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Posting Date: 07/22/2016
General Information
General Information If information entered belongs to a Corporate Office, select the “Corporate Office” checkbox. What is the Entity Name? This is the provider name that was submitted on the CMS-855 form when applying to participate with [...]
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Posting Date: 07/22/2016
EDI Registration Form
EDI Registration Form This form is used for batch billing enrollment: Part A/B providers who submit batch transactions to Medicare, such as transmitting 837 claims, receiving 835 electronic remittances and requesting 276/277 claims status [...]
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Posting Date: 07/22/2016
Part A Logon Request Form: Billing Service Using a Letter of Authorization PIN
Part A Logon Request Form Billing Service Using a Letter of Authorization PIN This option allows a billing service to complete the Part A Logon Request Form after the Letter of Authorization has been completed by the provider/facility [...]
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Posting Date: 07/22/2016
Entry Process Questions
Entry Process Questions I need to complete a Logon Request Form This option is used for a provider/facility to request/modify access to the Part A FISS/DDE system. (EDI Enrollment Agreement is included within this packet if needed.) [...]
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Posting Date: 07/22/2016
EDI ERA Enrollment Form
EDI ERA Enrollment Form The EDI ERA Enrollment Form is required to be on file for each PTAN/NPI currently setup or requesting to be setup for the first time to receive electronic remittances through NGS. Should I Complete This Form? The [...]
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Posting Date: 07/22/2016
Part A Logon Request Form: Provider/Facility Requesting Access
Part A Logon Request Form Provider/Facility Requesting Access This form is for Part A providers requesting access to the Fiscal Intermediary Standard System (FISS)/Direct Data Entry (DDE) Online System and check patient eligibility. Note: Up [...]
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Posting Date: 07/22/2016
Tracking my Enrollment Packet and Checking Status
Tracking my Enrollment Packet and Checking Status Once your packet is submitted (See the section on Submitting the Packet), a confirmation message is displayed on the screen with the assigned Packet ID (PID) number. The PID will be sent to the [...]
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Posting Date: 01/19/2023
MLN Connects® Newsletter: January 19, 2023
MLN Connects® Newsletter: January 19, 2023 News Additional Steps to Strengthen Nursing Home Safety and Transparency Increase in 2023 in Organizations and Beneficiaries Benefiting from Coordinated Care in Accountable [...]
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Posting Date: 01/23/2023
Billing and Reimbursement for Noncontact Real-Time Fluorescence Wound Imaging (CPT 0598T and CPT 0599T)
Billing and Reimbursement for Noncontact Real-Time Fluorescence Wound Imaging (CPT 0598T and CPT 0599T) National Government Services has updated its reimbursement policy on CPT codes 0598T and 0599T (Noncontact Real-Time Fluorescence Wound [...]
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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. Providers have identified instances of not [...]
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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 Inflation Rebate [...]
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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 Ownership CMS Proposes [...]
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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 services requiring prior authorization as a [...]
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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 Posted 2/23/2023
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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
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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 Accessory Items Expanded Home [...]
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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 and Codes Medicare [...]
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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 unauthorized disclosure or modification of [...]
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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
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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 entitlement for the dates of service when [...]
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Posting Date: 12/23/2020
(SE20024) FAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as Inpatients
MLN Matters®: SE20024 FAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as Inpatients
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Posting Date: 03/31/2023
CR12669 - Instructions Relating to the Evaluation of Section 1115 Waiver Days in the Calculation of Disproportionate Share Hospital Reimbursement
CR12669 - Instructions Relating to the Evaluation of Section 1115 Waiver Days in the Calculation of Disproportionate Share Hospital Reimbursement
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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
CR13122 - Implementation of Consolidated Appropriations Act (CAA) of 2023, Section 4143: Waiver of Cap on Annual Payments for Nursing and Allied Health Education Payments
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Posting Date: 07/27/2020
Modifiers Used During the COVID-19 Public Health Emergency
Modifiers Used During the COVID-19 Public Health Emergency Modifier Part A Billed on UB04? Part B Billed on 1500? Details References Exceptions/Special Usage CS Exception Yes Waives [...]
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Posting Date: 04/14/2023
CR13105 - Technical Revisions Only to the National Coverage Determination (NCD) Manual
CR13105 - Technical Revisions Only to the National Coverage Determination (NCD) Manual
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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 FAQs for the answers you need to common [...]
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Posting Date: 11/15/2023
Fraud Awareness Week and National Rural Health Day
Fraud Awareness Week and National Rural Health Day Since this week is Fraud Awareness Week and National Rural Health Day is tomorrow on 11/16/2023, we wanted to share these valuable resources with you. Fraud Awareness Week Traditional [...]
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Posting Date: 12/08/2023
CR13468 - Payment of Codes for Chemotherapy Administration and Nonchemotherapy Injections and Infusions
CR13468 - Payment of Codes for Chemotherapy Administration and Nonchemotherapy Injections and Infusions Posted 12/8/2023
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Posting Date: 07/13/2022
A/B MACs Team Up with DME MACs for Glucose Monitor and Supplies Webinar on August 25
A/B MACs Team Up with DME MACs for Glucose Monitor and Supplies Webinar on August 25 Local A/B MACs and the DME MACs are excited to announce a collaboration webinar coming Thursday, August 25. This webinar will focus on what providers need to [...]
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Posting Date: 03/29/2022
Molecular Pathology Procedures Reminder
Molecular Pathology Procedures Reminder National Government Services has been receiving many claims submitted for redetermination that were submitted for Group 3 Molecular Pathology Procedures. The Group 3 codes from LCD (L35000/A56199) are [...]
