Applying for an Extended Repayment Schedule

Processing Drivers and System Claim Paths

Chapter I: Online System Terminology   Processing Drivers and System Claim Paths Purpose Claims that are filed through the FISS DDE Provider Online System follow a prescribed route referred to as a system claim path. Claim paths [...]

Claim Status and Location Codes

Chapter I: Online System Terminology Claim Status and Location Codes Purpose The purpose of the status and location is to route claims through FISS. The status describes the general condition of the claim (i.e., whether paid, denied, [...]

Local Coverage Determination Open Meeting Announcement

Local Coverage Determination Open Meeting Announcement Jurisdiction 6/Jurisdiction K Part A/Part B MAC To ensure the development of LCDs occurs through a public and open process, we are soliciting scientific evidence and other [...]

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 redetermination, which is the first level of [...]

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 Drugs: Comparative [...]

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 Address Heart Health [...]

MLN Connects® Newsletter: February 2, 2023

MLN Connects® Newsletter: February 2, 2023 News Aligning Quality Measures across CMS — The Universal Foundation Medicare Ground Ambulance Data Collection System: Portal to Report is Open Skilled Nursing Facilities: Care Compare January [...]

Let's Chat About Counseling to Prevent Tobacco Use

Let's Chat About Counseling to Prevent Tobacco Use Do you have questions on how to bill Medicare for tobacco counseling? Join us on 1/24/2023 for the opportunity to ask questions about coverage and billing for Medicare’s preventative service [...]

MLN Connects® Newsletter: January 5, 2023

MLN Connects® Newsletter: January 5, 2023 News COVID-19: Updated Vaccines for Children Ages Six Months – Five Years Advisory Panel on Hospital Outpatient Payment: Request for Nominations Certificates of Medical Necessity and DME [...]

MLN Connects® Newsletter: December 15, 2022

MLN Connects® Newsletter: December 15, 2022 News Opioid Treatment Programs: New Information for 2023 Part B Immunosuppressive Drug Benefit: Check Medicare Eligibility Home Health Quality Reporting Program: Get Final OASIS-E Instrument [...]

MLN Connects® Newsletter: December 1, 2022

MLN Connects® Newsletter: December 1, 2022 News CMS Urges Timely Patient Access to COVID-19 Vaccines, Therapeutics Quality Payment Program: Preview Your Performance Information by December 20 Clinical Laboratory Fee Schedule: CY 2023 [...]

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 & Productivity Adjustment Medicare [...]

MLN Connects® Newsletter: September 7, 2023

MLN Connects® Newsletter: September 7, 2023     News New Version of CMS.gov HHS Proposes Minimum Staffing Standards to Enhance Safety and Quality in Nursing Homes CMS Announces Resources and Flexibilities to Assist with [...]

MLN Connects® Newsletter: September 14, 2023

MLN Connects® Newsletter: September 14, 2023     News Inflation Reduction Act Continues to Lower Out-of-Pocket Prescription Drug Costs for Drugs with Price Increases Above Inflation CMS Roundup (Sept 8, 2023) New Provider [...]

Ambulatory Surgical Center Pass-Through Devices

Ambulatory Surgical Center Pass-Through Devices What is a Pass-Through Device? Pass-through status is determined for newly FDA-approved drug and device products on an individual basis. Drugs and devices qualifying for pass-through status [...]

MLN Connects® Newsletter: COVID-19: Updated mRNA Vaccines for Patients 6 Months & Older – September 14, 2023

MLN Connects® Newsletter: COVID-19: Updated mRNA Vaccines for Patients 6 Months & Older – September 14, 2023     News COVID-19: Updated mRNA Vaccines for Patients 6 Months & Older Posted 9/14/2023

URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations

URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations Table of Contents Urgent: Provider Compliance Required Effective 8/1/2023 Requirements Claim Filing Requirements Final Reminders Related Content [Return to [...]

MLN Connects® Newsletter: September 21, 2023

MLN Connects® Newsletter: September 21, 2023     News CMS Announces Resources and Flexibilities to Assist with the Public Health Emergency in the State of Georgia Organ Transplantation Affinity Group: Strengthening [...]

