletter for Thursday, September 22, 2022

MLN Connects® Newsletter for Thursday, September 22, 2022 Encourage Preferred Flu Vaccines for Patients 65+ News Flu Shot: Encourage Preferred Vaccines for Patients 65+ Cataract Surgery: Comparative B...

Posting Date: 09/22/2022

Notice Regarding Targeted Probe and Educate Topic: Breast Ultrasound

Notice Regarding Targeted Probe and Educate Topic: Breast Ultrasound National Government Services has received approval from CMS to deny related claims (modifier 26 and/or TC) in accordance to the CMS...

Posting Date: 09/19/2022

Attention All Medicare Providers: Are You Using an Outsource Company?

Attention All Medicare Providers: Are You Using an Outsource Company? Do you use an outsource company for your Medicare billing and account receivables? Do you know who is using your data? Do you know...

Posting Date: 09/19/2022

EDI Self-Service Gateway Password Portal

EDI Self-Service Gateway Password Portal The EDI Gateway Self-Service Password Portal is a simple/secure, web-based process for changing or resetting passwords for EDI Trading Partners. There are diff...

Posting Date: 09/19/2022

The Medicare Essentials Virtual Conference

The Medicare Essentials Virtual Conference Are you new to working with Medicare or just need a refresher? The Medicare Essentials Virtual Conference, offers two pre-virtual sessions and eight sessions...

Posting Date: 09/19/2022

Reminder: Documenting Physical Therapy Services

Reminder: Documenting Physical Therapy Services Insufficient documentation causes most improper payments. Visit our CERT Alerts webpage for Topic specific articles that provide instructions and resour...

Posting Date: 09/15/2022

MLN Connects® Newsletter for Thursday, September 15, 2022

MLN Connects® Newsletter for Thursday, September 15, 2022 Make Your Voice Heard News Make Your Voice Heard Request for Information Seeks Public Comment to Promote Efficiency, Reduce Burden, & Advance ...

Posting Date: 09/12/2022

MLN Connects® Special Edition for Monday, September 12, 2022

MLN Connects® Special Edition for Monday, September 12, 2022 News Updated COVID-19 Vaccines Providing Protection Against Omicron Variant Available at No Cost Posted 9/12/2022

Posting Date: 09/08/2022

MLN Connects® Newsletter for Thursday, September 8, 2022

MLN Connects® Newsletter for Thursday, September 8, 2022 Prostate Cancer: Talk to Your Patients about Screening News Short-Term Acute Care Hospitals: Program for Evaluating Payment Patterns Electronic...

Posting Date: 09/08/2022

Don’t Let Your Flu Vaccination Claims Deny!

Don’t Let Your Flu Vaccination Claims Deny! The 2022-2023 flu vaccine season has begun. At the beginning of each flu season, National Government Services sees an increase in claim denial volume for fl...

Posting Date: 09/07/2022

Seasonal Influenza Vaccines Pricing

Seasonal Influenza Vaccines Pricing For Medicare billing purposes, the flu season runs from August to July of the following year. Medicare Part B covers one flu shot per flu season, if medically neces...

Posting Date: 09/07/2022

Billing for Qutenza Administration (REVISED)

Billing for Qutenza Administration (REVISED) Qutenza is topical high concentration (8%) capsaicin which is administered by a physician. The FDA approved this treatment for neuropathic pain associated ...

Posting Date: 09/06/2022

Billing New Monkeypox Vaccine and Laboratory Codes

Billing New Monkeypox Vaccine and Laboratory Codes On 7/23/2022, the WHO declared monkeypox a PHE. The HHS issued a statement regarding the Biden-Harris Administration’s actions to make vaccines, test...

Posting Date: 09/01/2022

MLN Connects® Newsletter for Thursday, September 1, 2022

MLN Connects® Newsletter for Thursday, September 1, 2022 Payment Allowances for Influenza Vaccine News CORRECTION: Monkeypox & Smallpox Vaccines: Include Product Code on Claims COVID-19: Novavax Vacci...

Posting Date: 09/01/2022

Prior Authorization Exemption Status Inquiry Tool Alert

Prior Authorization Exemption Status Inquiry Tool Alert National Government Services continues to see PARs submitted by exempt providers. In an effort to prevent unnecessary submission, NGS has develo...

Posting Date: 08/30/2022

Use National Government Services Self-Service Tools to Maximize your Workload

Use National Government Services Self-Service Tools to Maximize your Workload Our PCC telephone lines are busiest at the beginning and end of each month, and this creates long wait times for providers...

