Consultations

Consultations Does CMS permit payment for consultative E/M services? Answer: CMS permits payment for medically necessary consultative E/M services. The specific E/M codes previously used to represent consultative services were [...]

Update-CMS Delay of Skin Substitutes Effective Date

Update-CMS Delay of Skin Substitutes Effective Date As part of the transition to a new Administration, CMS is reviewing its coverage policies for skin substitute products. CMS believes it is important to maintain patient access to skin [...]

PC-ACE: Is there a resource I can use to assist me with Medicare Secondary Payer (MSP) claims when using PC-ACE?

DDE: I tried to access my claim through the FISS/DDE system and it will not let me pull it up. What is the problem?

DDE: Is there some place on FISS/DDE that shows how many physical therapy (PT) or occupational therapy (OT) visits the beneficiary has had?

CLAIMS: I received a denial stating that the documentation submitted did not support the medical necessity of laboratory services. Can you tell me what I can submit to support these services?

DDE: I have a claim which was fully denied and I am attempting to use the automated denial adjustment process, but the FISS/DDE system is not allowing me to adjust my claim. Why am I not able to bring up my claim and submit the adjustment?

DDE: My name changed and I need to change the name associated to my log on ID. How do I do that?

Revised and Updated Educational Frequently Asked Questions

Revised and Updated Educational Frequently Asked Questions Our educational FAQs have been updated. Please visit the Help and FAQs page under the Education section of our website to explore topics such as: ASCA Appeals CAR T-cell Therapy [...]

Acute Care Hospitals Preparing Inpatient Claims: Taking a Deeper Dive Part 2

This is part 2 of a 2-part webinar event (part 1 will be held on 4/17/2025). In part 2, Acute Care Hospitals (ACH) will learn how to complete inpatient claims for submission to Medicare in a variety of situations. Topics include bill types, [...]

Federally Qualified Health Center Basic Billing and Reimbursement

Are you a federally qualified health center (FQHC) provider eager to deepen your understanding of billing and reimbursement under FQHC prospective payment system (PPS)? Whether you're new to the role or just need a refresher, this webinar is for you!

[URGENT] NGSConnex Experiencing Intermittent Issues

NGSConnex Experiencing Intermittent Issues We are experiencing intermittent outages with NGSConnex. This is impacting Part A providers only. In some cases when a provider account is selected to perform a transaction such as ‘Eligibility [...]

FQHC Example of a Per Visit Rate Calculation for MAO Supplemental Payments

National AB Medicare Administrative Contractor Ambulance Provider/Supplier Coalition

National AB Medicare Administrative Contractor Ambulance Provider/Supplier Coalition Attention Ambulance Providers In response to numerous and continued requests from the ambulance community, the AB MACs have put together a National AB MAC [...]

MLN Connects® Newsletter: April 17, 2025

MLN Connects® Newsletter: April 17, 2025 News Clotting Factors: Medicare Part B Pays for Alhemo & Qfitlia Skilled Nursing Facilities: Revalidation Deadline Extended to August 1 Raise Awareness & Understanding of Alcohol Use and [...]

Reducing Unprocessable Claims

When claims are submitted with invalid, incomplete or incorrect information, our claims processing system will detect these errors and will reject claims as unprocessable. Our goal is to assist our providers in submitting claims correctly the [...]

National A/B Medicare Administrative Contractor Ambulance Provider/Supplier Coalition

National A/B Medicare Administrative Contractor Ambulance Provider/Supplier Coalition Attention Ambulance Providers In response to numerous and continued requests from the ambulance community, the AB MACs have put together a National AB MAC [...]

Using the Medicare Coverage Database: How to Find Important Medicare Coverage Information

Are you responsible for looking up whether a service is covered in the Medicare Program at your facility but you're not sure where to look for the most relevant information? As a healthcare provider, you are responsible for understanding and [...]

Medicare Secondary Payer: Let’s Chat About Preparing MSP and Conditional Claims

Were you unable to attend our Medicare Secondary Payer (MSP) and/or Conditional Billing webinars in January and February? Do you have questions about these topics? If so, join us for this "Let's Chat" session! You may ask questions and receive [...]

Learn Over Lunch-NGSConnex Introduction

Are you considering utilizing NGSConnex and want to learn more about this portal? During this brief webinar, we will provide an overview of NGSConnex and all it has to offer.