MLN Connects® Newsletter: September 28, 2023

MLN Connects® Newsletter: September 28, 2023     News CMS Statement on Current Status of Blood Tests for Organ Transplant Rejection CMS Roundup (Sept 22, 2023) Cardiovascular Disease: Talk with Your Patients about [...]

MLN Connects® Newsletter: October 5, 2023

MLN Connects® Newsletter: October 5, 2023     News Administration Moves Forward with Medicare Drug Price Negotiations to Lower Prescription Drug Costs for People with Medicare CMS Requests Public Input on Coverage of [...]

MLN Connects® Newsletter: October 6, 2023

MLN Connects® Newsletter: October 6, 2023     News COVID-19: Updated Novavax COVID-19 Vaccine, Adjuvanted for Patients 12 & Older Posted 10/6/2023

Notification of the 2024 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review

Notification of the 2024 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 [...]

MLN Connects® Newsletter: October 12, 2023

MLN Connects® Newsletter: October 12, 2023     News CMS Roundup (Oct 6, 2023) Protect Your Patients: Give Them a Flu Shot Publications Direct Data Entry: 10-Digit Screen Expansion Medicare Preventive Services — [...]

Let’s Get Ready for The Great American Smokeout on 11/16/2023!

Let’s Get Ready for The Great American Smokeout on 11/16/2023! For more than 40 years, the American Cancer Society has hosted the Great American Smokeout on the third Thursday of November. This yearly event is a call for action, not just for [...]

MLN Connects® Newsletter for Thursday, December 2, 2021

MLN Connects® Newsletter for Thursday, December 2, 2021 National Influenza Vaccination Week News National Influenza Vaccination Week Clinical Laboratory Fee Schedule: CY 2022 Final Payment Determinations Skilled Nursing Care & [...]

MLN Connects® Special Edition for Friday, January 7, 2022

MLN Connects® Special Edition for Friday, January 7, 2022 COVID-19: New HCPCS Code for Remdesivir Antiviral Medication Following the recent statement from the National Institutes of Health (NIH) COVID-19 Treatment Guidelines Panel regarding [...]

MLN Connects® Newsletter for Thursday, February 3, 2022

MLN Connects® Newsletter for Thursday, February 3, 2022 Provider Compliance Virtual Focus Group — February 24 News COVID-19: Letter to Health Care Facility Administrators on Health Care Worker Vaccination Rule COVID-19 Vaccine & [...]

MLN Connects® Newsletter for Thursday, February 17, 2022

MLN Connects® Newsletter for Thursday, February 17, 2022 Expanded Coverage: Lung Cancer Screening with Low Dose Computed Tomography News CMS Expands Coverage of Lung Cancer Screening with Low Dose Computed Tomography There’s Still Time [...]

MLN Connects® Special Edition for Friday, February 18, 2022

MLN Connects® Special Edition for Thursday, February 18, 2022 COVID-19 Monoclonal Antibodies: FDA Authorized Bebtelovimab On February 11, the FDA authorized the emergency use of the monoclonal antibody bebtelovimab for the treatment of [...]

MLN Connects® Newsletter for Thursday, February 24, 2022

MLN Connects® Newsletter for Thursday, February 24, 2022 CMS Released Skilled Nursing Facility & ESRD Web Pricers News Podiatry Nail Debridement & Evaluation and Management Services: Comparative Billing Report Skilled Nursing [...]

MLN Connects® Newsletter for Thursday, March 17, 2022

MLN Connects® Newsletter for Thursday, March 17, 2022 Kidney Health: Help Address Disparities News Medicare Shared Savings Program: Application Deadlines for January 1, 2023, Start Date Kidney Health: Help Address Disparities Claims, [...]

MLN Connects® Newsletter for Thursday, February 10, 2022

MLN Connects® Newsletter for Thursday, February 10, 2022 COVID-19: New HCPCS Code for Convalescent Plasma in Outpatient Setting News COVID-19: New HCPCS Code for Convalescent Plasma in Outpatient Setting Long-term Care Hospital [...]

