News - NGSMEDICARE

Posting Date: 10/03/2024

Claim Denials During Hospice Elections Liability Reminder

Claim Denials During Hospice Elections Liability Reminder When a Medicare beneficiary elects hospice benefits, the hospice is required to provide all items and services needed for the hospice treatmen...

Posting Date: 10/03/2024

MLN Connects® Newsletter: October 3, 2024

MLN Connects® Newsletter: October 3, 2024 News HHS Releases Final Guidance for Second Cycle of Historic Medicare Drug Price Negotiation Program Resources & Flexibilities to Assist with the Public He...

Posting Date: 09/30/2024

Provider Enrollment: Reduce Development Requests for Additional Action

Provider Enrollment: Reduce Development Requests for Additional Action In an effort to reduce the request of additional information and/or documentation on provider enrollment applications, verify all...

Posting Date: 09/30/2024

Tobacco Counseling via Telehealth

Tobacco Counseling via Telehealth Health equity in telehealth is the opportunity for everyone to receive the health care they need and deserve, regardless of social or economic status. Telehealth help...

Posting Date: 09/27/2024

LCD and Article Updates for September/October 2024

LCD and Article Updates for September/October 2024 A58152 Billing and Coding: Computed Tomography Cerebral Perfusion Analysis (CTP) The following ICD-10-CM diagnosis codes were added to Group 1- ICD-1...

Posting Date: 09/26/2024

MLN Connects® Newsletter: September 26, 2024

MLN Connects® Newsletter: September 26, 2024 News CMS Roundup (September 20, 2024) Cardiovascular Disease: Talk with Your Patients about Screening Claims, Pricers, & Codes Cardiology CPT Code 75580: I...

Posting Date: 09/26/2024

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 “Stay of ...

Posting Date: 09/26/2024

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 “Stay of ...

Posting Date: 09/19/2024

Laboratory and Diagnostic Services: Documentation Responsibilities

Laboratory and Diagnostic Services: Documentation Responsibilities When National Government Services is conducting a pre-pay or post-pay review of claims and services, we may request additional docume...

Posting Date: 09/19/2024

MLN Connects® Newsletter: September 19, 2024

MLN Connects® Newsletter: September 19, 2024 News Resources & Flexibilities to Assist with the Public Health Emergency in Louisiana Skilled Nursing Facilities: Report Your Expanded Ownership, Manageme...

Posting Date: 09/19/2024

Billing Errors on 2024/2025 Influenza Season Claims

Billing Errors on 2024/2025 Influenza Season Claims The influenza season runs from August 1st of each year until July 31st the following year. Every influenza vaccine is assigned a new NDC each season...

Posting Date: 09/17/2024

National Government Services Contractor Advisory Committee Meeting

National Government Services Contractor Advisory Committee Meeting There will be a multi-jurisdictional CAC meeting held on Thursday 10/17/2024 at 3:00-5:00 p.m. ET, 2:00-4:00 p.m. CT. Meeting details...

Posting Date: 09/16/2024

Third Quarter Top Ten EDI Part B Edits

Third Quarter Top Ten EDI Part B Edits Using data analysis we’ve updated the Top Ten EDI Edits for the third quarter. Visit Quarterly Top Ten EDI Part B Edits to view the edits and their description, ...

Posting Date: 09/16/2024

Third Quarter Top Ten EDI Institutional Edits

Third Quarter Top Ten EDI Institutional Edits Using data analysis, we’ve updated the Top Ten EDI Edits for the third quarter. Visit Quarterly Top Ten EDI Institutional Edits to view the edits and thei...

Posting Date: 09/13/2024

Credit Balance Reporting Reminder: Submissions for Quarter Ending 9/30/2024 Start Soon!

Credit Balance Reporting Reminder: Submissions for Quarter Ending 9/30/2024 Start Soon! CBR submissions can be submitted starting on 10/1/2024 and are due within 30 days to be considered timely. Remem...

Posting Date: 09/12/2024

National Government Services Medicare Part B Care Management Services September Series

National Government Services Medicare Part B Care Management Services September Series According to the CDC, six in ten adults in the U.S. have a chronic disease and four in ten adults have two or mor...

