Advanced Care Planning

Advanced Care Planning ACP is a voluntary, face-to-face discussion between you and your patient, their family member, caregiver or surrogate (as appropriate) to discuss the patient’s health care wishes if they become unable to make their own [...]

Behavioral Health Integration

Behavioral Health Integration Table of Contents BHI Overview Eligible Conditions Part B Billing/Coding BHI Services New Coding and Payment for BHI Conditions Billed by Clinical Psychologists and Clinical Social Workers Initiating [...]

CERT Awareness Week One – 2025 CERT Documentation Deadline

CERT Awareness Week One – 2025 CERT Documentation Deadline  The Part A, Part B, DME, home health and hospice, and Railroad Board MACs are working together to promote the importance of complying with CERT documentation requests. This is [...]

Prior Authorization Outpatient Department Exemption and ABN ADRs

Prior Authorization Outpatient Department Exemption and ABN ADRs National Government Services Prior Authorization initiated the process of issuing ADRs to 2025 exempt providers. Historically, claims await a provider’s response in FISS DDE [...]

Chronic Care Management

Chronic Care Management Table of Contents Billing Codes Chronic Pain Management and Treatment Codes Billing and Documentation Care management for chronic conditions Related Content [Return to Top] Billing Codes 99490: Provide at [...]

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 [...]

Need Answers? The Options to Consider Before Calling or Writing Into Medicare

National Government Services self-service options and other channels can answer most of provider’s questions. During this session, we will show you how to effectively utilize these tools.

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 [...]

July Code Set Update for PC Print: July 2025

July Code Set Update for PC Print: July 2025 The PC Print July code set update will be available on our website 7/9/2025. The update contains the following enhancements:    CR13999 Remittance Advice Remark Code (RARC), Claims [...]

July Code Set Update for PC Print: July 2025

July Code Set Update for PC Print: July 2025 The PC Print July code set update will be available on our website 7/9/2025. The update contains the following enhancements:    CR13999 Remittance Advice Remark Code (RARC), Claims [...]

Separately Identifiable Service

Separately Identifiable Service Please define the appropriate use of modifier 57 to identify a separately payable E/M with an initial decision for surgery. Answer: Modifier 57 is added to an E/M service that resulted in an initial [...]

Skilled Nursing Facility Services

Skilled Nursing Facility Services Please define rules for initial and subsequent SNF services, when the same provider has treated the patient at another site on the same date of service. Answer: This depends on the site of the prior [...]

Smoking Cessation

Smoking Cessation Please clarify appropriate codes for smoking cessation services. Answer: CPT codes 99406 and 99407 may be used for smoking and tobacco-use cessation counseling visits. Please clarify what constitutes a session which [...]

Split/Shared and Incident To Services

Split/Shared and Incident To Services Please define the substantive portion of a split (or shared) visit. Answer: The following factors apply in determining the substantive portion of a split (or shared) visit:   Total time [...]

Teaching Environment E/M Services

Teaching Environment E/M Services Please define levels of care for E/M services that can be performed by residents in a hospital outpatient setting under the PCE rules. Answer: CMS PCE guidelines for the hospital outpatient setting permit [...]

Telehealth Services

Telehealth Services Please explain Medicare’s definition of a telehealth service. Answer: Medicare defines a telehealth service as a service provided by a Medicare-enrolled practitioner from an approved distant site for a beneficiary who [...]

Time-Based Services

Time-Based Services Please define rules for using time to level-set a service. Answer: In both the office and observation/inpatient setting, the provider’s time is calculated based on pre-visit, intra-visit, and post-visit activities [...]

Transitional Care Management

Transitional Care Management Please clarify responsibility for the TCM interactive contact. Can this be performed by a hospital-employed nurse prior to discharge? Answer: The provider who is billing the TCM service is responsible for the [...]

Urgent Care

Urgent Care Please explain the concepts of split/shared and incident to E/M services in the urgent care setting. Answer: The urgent care setting is defined by CMS as a nonfacility setting. This means the split/shared concept does not [...]

Exemption Process

Exemption Table of Contents Exemption Exemption Database Standard Review Cycle Process Exemption Cycle Process Ten Claim Sample Additional Documentation Requests (ADRs) How to Find and Respond to a Prior Authorization ADR Related [...]

Proper Part B Claim Submissions

This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments or denials. We will guide you through the Centers for Medicare & Medicaid Services (CMS)-1500 [...]

Proper Part B Claim Submissions

This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments or denials. We will guide you through the Centers for Medicare & Medicaid Services (CMS)-1500 [...]

Steps to Claim Corrections

This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

Steps to Claim Corrections

This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

The National Correct Coding Initiative and Medically Unlikely Edits for Part B Providers

This webinar will assist Part B providers with navigating tables for the National Correct Coding Initiative and the medically unlikely edits. We'll also review the proper modifiers to use to avoid denials. There will be time for your [...]

The National Correct Coding Initiative and Medically Unlikely Edits for Part B Providers

This webinar will assist Part B providers with navigating tables for the National Correct Coding Initiative and the medically unlikely edits. We'll also review the proper modifiers to use to avoid denials. There will be time for your [...]

How to Avoid Duplicate Claims

Duplicate denials continue to be one of the top billing errors. Unnecessary duplicate filing of Medicare claims cost the provider's office valuable time and resources, as well as Medicare's time and money to process them. Please join us [...]

How to Avoid Duplicate Claims

Duplicate denials continue to be one of the top billing errors. Unnecessary duplicate filing of Medicare claims cost the provider's office valuable time and resources, as well as Medicare's time and money to process them. Please join us [...]

Utilizing Third Party Billing Companies

Medicare providers frequently outsource their billing, financial, and enrollment services. During this webinar, we’ll highlight the need to contract with Centers for Medicare & Medicaid Services (CMS)-approved entities and ensure these [...]

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 [...]

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 [...]

ADR Documentation List by Reason Code

How to Find and Respond to a Prior Authorization ADR Table of Contents How to Find and Respond to a PA Pre and Post Payment ADR Steps to View and Print ADRs from FISS/DDE Provider Online System Related Content [Return to Top] How to [...]

MLN Connects® Newsletter: July 10, 2025

MLN Connects® Newsletter: July 10, 2025 News Hospital Price Transparency: Respond to Accuracy & Completeness RFI by July 21 Alert: Medicare Fraud Scheme Involving Phishing Requests Via Fax and Other Means Transcatheter Edge-to-Edge [...]

Proper Part B Claim Submissions

This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments or denials. We will guide you through the CMS-1500 claim form and the electronic equivalent loops [...]

Steps to Claim Corrections

This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

Phonetic Alphabet

table, td, th table { border-collapse: collapse; width: 50%; } Phonetic Alphabet To assist you when speaking terms that are alpha-numeric, we've implemented the phonetic alphabet. When speaking an alpha character, please use the either [...]