MLN Connects® Newsletter for Thursday, January 20, 2022

MLN Connects® Newsletter for Thursday, January 20, 2022 COVID-19: Long-term Care, RHCs, & FQHCs   News COVID-19: Vaccine Access in Long-term Care Settings There’s Still Time: Recommend the Flu Shot Chiropractic Treatment of [...]

MLN Connects® Newsletter for Thursday, March 3, 2022

MLN Connects® Newsletter for Thursday, March 3, 2022 2022 Payment, Quality & Policy Changes News Ambulance Prior Authorization Model Expands April 1 Nutrition-related Health Conditions: Recommend Medicare Preventive Services [...]

Place of Service 10 for Telehealth Services Not for Medicare Billing

Place of Service 10 for Telehealth Services Not for Medicare Billing National Government Services is receiving calls from providers to our call center in regard to the usage of the new Place of Service 10 code.  POS 10 was established [...]

Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2022

Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2022 This announcement provides information that may be helpful to clinicians in determining whether to become a Medicare participating provider, or to continue [...]

Provider Compliance Virtual Focus Group - February 24, 2022

Provider Compliance Virtual Focus Group - February 24, 2022 Thursday, 2/24/2022 from 1:00–4:00 p.m. ET Register by Friday, 2/18/2022 - Registration Closed How can CMS improve its processes and eliminate unnecessary requirements for [...]

2022 Gap-Fill Request for Information

2022 Gap-Fill Request for Information National Government Services, the MAC for JK and J6, is in receipt of the new laboratory test codes identified by the CMS to be gap-fill priced for 2022. The PAMA regulations instruct the MACs to establish [...]

Home Health Bill Type 32A Returning With Reason Code U537I

Home Health Bill Type 32A Returning With Reason Code U537I CMS implemented HH TOB 32A for the NOA effective for period of care claims on or after 1/1/2022. The NOA is required for all HH period of care claim billing, including demand billing [...]

2021 Calendar Year 1099 Form Information

2021 Calendar Year 1099 Form Information Medicare providers and beneficiaries, who are serviced by National Government Services, regardless of their location, will receive a single Part A and Part B combined Form 1099 from NGS for calendar [...]

Transvenous Phrenic Nerve Stimulation in the Treatment of Central Sleep Apnea (L37929)

Transvenous Phrenic Nerve Stimulation in the Treatment of Central Sleep Apnea (L37929) Currently, National Government Services has LCD Transvenous Phrenic Nerve Stimulation in the Treatment of Central Sleep Apnea (L37929) as well as a Draft [...]

How to Avoid Costly Appeals

How to Avoid Costly Appeals National Government Services has noticed an increase in requests for claim appeals. Upon review, we have found that many of the requests are not appropriate and/or necessary for a claim appeal submission. The [...]

MLN Connects® Special Edition for Thursday, May 6, 2021

MLN Connects® Special Edition for Thursday, May 6, 2021 CMS Increases Medicare Payment for COVID-19 Monoclonal Antibody Infusions New payment policy for at-home administration As part of the ongoing response to address the COVID-19 [...]

MLN Connects® Special Edition for Monday, December 6, 2021

MLN Connects® Special Edition for Monday, December 6, 2021 Provider Requirements Under the No Surprises Act Special ODF — December 8 Wednesday, December 8, 2021 from 2:00-3:00 p.m. eastern time ​​​CMS will host a Special Open Door Forum [...]

Medicare Part A and Part B Billing for the COVID-19 Vaccine and Monoclonal Antibody

Medicare Part A and Part B Billing for the COVID-19 Vaccine and Monoclonal Antibody Medicare Billing for COVID-19 Vaccine Shot Administration How to Bill for COVID-19 Shot Administration You’ll be able to bill on single claims for the [...]

Home Health and Hospice December Educational Videos are Now Available On-Demand

Home Health and Hospice December Educational Videos are Now Available On-Demand The National Government Services Home Health and Hospice Provider Outreach & Education team “On-Demand Video Library” offers providers the ability to watch or [...]

