Search Results - NGSMEDICARE

Posting Date: 05/28/2020

Hospital Discharge Summary: Insufficient Documentation Causes Most Improper Payments

Hospital Discharge Summary: Insufficient Documentation Causes Most Improper Payments Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there [...]

Posting Date: 01/29/2021

Bill Inpatient or Outpatient Services

Bill Inpatient or Outpatient Services To help avoid denials, National Government Services has compiled information regarding references that will aid in determining whether to bill inpatient or outpatient services. CMS Medicare Learning [...]

Posting Date: 01/29/2021

Process for Requesting Medical Records

Process for Requesting Medical Records Additional Documentation Requests INITIAL ADR letters for CERT are sent to the address on file with the NSC for DMEPOS suppliers, or the MAC for the provider/supplier that billed/submitted the [...]

Posting Date: 01/29/2021

Inpatient Psychiatric Certification/Recertification/Delayed Certification

Inpatient Psychiatric Certification/Recertification/Delayed Certification Physicians are required to certify the medical necessity of inpatient services. This is required on admission and if the service is needed for an extended period of [...]

Posting Date: 01/29/2021

SNF Inpatient Stays

SNF Inpatient Stays The CERT contractor has seen increased denials of SNF inpatient stays due to missing or incomplete physician certification statement of medical necessity. Certification of medical necessity of inpatient skilled nursing [...]

Posting Date: 06/23/2021

When to Use the Provider Contact Center Versus Self-Service Tools

When to Use the Provider Contact Center Versus Self-Service Tools The CMS requires contractors to provide self-service and electronic communication technologies as efficient, cost effective means of disseminating Medicare provider information, [...]

Posting Date: 09/20/2019

Prolonged Services

Prolonged Services Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was [...]

Posting Date: 06/27/2019

Annual Wellness Visit

Annual Wellness Visit Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient documentation that caused improper payments for an [...]

Posting Date: 01/29/2021

Hyperbaric Oxygen Therapy Treatment

Hyperbaric Oxygen Therapy Treatment Insufficient documentation is documentation that was incomplete, inaccurate or was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient [...]

Posting Date: 01/29/2021

Surgery Services

Surgery Services Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient documentation that caused improper payments for [...]

Posting Date: 01/29/2021

Medication Administration

Medication Administration Insufficient documentation means something was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient documentation that caused improper payments for [...]

Posting Date: 01/29/2021

Stereotactic Body Radiation Therapy

Stereotactic Body Radiation Therapy Insufficient documentation means that something was missing from the medical records. Below are the most common reasons CERT determined there was insufficient documentation that caused improper payments for [...]

Posting Date: 01/29/2021

Diagnostic Testing Services

Diagnostic Testing Services Insufficient documentation means something was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient documentation that caused improper payments for [...]

Posting Date: 11/19/2020

2020 Changes Driven by You – National Government Services Self-Service Tools

2020 Changes Driven by You – National Government Services Self-Service Tools We are committed to improving your experience while using our secure self-service tools which includes our NGSConnex portal, our NGSMedicare.com website and our IVR [...]

Posting Date: 10/16/2023

Tips for Documenting Homebound Status

Tips for Documenting Homebound Status Comprehensive and accurate documentation is crucial to providing safe and effective care to Medicare beneficiaries. National Government Services' medical review team reviews this documentation while making [...]

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 of the Social Security Act is [...]

Posting Date: 10/19/2023

MLN Connects® Newsletter: October 19, 2023

MLN Connects® Newsletter: October 19, 2023 News 2024 Medicare Parts A & B Premiums and Deductibles Help CMS Improve Provider Resources — Respond by November 9 CMS Health Information Handler Helps You Submit [...]

Posting Date: 10/26/2023

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 delays. We’ve listed the error reason code, a [...]

Posting Date: 07/21/2023

Prior Authorization Outpatient Department Exemption Additional Documentation Requests

Prior Authorization Outpatient Department Exemption Additional Documentation Requests National Government Services Prior Authorization initiated the process of issuing ADRs to exempt providers. Please monitor your facility’s ADR location [...]

Posting Date: 10/26/2023

Coming Soon ‒ The CY 2024 Medicare Physician Fee Schedule

Coming Soon - The CY 2024 Medicare Physician Fee Schedule The CY 2024 MPFS will soon be available on the Fee Schedule Lookup tool located on NGSMedicare.com, after the CY 2024 physician fee schedule regulation is put on display. Once the Fee [...]

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 of Medicare-covered preventive services, [...]

