News - NGSMEDICARE

Posting Date: 04/21/2023

LCD, Billing and Coding Article Updates for April and May 2023

LCD, Billing and Coding Article Updates for April and May 2023 Billing and Coding Article (A56937): Psychiatry and Psychology Services Removed sentence from article text section - “For psychotherapy s...

Posting Date: 04/21/2023

New Service Added to the Hospital Outpatient Department Prior Authorization Program - Facet Joint Interventions

New Service Added to the Hospital Outpatient Department Prior Authorization Program - Facet Joint Interventions As a reminder, effective for dates of service rendered on or after 7/1/2023, facet joint...

Posting Date: 04/21/2023

Telligen QIN-QIO Hosting Chronic Kidney Disease Topics with National Kidney Foundation

Telligen QIN-QIO Hosting Chronic Kidney Disease Topics with National Kidney Foundation Chronic kidney disease (CKD) affects more than 1 in 7 U.S. adults—an estimated 37 million Americans. For American...

Posting Date: 04/20/2023

Providers Using NGSConnex to Submit Appeals and Supporting Documentation

Providers Using NGSConnex to Submit Appeals and Supporting Documentation We strongly recommend our providers use NGSConnex to submit your redetermination requests and any supporting documentation. Ple...

Posting Date: 04/20/2023

Medicare University Continuing to Experience Intermittent Issues

Medicare University Continuing to Experience Intermittent Issues We are continuing to experience intermittent outages with Medicare University. You do not need to report these issues with Medicare Uni...

Posting Date: 04/20/2023

MLN Connects® Newsletter: April 20, 2023

MLN Connects® Newsletter: April 20, 2023 News Billing Medicare Part B for Insulin with New Limits on Patient Monthly Coinsurance Medical Review & Compliance: Respond to Additional Documentation Reque...

Posting Date: 04/19/2023

Telehealth Frequently Asked Questions are Updated

Telehealth Frequently Asked Questions are Updated We’ve updated our telehealth frequently asked questions to include changes and flexibilities due to the end of the PHE on 5/11/2023. Please view these...

Posting Date: 04/18/2023

Part B Top Claim Errors Are Updated

Part B Top Claim Errors Are Updated Our top claim errors are updated on a quarterly basis to reflect current information. Visit Top Claim Errors to learn what you can do to avoid claim processing dela...

Posting Date: 04/18/2023

Attention Home Health and Hospice Providers Using NGSConnex to Submit Level One Appeals Redetermination Requests

Attention Home Health and Hospice Providers Using NGSConnex to Submit Level One Appeals Redetermination Requests National Government Services strongly recommends that all providers, including home hea...

Posting Date: 04/14/2023

Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line

Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line Attention: Provider Enrollment and Credentialing Departments Revalidate before your due date to avoid a hold on y...

Posting Date: 04/14/2023

CR13105 - Technical Revisions Only to the National Coverage Determination (NCD) Manual

Posting Date: 04/13/2023

The Advance Beneficiary Notice of Noncoverage

The Advance Beneficiary Notice of Noncoverage We’ve updated our Advance Beneficiary Notice of Noncoverage article to include examples for using an ABN for outpatient therapy and using the KX and GA mo...

Posting Date: 04/13/2023

Top Tobacco Counseling Claim Denials and How to Avoid/Correct Them

Top Tobacco Counseling Claim Denials and How to Avoid/Correct Them Providers, are your claims being denied for tobacco counseling services utilizing codes 99406 and 99407? In order to assist our provi...

Posting Date: 04/13/2023

MLN Connects® Newsletter: April 13, 2023

MLN Connects® Newsletter: April 13, 2023 News COVID-19: End of Public Health Emergency CMS Roundup (Apr. 07, 2023) Medicare Shared Savings Program: Application Toolkit Materials Inpatient Rehabilitat...

Posting Date: 04/13/2023

Provider Enrollment: NGSMedicare.com Website Resources to Help Reduce Development on CMS-855A Application

Provider Enrollment: NGSMedicare.com Website Resources to Help Reduce Development on CMS-855A Application To reduce requests for additional information, National Government Services offers several pro...