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Posting Date: 12/14/2023
Medicare Demand Letter Rebuttals
Medicare Demand Letter Rebuttals National Government Services has seen an influx of overpayment rebuttal inquiries and here’s what you need to know. Rebuttals should be rare and only approved if NGS has processed an account(s) receivable [...]
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Posting Date: 04/21/2022
CMS Region 2 Office Hours
CMS Region 2 Office Hours The CMS Region 2 Office recently began conducting a series of “Office Hours” calls. The purpose of these sessions is to provide brief updates on Medicare topics of current interest to Part A facilities, physicians and [...]
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Posting Date: 01/11/2024
MLN Matters® MM13331: Incorporation of Recent Provider Enrollment Regulatory Changes into Chapter 10 of CMS Publication (Pub.) 100-08 - Physician Fee Schedule (PFS) Final Rule
MLN Matters® MM13331 - Incorporation of Recent Provider Enrollment Regulatory Changes into Chapter 10 of CMS Publication (Pub.) 100-08 - Physician Fee Schedule (PFS) Final Rule Revised 1/12/2024
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Posting Date: 03/23/2021
Low and No Medicare Utilization Cost Report
Low and No Medicare Utilization Cost Report No Utilization Cost Reports To comply with program cost reporting requirements, a provider that has not furnished any covered Medicare services during a cost reporting period must only complete the [...]
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Posting Date: 01/26/2024
A/B DME MAC Collaborative Webinar: General Documentation Requirements
A/B DME MAC Collaborative Webinar: General Documentation Requirements Physicians/Practitioners! Are you ordering durable medical equipment, prosthetics, orthotics and supplies for your patients? This is your opportunity to hear directly from [...]
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Posting Date: 09/29/2022
National Government Services Proposed LCDs for Comment 9/29/2022-11/12/2022
National Government Services Proposed LCDs for Comment 9/29/2022-11/12/2022 The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from [...]
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Posting Date: 04/29/2024
National Government Services Proposed LCDs for Comment (4/25/2024-6/8/2024)
National Government Services Proposed LCDs for Comment (4/25/2024-6/8/2024) The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 4/25/2024 through [...]
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Posting Date: 04/30/2024
2024 Medicare Cost Report Due Dates
2024 Medicare Cost Report Due Dates FYE 12/31/2023 cost reports are due by 5/31/2024. We strongly encourange early filing of the cost report. Early-filed cost reports that are rejected will receive a grace period to re-submit prior to [...]
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Posting Date: 08/15/2022
Staying Up To Date on Vaccines
Staying Up To Date on Vaccines It's important to stay up to date on vaccines. Vaccines protect your patients from serious illness and can keep them out of the hospital. Talk with your patients about which vaccines may be right for them, many [...]
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Posting Date: 05/16/2024
CR13566 - Outlier Reconciliation and Cost-to-Charge Ratio (CCR) Updates for the Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS
CR13566 - Outlier Reconciliation and Cost-to-Charge Ratio (CCR) Updates for the Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Posted 5/16/2024
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Posting Date: 05/03/2022
National Government Services: Raising Awareness about Care Management
National Government Services: Raising Awareness about Care Management According to the CDC, six in ten adults in the U.S. have a chronic disease and four in ten adults have two or more. As your Medicare Contractor for Jurisdiction 6 and [...]
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Posting Date: 10/27/2022
Primary Care Exception Guidelines
Primary Care Exception Guidelines Services performed by attending physicians at teaching hospitals, in collaboration with house staff in an approved GME program, generally require evidence of direct care by the attending physician in order to [...]
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Posting Date: 10/19/2022
Answers to Common Fee-for-Time Compensation Arrangements Questions
Answers to Common Fee-for-Time Compensation Arrangements Questions Does a fee-for-time compensation arrangement physician need to enroll with Medicare prior to acting as a physician? Answer: Currently, a fee-for-time compensation [...]
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Posting Date: 10/19/2022
Nonphysician Practitioners Billing for Surgical Procedures
Nonphysician Practitioners Billing for Surgical Procedures Several providers have asked about the Medicare guidance for NPPs include billing for surgical procedures. For the purpose of this education, NPPs include NPs, PA, and CNSs. State law [...]
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Posting Date: 10/12/2022
Surgical Pathology Billing Tips
Surgical Pathology Billing Tips CPT Codes: 88300-88399 Surgical pathology is the study of tissues removed from living patients during surgery to help diagnose a disease and determine a treatment plan. Surgical pathology involves gross and [...]
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Posting Date: 10/13/2022
Pathology Interpretation Services
Pathology Interpretation Services National Government Services has noted that there is some confusion and questions regarding the billing of professional components on some laboratory services. There is a certain subset of CPT codes for which [...]
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Posting Date: 05/23/2019
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 [...]
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Posting Date: 10/24/2024
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 [...]
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Posting Date: 11/01/2024
Instructions for Unfinished PECOS Enrollment Application(s)
Table of Contents Instructions for Unfinished PECOS Enrollment Application(s) Instructions for Unfinished PECOS Application(s) Instructions for Application Status “Pending E-Signature” Submitted Enrollment Application(s) on Behalf of an [...]
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Posting Date: 11/07/2024
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 [...]
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Posting Date: 01/29/2021
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 [...]
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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 [...]
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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 [...]
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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 [...]
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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 [...]
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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 [...]
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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, [...]
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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 [...]
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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 [...]
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Posting Date: 03/09/2020
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 [...]
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