Chiropractic Resources

Medicare Coverage of Chiropractic Services Chiropractic Resources Code of Federal Regulations Code of Federal Regulations (Annual Edition) web page 42 CFR Section 410.21 describes limitations on services of a chiropractor 42 CFR [...]

Limiting Charge

Medicare Part B 101 Manual Limiting Charge Table of Contents Federal Limiting Charge Federal Limiting Charge for Medicare Secondary Payer [Return to Top] Federal Limiting Charge As part of the Omnibus Budget Reconciliation Act of [...]

Performance Standards

Performance Standards If providers are credentialing as an IDTF, then the performance standards shall be reviewed thoroughly before submitting a Medicare application. Refer to the IDTF Performance Standards and Attachment 2 beginning on page [...]

Notification of the 2025 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review

Notification of the 2025 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 controversy for ALJ hearing requests filed on or [...]

November is Lung Cancer Awareness Month

November is Lung Cancer Awareness Month Lung cancer is the leading cause of cancer death in the United States and worldwide. Although education, research and treatment options for lung cancer have dramatically improved in recent years, lung [...]

Physical Therapy Services

Physical Therapy Services Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means something was missing from the medical records. Below is a list of the most common reasons CERT determined there was [...]

Chiropractic Services

Chiropractic 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 [...]

Psychiatry and Psychology Services

Psychiatry and Psychology Services CERT has determined that insufficient documentation caused improper payments for psychiatry and psychotherapy; insufficient documentation means that information was missing from the medical [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

Physician Orders to Admit to Inpatient Hospital or for Observation Services

Physician Orders to Admit to Inpatient Hospital or for Observation Services Lack of a formal order for inpatient admission or observation services results in an increase of the CERT error rate for National Government Services. CERT auditors [...]

Pacemakers and Cardiac Defibrillators

Pacemakers and Cardiac Defibrillators National Government Services would like to alert providers that although coverage indications of pacemakers and implantable cardiac defibrillators was revised and expanded effective with dates of service [...]

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, [...]

Anesthesia Services

Anesthesia 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 [...]

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 [...]

Redetermination/Reopening Requests Online with NGSConnex

Redetermination/Reopening Requests Online with NGSConnex The NGSConnex web application allows providers/suppliers the ability to electronically submit and check the status of all redeterminations and/or reopenings requests online with no costs [...]

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 [...]

Physicians: Are You Ordering DMEPOS for Your Patients?

Physicians: Are You Ordering DMEPOS for Your Patients? Physicians provide the foundation for correctly billing services and/or supplies to Medicare. DMEPOS suppliers rely on prescribing providers to substantiate the need for services and/or [...]

Overpayment Recovery Unit FQHC Voluntary Refund Form

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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, [...]

Electrical Stimulation Therapy: Important Coverage and Documentation Reminders

Electrical Stimulation Therapy: Important Coverage and Documentation Reminders Table of Contents CPT/HCPCS: 97032 Coverage and Documentation Provider Actions Related Content [Return to Top] CPT/HCPCS: 97032 National Government [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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

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 [...]

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 [...]

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

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 [...]

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 [...]

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 [...]

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 [...]

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

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 [...]

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 [...]

Reason Codes

Chapter I: Online System Terminology Reason Codes Purpose Reason codes direct the outcome of an edit or process within FISS—they are the traffic cops of the system. Each reason code, when assigned, sends the claim to a specific [...]

Document Control Number

Chapter I: Online System Terminology Document Control Number Purpose The FISS DDE Provider Online System refers to the claim control number as a DCN. The DCN provides a reference number for the control and monitoring of each claim. To [...]

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 [...]

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 [...]

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 Reports Prostate Cancer: Talk to [...]

Electronic Medicare Secondary Payer Specifications for Inbound Claims

Resources Electronic Medicare Secondary Payer Specifications for Inbound Claims The following information is intended to provide you and your software vendor with a reference point for electronically billing MSP claims. Use this information [...]

Chronic Disease Management and Preventive Services Learning and Action Series

Chronic Disease Management and Preventive Services Learning and Action Series A Collaborative Learning Opportunity with the Medicare Administrative Contractors National Government Services, Novitas Solutions, Wisconsin Physician Services [...]

Claims/Attachments Submenu

  Chapter II: Online Menu Functions Overview Claims/Attachments Submenu Purpose The CLAIMS/ATTACHMENTS submenu is primarily used for data entry of claims. Influenza virus vaccine, pneumococcal pneumonia vaccine and COVID-19 vaccine [...]

Medicare Fee-for-Service Claims and the Sequestration Payment Adjustment Changes

Medicare Fee-for-Service Claims and the Sequestration Payment Adjustment Changes Just a reminder: The Protecting Medicare and American Farmers from Sequester Cuts Act impacts payments for all Medicare fee-for-service claims. As a result of [...]

Customer Experience Surveys

Customer Experience Surveys We are pleased to offer two new surveys for you to tell us about your experience with our Provider Contact Center. When you use our IVR system, access the survey from the main menu after you complete your [...]

Tips to Ensure an Optimal NGSMedicare.com Experience

Tips to Ensure an Optimal NGSMedicare.com Experience Most of you are probably aware, but if not, on Friday, 5/14/2021, we launched our new combined homepage. These changes were a result of your feedback. You now only need to go to [...]

Skilled Nursing Facility Patient Driven Payment Model Billing For Noncovered Days With An Occurrence Span Code 76

Skilled Nursing Facility Patient Driven Payment Model Billing For Noncovered Days With An Occurrence Span Code 76 The CR 11992 updated the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 6, Sections 40.3.2 and 40.6 to [...]

There’s Still Time to Register – National Government Services Preventive Service Week

There’s Still Time to Register – National Government Services Preventive Service Week National Government Services Provider Outreach and Education Team is holding a Special Virtual Conference on Medicare Preventive Services. Join us on [...]