Posting Date: 09/12/2024

MLN Connects® Newsletter: September 12, 2024

MLN Connects® Newsletter: September 12, 2024 News COVID-19: Updated Vaccines for 2024–2025 Season Rural Emergency Hospital Provisions, Conversion Process, & Conditions of Participation: Revised Guidan...

Posting Date: 09/10/2024

Expected Timeframes for Therapy Services

Expected Timeframes for Therapy Services CMS and CPT guidelines for provider time spent and documented on therapy services may vary, depending on the definition of the service and the context in which...

Posting Date: 09/09/2024

Common Working File (CWF) Host Dark Days for October 2024 Release

Common Working File Host Dark Days for October 2024 Release For the upcoming October 2024 Release: For Production, CWF will be observing the Gray Day on Thursday, 10/3/2024, and Dark Days starting Fri...

Posting Date: 09/09/2024

Psychotherapy Services and Targeted Probe and Educate

Psychotherapy Services and Targeted Probe and Educate We’ve added a new section to our website for Psychotherapy Services. Visit this page for informative instruction about completing a psychotherapy ...

Posting Date: 09/06/2024

LCD and Article Updates for August/September 2024

LCD and Article Updates for August/September 2024 Local Coverage Determinations Facet Joint Interventions for Pain Management L35936 Effective 8/1/2024 - Updated "Coverage Indications, Limitations and...

Posting Date: 09/05/2024

MLN Connects® Newsletter: September 5, 2024

MLN Connects® Newsletter: September 5, 2024 News Osteogenesis Stimulators: Prior Authorization Requirements Suspended Hospice Benefit: Expanding Prepayment Review in 4 States Skilled Nursing Facility ...

Posting Date: 08/29/2024

MLN Connects® Newsletter: August 29, 2024

MLN Connects® Newsletter: August 29, 2024 News CMS Roundup (August 23, 2024) Physicians, Teaching Hospitals, & Non-Physician Practitioners: Review Your Open Payment Data by December 31 Claims, Pricers...

Posting Date: 08/22/2024

MLN Connects® Newsletter: August 22, 2024

MLN Connects® Newsletter: August 22, 2024 News Commemorating the 2nd Anniversary of the Lower Cost Prescription Drug Law MolDx Local Coverage Determination Statement Hospital Price Transparency: Get R...

Posting Date: 08/20/2024

Electronically Submitted Claims that Exceed $99,999.99 Reminder

Electronically Submitted Claims that Exceed $99,999.99 Reminder Electronically submitted claims containing a dollar amount in excess of 99,999.99 will be rejected as a front-end EDI edit. The Standard...

Posting Date: 08/15/2024

MLN Connects® Newsletter: August 15, 2024

MLN Connects® Newsletter: August 15, 2024 News Negotiating for Lower Drug Prices Works, Saves Billions Resources & Flexibilities to Assist with the Public Health Emergency in Florida, Georgia, and Sou...

Posting Date: 08/15/2024

Additional Development Requests for Part A Claims for CPT J9299

Additional Development Requests for Part A Claims for CPT J9299 A system error on 7/25/2024 caused ADR letters to be issued in error on Part A claims for CPT J9299 with DOS on or after 3/1/2024. The i...

Posting Date: 08/08/2024

Supplemental Security Income Ratio Realignment for Cost Reporting Periods Starting Before 10/1/2013

Supplemental Security Income Ratio Realignment for Cost Reporting Periods Starting Before 10/1/2013 On 6/9/2023, in response to the Supreme Court’s ruling in Azar v. Allina Health Services, 139 S. Ct....

Posting Date: 08/08/2024

MLN Connects® Newsletter: August 8, 2024

MLN Connects® Newsletter: August 8, 2024 Final Payment Rule Hospital Inpatient Prospective Payment System & Long-Term Care Hospital Prospective Payment System FY 2025 Final Rule News Transitional Cove...

Posting Date: 08/07/2024

Unnecessary Adjustments for Part B Claims

Unnecessary Adjustments for Part B Claims A recent transition process at the Medicare Part B system maintainer has resulted in unnecessary and inappropriate Part B claim adjustments, impacting all MAC...