Posting Date: 04/13/2023

Registration is Open for the Part B Claim Submission Learning Day

Registration is Open for the Part B Claim Submission Learning Day Join us on Tuesday, 5/9/2023 for our Part B Claim Submission Learning Day! Our Part B POE Team is hosting a full day of educational we...

Posting Date: 04/12/2023

Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line

Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line Attention: Provider Enrollment and Credentialing Departments Revalidate before your due date to avoid a hold on y...

Posting Date: 04/12/2023

Provider Enrollment: NGSMedicare.com Website Resources to Help Reduce Development on CMS Enrollment Forms

Provider Enrollment: NGSMedicare.com Website Resources to Help Reduce Development on CMS Enrollment Forms To reduce requests for additional information, National Government Services offers several pro...

Posting Date: 04/12/2023

Home Health and Hospice Targeted Probe and Educate Resources

Home Health and Hospice Targeted Probe and Educate Resources It is imperative to keep up-to-date with all National Government Services JK and J6 HH+H TPE audit focus areas. This information can be loc...

Posting Date: 04/11/2023

NGS-ACE Enhancement Coming Soon

NGS-ACE Enhancement Coming Soon The National Government Services EDI team is pleased to share an upcoming enhancement to the 277CA (Claims Acknowledgement) transaction. Informational messages will be ...

Posting Date: 04/11/2023

MLN Connects® Newsletter: CMS Proposes Policies to Improve Patient Safety and Promote Health Equity — April 10, 2023

MLN Connects® Newsletter: CMS Proposes Policies to Improve Patient Safety and Promote Health Equity — April 10, 2023 Proposed Rule CMS Proposes Policies to Improve Patient Safety and Promote Health Eq...

Posting Date: 04/11/2023

Rural Tobacco Disparity

Rural Tobacco Disparity Tobacco use and exposure to SHS remain leading causes of preventable disease, disability and mortality in the United States and are responsible for approximately 480,000 deaths...

Posting Date: 04/10/2023

Reminder: Maintaining Ownership Consistency of Multiple Medicare Enrollments with same Tax Identification Number

Reminder: Maintaining Ownership Consistency of Multiple Medicare Enrollments with same Tax Identification Number View CMS’ “Medicare Enrollment: Maintain the Same Owners in All Enrollment Records” art...

Posting Date: 04/10/2023

Home Health Diagnosis Codes Grouper Update for 4/1/2023

Home Health Diagnosis Codes Grouper Update for 4/1/2023 Effective 4/1/2023, CMS is implementing new HH Grouper edits. The HH Grouper program has various data validity edits that make sure it uses cons...

Posting Date: 04/07/2023

New Fiscal Intermediary Shared System Consistency Edit to Validate Attending Physician National Provider Identifier

New Fiscal Intermediary Shared System Consistency Edit to Validate Attending Physician National Provider Identifier Effective 4/1/2023, CMS implemented a new consistency edit to validate that the atte...

Posting Date: 04/06/2023

MLN Connects® Newsletter: April 6, 2023

MLN Connects® Newsletter: April 6, 2023 News Resources & Flexibilities to Assist with Public Health Emergency in Mississippi Due to Recent Storms Program for Evaluating Payment Patterns Electronic Re...

Posting Date: 04/06/2023

MLN Connects® Newsletter: April 6, 2023

MLN Connects® Newsletter: April 6, 2023 News Resources & Flexibilities to Assist with Public Health Emergency in Mississippi Due to Recent Storms Program for Evaluating Payment Patterns Electronic Re...

Posting Date: 04/05/2023

MLN Connects® Newsletter: 4 Proposed FY 2024 Payment Rules — April 4, 2023

MLN Connects® Newsletter: 4 Proposed FY 2024 Payment Rules — April 4, 2023 Proposed Rules FY 2024 Hospice Payment Rate Update Proposed Rule (CMS-1787-P) FY 2024 Medicare Inpatient Psychiatric Facility...

Posting Date: 04/05/2023

MLN Connects® Newsletter: 4 Proposed FY 2024 Payment Rules — April 4, 2023

MLN Connects® Newsletter: 4 Proposed FY 2024 Payment Rules — April 4, 2023 Proposed Rules FY 2024 Hospice Payment Rate Update Proposed Rule (CMS-1787-P) FY 2024 Medicare Inpatient Psychiatric Facility...