Removal of HCPCS Code

Removal of HCPCS Code Prior Authorization Update Effective immediately, for claims with dates of service on or after 1/7/2022, the Centers for Medicare & Medicaid Services is removing current procedural terminology code 67911 (correction [...]

Coronavirus Resources for Home Care and Hospice

Coronavirus Resources for Home Care and Hospice At National Government Services, the health and well-being of our beneficiary and provider communities is our top priority. The Centers for Medicare & Medicaid Services’ COVID-19 web page is [...]

Home Health Bill Type 32A Returning with Reason Code 32114

Home Health Bill Type 32A Returning with Reason Code 32114 The Centers for Medicare & Medicaid Services implemented new home health bill type 32A effective 1/1/2022. An issue with ZIP codes submitted on EMC claims has been identified, [...]

December 2021-January 2022 LCD and Billing and Coding Article Updates

December 2021-January 2022 LCD and Billing and Coding Article Updates Billing and Coding: Autonomic Function Testing (A57024) Due to the annual CPT/HCPCS code updates, effective 1/1/2022, CPT code 95943 has been deleted from the CPT/HCPCS [...]

MLN Connects® Newsletter for Thursday, November 18, 2021

MLN Connects® Newsletter for Thursday, November 18, 2021 COVID-19: Changes to Nursing Home Visitation & Survey Activities   News CMS Repeals MCIT/R&N; Will Consider Other Coverage Pathways to Enhance Access to Innovative [...]

MLN Connects® Newsletter for Thursday, November 4, 2021

MLN Connects® Newsletter for Thursday, November 4, 2021 COVID-19: Changes for Medicare Advantage Plan Claims Starting January 1   News COVID-19 Vaccines for Children COVID-19 Vaccine & Monoclonal Antibody Products: Changes for [...]

MLN Connects® Special Edition for Friday, September 24, 2021

MLN Connects® Special Edition for Friday, September 24, 2021 CMS Will Pay for COVID-19 Booster Shots, Eligible Consumers Can Receive at No Cost Coverage without cost-sharing available for eligible people with Medicare, Medicaid, CHIP, and [...]

MLN Connects® Newsletter for Thursday, September 30, 2021

MLN Connects® Newsletter for Thursday, September 30, 2021 Flu Season is Here: Protect Your Patients, Yourself, & Your Loved Ones View this edition as a: Webpage | PDF News Flu Season is Here: Protect Your Patients, Yourself, [...]

MLN Connects® Special Edition for Monday, September 20, 2021

MLN Connects® Special Edition for Monday, September 20, 2021 Help CMS Improve Your Experience with Provider Resources CMS is conducting a study to help us improve your experience with resources about the Medicare program and correct billing. [...]

MLN Connects® Newsletter for Thursday, August 19, 2021

MLN Connects® Newsletter for Thursday, August 19, 2021 COVID-19: Vaccinate Your Patients View this edition as a: Webpage | PDF News Immunization: Medicare Covers Vaccines Compliance Chiropractic Services: Comply with Medicare [...]

MLN Connects® Newsletter for Thursday, August 26, 2021

MLN Connects® Newsletter for Thursday, August 26, 2021 Health Care Code Sets: ICD-10 — Revised View this edition as a: Webpage | PDF News Impact of the PHE on Telehealth: Comparative Billing Report in August COVID-19 Monoclonal [...]

MLN Connects® Newsletter for Thursday, September 9, 2021

MLN Connects® Newsletter for Thursday, September 9, 2021 SNF: WBT & COVID-19 Reminder View this edition as a: Webpage | PDF    News PEPPERs for Short-term Acute Care Hospitals Outpatient Clinic Visit Services at [...]

MLN Connects® Special Edition for Friday, August 13, 2021

MLN Connects® Special Edition for Friday, August 13, 2021 COVID-19 Vaccine Additional Dose Medicare stands ready to pay for administering an additional dose of COVID-19 vaccine consistent with the FDA EUA. We’ll pay the same amount to [...]