Search Results - NGSMEDICARE

Posting Date: 07/24/2025

Prolonged Services

Prolonged Services Note: View the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.15.2 and Section 30.6.15.3 for CPT codes [...]

Posting Date: 07/28/2025

Submit Medicare Secondary Payer Claims Correctly the First Time!

Submit Medicare Secondary Payer Claims Correctly the First Time! If you're facing challenges related to MSP claim submissions for Medicare Part B, then this information is important for you. Ensuring that claims are submitted correctly the [...]

Posting Date: 07/28/2025

View our Educational Frequently Asked Questions

View our Educational Frequently Asked Questions Our educational FAQs have been reviewed and 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 [...]

Posting Date: 07/29/2025

Learning Medicare Secondary Payer Interactively

Join us for an interactive learning webinar where you can engage and have fun at the same time! It’s all about learning the Part B Medicare Secondary Payer (MSP) provisions with live case scenarios. Providers will understand their [...]

Posting Date: 02/26/2024

Ambulance Duplicate Claim Denials

Ambulance Duplicate Claim Denials Duplicate trips may be reported on the same claim if the ZIP code for the point of pick-up for both trips is the same. If separate claims are submitted for the same beneficiary on the same day with the same [...]

Posting Date: 03/27/2025

Ambulance Services and the Advance Beneficiary Notice of Noncoverage

Ambulance Services and the Advance Beneficiary Notice of Noncoverage To follow are Medicare’s guidelines regarding the use of an ABN for ambulance services. Per the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) [...]

Posting Date: 01/31/2015

Ambulance Transports Included in SNF Consolidated Billing

Ambulance Transports Included in SNF Consolidated Billing Transport Description Medical Necessity Met Ambulance Billing Modifiers and Other Considerations Who is Responsible for Payment? Reference(s) SNF to [...]

Posting Date: 04/15/2022

Ambulance Physician Certification Statement Guidelines

Ambulance Physician Certification Statement Guidelines Certification Type Certification Required? Yes/No Who May Sign the Certification Timeframe Other Information /Resources Nonemergency, scheduled, [...]

Posting Date: 10/27/2022

Coverage of Rural Air Ambulance Services

Coverage of Rural Air Ambulance Services Section 415 of the Medicare Modernization Act of 2003 provides coverage for rural air ambulance services that are reasonable and necessary and ordered by qualified personnel. Medicare considers the [...]

Posting Date: 04/15/2022

Ambulance Transports Excluded from SNF Consolidated Billing

Ambulance Transports Excluded from SNF Consolidated Billing When a Medicare beneficiary is a resident in a SNF under a Part A stay, not all ambulance transports are included in the PPS (prospective payment system) payment for a SNF. SNF [...]

Posting Date: 07/29/2025

National Government Services Contractor Advisory Committee Meeting

National Government Services Contractor Advisory Committee Meeting There will be a multi-jurisdictional CAC meeting held on Wednesday 8/20/2025 at 3:30-5:30 p.m. ET, 2:30-4:30 p.m. CT. Meeting details can be found on the National Government [...]

Posting Date: 12/31/2018

Ambulance Medical Necessity Reminder for ESRD Patients

Ambulance Medical Necessity Reminder for ESRD Patients National Government Services receives a significant amount of dialysis facility ambulance transports that do not meet medical necessity criteria. Documentation must explicitly describe the [...]

Posting Date: 04/22/2020

Ambulance Medical Necessity

Ambulance Medical Necessity According to the Centers for Medicare & Medicaid Services’ (CMS) Internet Only Manual (IOM) 100-02, Medicare Benefit Policy Manual, Chapter 10, Ambulance Services; (400 KB) 10.2 - Necessity and Reasonableness [...]

Posting Date: 06/27/2022

Billing for A0426 or A0428

Billing for A0426 or A0428 National Government Services has been receiving electronic claims with the 2300 REF segment (G1 qualifier) for prior authorization, however, the value entered in REF02 is a ZIP code. This segment is intended for the [...]

Posting Date: 08/06/2015

Medical Necessity of Ambulance Services

Medical Necessity of Ambulance Services Table of Contents Medical Necessity of Ambulance Services What You Can Do Nearest Appropriate Facility: GY Modifier What You Can Do Related Content [Return to Top] Medical [...]

Posting Date: 04/29/2022

Proper Claim Submission for Repetitive, Scheduled, Non-Emergent Ambulance Transports

Proper Claim Submission for Repetitive, Scheduled, Non-Emergent Ambulance Transports The CMS implemented the prior authorization of RSNAT. NGS J6 states Illinois, Minnesota, and Wisconsin were added to the RSNAT Model effective with dates [...]

Posting Date: 11/12/2020

Responsibility of Providing a Properly Executed Physician Certification Statement/Certificate of Medically Necessity

Responsibility of Providing a Properly Executed Physician Certification Statement/Certificate of Medically Necessity Recent National Government Services educational efforts have highlighted an issue between facilities and the ambulance [...]

Posting Date: 03/03/2025

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 [...]

Posting Date: 06/03/2022

Network Service Vendors

Network Service Vendors National Government Services requires connectivity to the EDI Gateway for exchange of EDI data through select NSVs. In addition to connectivity to the EDI Gateway for the exchange of HIPPAA transactions, these vendors [...]