Posting Date: 04/04/2023

NGS-ACE Edits for Ophthalmology

NGS-ACE Edits for Ophthalmology We continue working on enhancing NGS-ACE for providers in Jurisdiction 6 (Illinois, Minnesota, and Wisconsin) by adding additional edits and resources. The following NG...

Posting Date: 04/04/2023

NGS-ACE Edits for Ophthalmology

NGS-ACE Edits for Ophthalmology We continue working on enhancing NGS-ACE for providers in Jurisdiction 6 (Illinois, Minnesota, and Wisconsin) by adding additional edits and resources. The following NG...

Posting Date: 04/04/2023

NGS-ACE Edits for Ophthalmology

NGS-ACE Edits for Ophthalmology We continue working on enhancing NGS-ACE for providers in Jurisdiction 6 (Illinois, Minnesota, and Wisconsin) by adding additional edits and resources. The following NG...

Posting Date: 04/04/2023

NGS-ACE Edits for Ophthalmology

NGS-ACE Edits for Ophthalmology We continue working on enhancing NGS-ACE for providers in Jurisdiction 6 (Illinois, Minnesota, and Wisconsin) by adding additional edits and resources. The following NG...

Posting Date: 03/31/2023

MLN Connects® Newsletter: March 30, 2023

MLN Connects® Newsletter: March 30, 2023 News COVID-19: Booster Dose for Children 6 months – 4 years Identity & Access Management System: Easier for Surrogates Medicare Advantage Value-Based Insurance...

Posting Date: 03/31/2023

CR12669 - Instructions Relating to the Evaluation of Section 1115 Waiver Days in the Calculation of Disproportionate Share Hospital Reimbursement

Posting Date: 03/31/2023

CR13122 - Implementation of Consolidated Appropriations Act (CAA) of 2023, Section 4143: Waiver of Cap on Annual Payments for Nursing and Allied Health Education Payments

Posting Date: 03/31/2023

EDI Enrollment Spotlights Top Rejections

EDI Enrollment Spotlights Top Rejections Part A, Part B and DDE Periodically, EDI enrollment will publish articles to help eliminate the number of EDI applications that are denied. This month we are ...

Posting Date: 03/30/2023

Change in Pricing for Electroencephalogram Long-Term Monitoring Effective 4/1/2023

Change in Pricing for Electroencephalogram Long-Term Monitoring Effective 4/1/2023 After reviewing Medicare claims data for EEG continuous recording (CPT codes 95700 through 95718) as well as seeking ...

Posting Date: 03/29/2023

LCD, Billing and Coding Article Updates for March and April 2023

LCD, Billing and Coding Article Updates for March and April 2023 Pain Management (L33622) Effective 3/19/2023 The LCD has been revised to remove all references to sacroiliac joint injections. Please r...

Posting Date: 03/27/2023

Changes in G2066 Pricing Effective April 1, 2023

Changes in G2066 Pricing Effective April 1, 2023 After reviewing Medicare claims data for G2066 (Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic moni...

Posting Date: 03/23/2023

DDE Logon ID and Password Reminders

DDE Logon ID and Password Reminders CMS’ information security policy strictly prohibits the sharing or loaning of Medicare assigned IDs and passwords. Users should take appropriate measures to prevent...

Posting Date: 03/23/2023

Knee Orthosis: A/B and DME Collaborative Presentation

Knee Orthosis: A/B and DME Collaborative Presentation View the A/B and DME Knee Orthosis YouTube video for information on knee orthosis. Posted 3/23/2023

Posting Date: 03/23/2023

Resolved: Home Health Claims Editing for Reason Codes U5210/U5220

Resolved: Home Health Claims Editing for Reason Codes U5210/U5220 Some home health NOAs and claims were incorrectly hitting reason codes U5210 and U5220. These reason codes state there is no Medicare ...

Posting Date: 03/23/2023

MLN Connects® Newsletter: March 23, 2023

MLN Connects® Newsletter: March 23, 2023 News Additional Residency Positions: Apply by March 31 Laboratory Testing Urinalysis: Comparative Billing Report in March Long-Term Care Hospital Provider Prev...

Posting Date: 03/22/2023

Appealing a Denied Claim

Appealing a Denied Claim At times, providers submit a claim that ends up being denied; the denial may include appeal rights. Providers can appeal all of their overpayment claims on one request for red...

