Three-Day Qualifying Hospital Stay Required for Medicare-Covered SNF Stay

Three-Day Qualifying Hospital Stay Required for Medicare-Covered SNF Stay Medicare coverage of inpatient SNF services requires a qualifying, medically necessary inpatient hospital stay of at least three consecutive calendar days within 30 [...]

MLN Connects® Newsletter: July 3, 2025

MLN Connects® Newsletter: July 3, 2025 Proposed Payment Rules ESRD: CY 2026 Proposed Rule — Submit Comments by August 29 Home Health: CY 2026 Proposed Rule — Submit Comments by August 29 News CMS Launches New Model to Target Wasteful, [...]

Medicare Secondary Payer: A Review of the Non-Group Health Plan MSP Provisions

In this webinar, we review the workers’ compensation, No-Fault (including medical-payment coverage) and the Liability Medicare Secondary Payer (MSP) provisions. Understanding these provisions will help your facility identify and bill the [...]

Medicare Secondary Payer: Payment and Beneficiary Responsibility

In this webinar, we review how Medicare determines if an Medicare Secondary Payer (MSP) payment is due on a claim, how the MSP payment module determines the amount of an MSP payment, how coding reported on MSP claims can impact payment, and how [...]

Medicare Secondary Payer: Adjustment Claims

In this webinar, we will review how to prepare and submit adjustments (Type of Bill XX7) to change processed or rejected claims for Medicare Secondary Payer (MSP)-related reasons. We discuss adjusting Medicare primary, MSP, and cost-avoided [...]

Part A Ambulance Transport: Understanding the Basics

The purpose of this presentation is to give Medicare Part A Ambulance providers a better understanding of who is responsible to report services to Medicare.

Home Health Billing Coffee Break

Provider Outreach and Education is hosting a 30-minute coffee break to help answer your troublesome billing questions. This is a great opportunity to discuss areas of billing more in depth and review helpful guides and resources. Keep in mind [...]

Appeal Status <7>

Appeal Status <7> When Appeal Status is selected, the IVR will request and collect the following information: NPI PTAN TIN HICN or MBI Refer to the Phonetic Alphabet for assistance with speaking alpha characters [...]

Request an Immediate Recoupment

National Government Services has implemented a standardized “immediate recoupment” process that gives you the option to avoid interest from accruing on claims overpayments when the debt is recouped in full prior to or by the 30th day from the [...]

Complete a Voluntary Refund

A voluntary refund is when you have self-identified you have been overpaid and you need to refund the excess funds to Medicare. All checks are made payable to National Government Services. Whenever possible, the refund to Medicare should be [...]

Set Up an Extended Repayment Schedule

If repaying an overpayment would constitute a “hardship” on the provider, a request for an ERS should be submitted immediately. While you may request an ERS at any time during the debt-collection process, timely submission of a valid request [...]

Payment Withholding Information

Payment Withholding Information What Is a Payment Withholding? Why Are Payments Withheld? Who Can I Contact for Further Assistance? What About Cost Report Interim and Final Settlement Withholdings? What Is a Payment Withholding? An [...]

MSP Post-Pay Adjustments

If you have received an overpayment because Medicare paid as the primary insurer and another insurance carrier should be the primary payer, follow the instructions on the Part A voluntary refund form. A separate refund form is needed for [...]

Refunds Due to Beneficiaries by Providers

Refunds Due to Beneficiaries by Providers In some situations, providers are responsible for refunding monies to beneficiaries that have paid for services providers have determined to be noncovered and nonpayable by Medicare. When an ABN has [...]

Credit Balance Reporting

Table of Contents What is a Credit Balance? What Should I Do When I Have a Credit Balance? Additional Tips for a Successful Credit Balance Report Submission [Return to Top] What is a Credit Balance? Generally, when a provider [...]

CMS-855I Completion Tips for Physicians and NPPs in Private Practice Revalidation Application

CMS-855I Completion Tips for Physicians and NPPs in Private Practice Revalidation Application Follow the instructions printed on the CMS-855I application and refer to this list of sections required for revalidation. Section Required [...]

Cognitive Assessment

Cognitive Assessment Table of Contents Billing Codes Billing Information Documentation Related Content [Return to Top] Billing Codes 99483: 60 minute face-to-face [Return to Top] Billing Information Cognitive assessment [...]

Transitional Care Management

Transitional Care Management Table of Contents Billing Codes Billing Information Documentation Related Content [Return to Top] Billing Codes 99495: Moderate complexity F2F 7 to 14 days 99496: High complexity F2F 7 days [...]

Psychiatric Collaborative Care Model

Psychiatric Collaborative Care Model The psychiatric CoCM was introduced in 2018 and Medicare began making separate payments using CPT codes 99492, 99493 and 99494. Effective 1/1/2021, G2214 was added to Psychiatric CoCM to cover shorter [...]

Radiopharmaceutical Reimbursement National Government Services has reviewed the radiopharmaceutical pricing methodology set forth in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Section 303(h) which states that [...]