Posting Date: 04/06/2022

Tips to Find Local Coverage Determinations and Billing and Coding Instructions (REVISED 4/6/2022)

Tips to Find Local Coverage Determinations and Billing and Coding Instructions (REVISED 4/6/2022) We often receive suggestions through our website surveys to make it easier to find LCDs and the associated Billing and Coding articles. All [...]

Posting Date: 04/30/2021

Tips to Find Local Coverage Determinations and Billing and Coding Instructions

Tips to Find Local Coverage Determinations and Billing and Coding Instructionssp We frequently receive suggestions through our website surveys to make it easier to find LCDs and the associated Billing and Coding articles. All LCDs and [...]

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 effect providers who render and bill for [...]

Posting Date: 01/13/2021

Local Coverage Determination Open Meeting Announcement

Local Coverage Determination Open Meeting Announcement Jurisdiction 6/Jurisdiction K Part A/Part B MAC Open Meeting Date Meeting Time Meeting Location Wednesday, 2/24/2021 12:00‒4:00 p.m. CT 1:00‒5:00 p.m. ET [...]

Posting Date: 02/10/2022

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 from 2/10/2022 through 3/26/2022. These [...]

Posting Date: 04/01/2021

Revised Coverage Policies for Facet Joint Interventions for Pain Management

Revised Coverage Policies for Facet Joint Interventions for Pain Management FUTURE Local Coverage Determination (LCD) Facet Joint Interventions for Pain Management (L35936) Billing and Coding: Facet Joint Interventions for Pain Management [...]

Posting Date: 11/14/2023

Announcement About Medicare Participation for Calendar Year 2024

Announcement About Medicare Participation for Calendar Year 2024 The Centers for Medicare & Medicaid Services has posted the Announcement About Medicare Participation for Calendar Year 2024. Posted 11/14/2023

Posting Date: 08/02/2022

MLN Connects® Special Edition for Monday, August 1, 2022

MLN Connects® Special Edition for Monday, August 1, 2022 New CMS Rule Increases Payments for Acute Care Hospitals & Advances Health Equity, Maternal Health On August 1, CMS issued a final rule for inpatient and long-term care [...]

Posting Date: 04/14/2020

NGS Telehealth Billing FAQs for COVID-19

NGS Telehealth Billing FAQs for COVID-19 Changes What has changed in Medicare coverage for telehealth services? Answer: There are 85 new codes added to the list of services that can be delivered via telehealth. List of Telehealth [...]

Posting Date: 07/05/2023

CR13220 - Technical Revisions Only to the National Coverage Determination (NCD) Manual, Publication (Pub) 100-03

CR13220 - Technical Revisions Only to the National Coverage Determination (NCD) Manual, Publication (Pub) 100-03 Posted 7/5/2023

Posting Date: 07/17/2023

Frequently Asked Questions Reviewed and Updated

Frequently Asked Questions Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Topics available are: ASCA Appeals CAR T-cell Therapy [...]

Posting Date: 07/17/2023

Frequently Asked Questions Reviewed and Updated

Frequently Asked Questions Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Topics available are: ASCA CAR T-cell Therapy Claims EDI [...]

Posting Date: 07/17/2023

Frequently Asked Questions Reviewed and Updated

Frequently Asked Questions Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Topics available are: ASCA CAR T-cell Therapy Claims EDI [...]

Posting Date: 07/17/2023

Frequently Asked Questions Reviewed and Updated

Frequently Asked Questions Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Topics available are: ASCA CAR T-cell Therapy Claims EDI [...]

Posting Date: 07/20/2023

Activation of Validation Edits for Providers with Multiple Service Locations (MLN Matters Number: SE19007 Revised)

Activation of Validation Edits for Providers with Multiple Service Locations (MLN Matters Number: SE19007 Revised) Posted 7/20/2023

Posting Date: 07/21/2023

Multi-Jurisdictional CAC Meeting Notice on Cervical Fusion

Multi-Jurisdictional CAC Meeting Notice on Cervical Fusion Information has been posted on our website in regards to multi-jurisdictional Contractor Advisory Committee Meeting regarding Cervical Fusion to be held on 8/16/2023. For more [...]

Posting Date: 07/25/2023

National Government Services CAC Meeting Notice on KidneyIntelX Test

National Government Services CAC Meeting Notice on KidneyIntelX Test Information has been posted on our website in regards to the National Government Services l Contractor Advisory Committee Meeting regarding KidneyIntelX Test to be [...]

Posting Date: 01/26/2023

MLN Connects® Newsletter: January 26, 2023

MLN Connects® Newsletter: January 26, 2023 News Medicare Enrollment in PECOS: Faster and Easier Application Process — Coming Summer 2023 Medicare Enrollment: Maintain the Same Owners in All Enrollment Records Hospitals: Revised [...]

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 Outpatient Hospital and Surgical [...]