Posting Date: 03/22/2023

Hierarchy of Medicare Regulations

Hierarchy of Medicare Regulations Have you wondered how Medicare determines what is covered? Below you will find the hierarchy of how Medicare regulations are created. Social Security Act Title XVIII ...

Posting Date: 03/16/2023

MLN Connects® Newsletter: March 16, 2023

MLN Connects® Newsletter: March 16, 2023 News HHS Releases Initial Guidance for Historic Medicare Drug Price Negotiation Program for Price Applicability Year 2026 Quality Payment Program: 2021 Care Co...

Posting Date: 03/15/2023

MLN Connects® Newsletter: March 15, 2023

MLN Connects® Newsletter: March 15, 2023 News Inflation Reduction Act Tamps Down on Prescription Drug Price Increases Above Inflation Posted 3/15/2023

Posting Date: 03/14/2023

Provider Enrollment: Verify Bank Account Information to Prevent Interruption in Medicare Payment

Provider Enrollment: Verify Bank Account Information to Prevent Interruption in Medicare Payment National Government Services receives numerous electronic funds transfer banking rejections each year d...

Posting Date: 03/14/2023

Sacroiliac Joint Injections and Procedures Frequently Asked Questions

Sacroiliac Joint Injections and Procedures Frequently Asked Questions We’ve added frequently asked questions related to New Local Coverage Determination for Sacroiliac Joint Injections and Procedures...

Posting Date: 03/14/2023

Provider Enrollment: Verify Bank Account Information to Prevent Interruption in Medicare Payment

Provider Enrollment: Verify Bank Account Information to Prevent Interruption in Medicare Payment National Government Services receives numerous electronic funds transfer banking rejections each year d...

Posting Date: 03/13/2023

2023 Evaluation and Management Services – New Frequently Asked Questions

2023 Evaluation and Management Services – New Frequently Asked Questions Based on recent CMS clarifications for 2023 evaluation and management services, we’ve added new frequently asked questions for ...

Posting Date: 03/09/2023

MLN Connects® Newsletter: March 9, 2023

MLN Connects® Newsletter: March 9, 2023 News Nutrition-Related Health Conditions: Recommend Medicare Preventive Services Compliance Advance Care Planning: Bill Correctly for Services Claims, Pricers a...

Posting Date: 03/09/2023

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: 03/07/2023

Audiology Services

Audiology Services CMS finalized an exception to the physician order requirement for certain diagnostic testing services to broaden patient access to services furnished by audiologists in the CY 2023 ...

Posting Date: 03/03/2023

Attention Illinois Medicare Providers: Stepping Into a New Era with Opioids - CDC Best Practices

Attention Illinois Medicare Providers: Stepping Into a New Era with Opioids - CDC Best Practices Presented by Telligen QIN-QIO As part of our continuing work together, National Government Services wou...

Posting Date: 03/02/2023

MLN Connects® Newsletter: March 2, 2023

MLN Connects® Newsletter: March 2, 2023 News The Future of Medicare Enrollment: Save Time with PECOS's Consolidated Application Voluntary Prior Authorization Process for Certain Power Mobility Device ...

Posting Date: 02/28/2023

MLN Connects® Newsletter: COVID-19 Public Health Emergency (PHE) New Overview Fact Sheet — Feb 27, 2023

MLN Connects® Newsletter: COVID-19 Public Health Emergency (PHE) New Overview Fact Sheet — Feb 27, 2023 News COVID-19 Public Health Emergency (PHE) New Overview Fact Sheet Posted 2/28/2023

Posting Date: 02/27/2023

Credit Balance Report Reminder for Jurisdiction 6 Part A Providers

Credit Balance Report Reminder for Jurisdiction 6 Part A Providers For the quarter ending 12/31/2022, CBR must be submitted and received by the ORU by 3/1/2023 to be considered timely. Failure to subm...

Posting Date: 02/24/2023

LCD, Billing and Coding Article Updates for March 2023

LCD, Billing and Coding Article Updates for March 2023 Billing and Coding: Billing and Coding: Implantable Automatic Defibrillators (A56326) Based on Transmittal 11832 (CR13070) ICD-10-CM and Other Co...