Posting Date: 08/26/2022

Treatment Plans for Cardiac Rehabilitation Services

Treatment Plans for Cardiac Rehabilitation Services In order for cardiac rehabilitation services to be covered under Medicare, an individualized treatment plan is required. The individualized treatmen...

Posting Date: 08/26/2022

August and September 2022 LCD, Billing and Coding Article Updates

August and September 2022 LCD, Billing and Coding Article Updates Routine Foot Care and Debridement of Nails – L33636 Under the Limitations section, the active care requirement for systemic conditions...

Posting Date: 08/25/2022

MLN Connects® Newsletter for Thursday, August 25, 2022

MLN Connects® Newsletter for Thursday, August 25, 2022 Medicare Secondary Payer: Manual Updates News Interns and Residents Information System XML Format: Updated Vendor List Claims, Pricers, & Codes I...

Posting Date: 08/25/2022

Use Our Provider Self-Service Tools To Spend Less Time on the Phone

Use Our Provider Self-Service Tools To Spend Less Time on the Phone Did you know our PCC experiences high call volumes at the beginning and the ending of each month? To avoid experiencing prolonged ho...

Posting Date: 08/25/2022

Updated fee for Fluorodeooxyglucose (F-18 FDG)

Updated fee for Fluorodeooxyglucose (F-18 FDG) Effective 10/1/2022, National Government Services will revise the amount allowed for Fluorodeooxyglucose (F-18 FDG, diagnostic, per study dose, up to 45m...

Posting Date: 08/24/2022

Provider Enrollment: Description of NPI and Link to NPPES Registry

Provider Enrollment: Description of NPI and Link to NPPES Registry We’ve added Description of NPI and a Link to NPPES Registry in the enrollment section of our website to assist with clarification of ...

Posting Date: 08/23/2022

Part A Prior Authorization Status Update Requests

Part A Prior Authorization Status Update Requests NGS has noticed an increase in calls to the NGS Provider Customer Service Department requesting an update on the status of a prior authorization reque...

Posting Date: 08/23/2022

Physical, Occupational and Speech and Language Pathology Therapy Services: Prevent Easily Avoidable Errors

Physical, Occupational and Speech and Language Pathology Therapy Services: Prevent Easily Avoidable Errors Evaluation/Plan of Care Documentation Elements The POC must contain, at a minimum, the follow...

Posting Date: 08/23/2022

New YouTube Video: Medical Documentation: A/B and DME Collaborative Presentation Now Available

New YouTube Video: Medical Documentation: A/B and DME Collaborative Presentation Now Available The A/B and DME MACs YouTube Video: Medical Documentation: A/B and DME Collaborative Presentation is avai...

Posting Date: 08/22/2022

Advance Communication Engine (NGS-ACE) System Edit Module for Electronic Claim Submission

Advance Communication Engine (NGS-ACE) System Edit Module for Electronic Claim Submission We are diligently working on enhancing NGS-ACE for providers in Jurisdiction 6 (Illinois, Wisconsin and Minnes...

Posting Date: 08/18/2022

MLN Connects® Newsletter for Thursday, August 18, 2022

MLN Connects® Newsletter for Thursday, August 18, 2022 Discontinuing Use of Certificates of Medical Necessity & Durable Medical Equipment Information Forms News CMS Discontinuing the Use of Certifi...

Posting Date: 08/18/2022

MLN Connects® Special Edition for Thursday, August 18, 2022

MLN Connects® Special Edition for Thursday, August 18, 2022 Creating a Roadmap for the End of the COVID-19 Public Health Emergency News Creating a Roadmap for the End of the COVID-19 Public Health Eme...

Posting Date: 08/18/2022

New Gamification Course Now Available in Medicare Arcades!

New Gamification Course Now Available in Medicare Arcades! Medicare University is expanding with a new gamification course in Medicare Arcades. You can now find the course, Introduction to Hospice B...

Posting Date: 08/17/2022

Medicare Mobile Has Expanded

Medicare Mobile Has Expanded We’ve expanded Medicare Mobile so you can stay up-to-date on the latest Medicare news. Joining is simple, text NEWS to 37702 to receive exclusive notifications straight to...

Posting Date: 08/17/2022

CMS Identifies National System Issue

CMS Identifies National System Issue CMS identified a national system issue, which may have inadvertently adjusted previously processed Part B claims with dates of service (DOS) on or after January 1,...