Posting Date: 02/24/2023

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

April 2023 Release "Dark Days" for the Common Working File Hosts For the upcoming April 2023 Release: For Production, CWF will be observing the Gray Day on Thursday, 3/30/2023 and Dark Days starting F...

Posting Date: 02/23/2023

MLN Connects® Newsletter: Public Health Emergency 1135 Waivers: Updated Guidance for Providers - February 23, 2023

MLN Connects®Newsletter: Public Health Emergency 1135 Waivers: Updated Guidance for Providers - February 23, 2023 News Public Health Emergency (PHE) 1135 Waivers: Updated Guidance for Providers P...

Posting Date: 02/23/2023

MLN Connects® Newsletter: February 23, 2023

MLN Connects® Newsletter: February 23, 2023 News Hospital Price Transparency: Progress and Commitment to Achieving Its Potential Home Infusion Therapy Services Monitoring Report Immunosuppressive ...

Posting Date: 02/22/2023

Chimeric Antigen Receptor (CAR) T-cell Therapy Billing Instructions

Chimeric Antigen Receptor (CAR) T-cell Therapy Billing Instructions Effective for dates of service on or after 8/7/2019, Medicare will pay claims from approved providers for administration of autologo...

Posting Date: 02/22/2023

New Local Coverage Determination for Sacroiliac Joint Injections and Procedures

New Local Coverage Determination for Sacroiliac Joint Injections and Procedures National Government Services, as your MAC, is bringing to your attention a newly created LCD policy change that will eff...

Posting Date: 02/21/2023

Important Steps When Responding to Additional Development Response Letters

Important Steps When Responding to Additional Development Response Letters When National Government Services requests documentation, you must send us only what has been requested. We are receiving num...

Posting Date: 02/17/2023

New Service Added to the Hospital Outpatient Department Prior Authorization Program

New Service Added to the Hospital Outpatient Department Prior Authorization Program Effective for dates of service rendered on or after 7/1/2023, facet joint interventions are added to the HOPD servic...

Posting Date: 02/16/2023

MLN Connects® Newsletter: February 16, 2023

MLN Connects® Newsletter: February 16, 2023 News Billing Medicare Part B for Insulin with New Limits on Patient Monthly Coinsurance Unprecedented Efforts to Increase Transparency of Nursing Home O...

Posting Date: 02/14/2023

Changing Diagnosis Codes on Previously Processed Claims

Changing Diagnosis Codes on Previously Processed Claims National Government Services, is frequently asked about diagnosis code changes on claims that have already been processed. We hope this notifica...

Posting Date: 02/13/2023

2023 Evaluation and Management Services – Prolonged Services

2023 Evaluation and Management Services – Prolonged Services Based on recent CMS clarifications for 2023 Evaluation and Management Services, particularly for prolonged services, National Government Se...

Posting Date: 02/10/2023

MLN Connects® Newsletter: Prescription Drug Inflation Rebate Program Guidance – Feb 9, 2023

MLN Connects® Newsletter: Prescription Drug Inflation Rebate Program Guidance – Feb 9, 2023 News Medicare Part B Drug Inflation Rebates HHS Releases Initial Guidance for Medicare Prescription Drug...

Posting Date: 02/09/2023

Hospice Cap Self-Reporting Reminder for the 2022 Cap Year

Hospice Cap Self-Reporting Reminder for the 2022 Cap Year The hospice cap self-reporting for the 2022 cap year (10/1/2021-9/30/2022) is due no later than 2/28/2023. Hospice providers should submit the...

Posting Date: 02/09/2023

CMS Updates to Clinical Lab Fee Schedule for 2023 Reminder

CMS Updates to Clinical Lab Fee Schedule for 2023 Reminder National Government Services has received many calls in relation to the CMS updates to the Clinical Laboratory Fee Schedule for 2023. Provide...

Posting Date: 02/09/2023

MLN Connects® Newsletter: February 9, 2023

MLN Connects® Newsletter: February 9, 2023 News DMEPOS: Get Benefit Category Determinations Nurse Practitioners and Clinical Nurse Specialists: Update to List of National Certifying Bodies Help Ad...

Posting Date: 02/09/2023

National Government Services Proposed LCDs For Comment

National Government Services Proposed LCDs For Comment The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends ...