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Posting Date: 03/30/2020
How to Bill When the Hospice Face-to-Face is Late from a Previous Benefit Period
How to Bill When the Hospice Face-to-Face is Late from a Previous Benefit Period Background CMS requires that a hospice physician or hospice nurse practitioner must have a FTF encounter with each hospice patient prior to the beginning of the [...]
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Posting Date: 06/20/2025
EDI Enrollment Process User Guide
This guide provides information on the different options available within the National Government Services EDI Enrollment Process User Guide. Please share your thoughts about your experience with our EDI Enrollment process. Reviewed [...]
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Posting Date: 06/20/2025
EDI Enrollment
Welcome This page is for providers who wish to submit Part A/B claims to Medicare. Once you have completed the initial provider enrollment and received your Welcome letter with Medicare, you can begin the EDI Enrollment process. Table of [...]
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Posting Date: 06/20/2025
HETS EDI Enrollment Form
HIPAA Eligibility Transaction System (HETS) allows users to exchange HIPAA compliant ANSI ASC X12 270/271 transactions for the purpose of checking Medicare eligibility. The HETS EDI Enrollment Form allows providers to attest their [...]
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Posting Date: 09/21/2020
Interactive Voice Response System
Interactive Voice Response System State IVR Number Hours Available* Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont 877-567-7205 Monday–Friday: 6:00 a.m.–7:00 p.m. ET [...]
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Posting Date: 04/22/2021
Provider Contact Center
Provider Contact Center Table of Contents Want to talk to us? Make the Most of Your Call Customer Care Representative Assistance Interactive Voice Response System NGSConnex Online Inquiry System Freedom of Information Act (FOIA) [...]
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Posting Date: 04/01/2020
EDI Help Desk Information
EDI Help Desk Information Toll-Free Number Jurisdiction 6: 877-273-4334 Jurisdiction K: 888-379-9132 Hours of Operation Monday–Friday: 8:00 a.m.–5:00 p.m. ET * Closed for training on the 2nd and 4th Friday of the month from 12:00–4:00 [...]
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Posting Date: 06/09/2021
About Hospital OPD PA Model
About Hospital OPD PA Model Table of Contents General Information Related Content [Return to Top] General Information Question Description WHO It is the responsibility of the hospital OPD to submit all [...]
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Posting Date: 06/09/2021
Expedited Requests
Expedited Requests The requester may submit an expedited review of the PAR if it is determined that a delay could seriously jeopardize the beneficiary’s life, health, or ability to regain maximum function. If the medical documentation does not [...]
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Posting Date: 06/23/2025
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.
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Posting Date: 06/09/2021
Ways to Submit Requests
Ways to Submit Requests NGSConnex Part A: NGSConnex User Guide Part B: NGSConnex User Guide esMD Content type 8.5 Fax JK: 317-841-4530 J6: 317-841-4528 Mail National Government Services, Inc. [...]
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Posting Date: 06/09/2021
OPD Facility/Physician Communication
OPD Facility/Physician Communication The implementation of the Outpatient Department (OPD) Prior Authorization (PA) program has specific implications for Part B physicians performing services within hospital OPDs. Each prior authorization [...]
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Posting Date: 05/03/2024
About Prior Authorization
About Prior Authorization CMS has implemented Prior Authorization (PA) programs nationwide to ensure that Medicare beneficiaries continue to receive reasonable and necessary care while protecting the Medicare Trust Fund from improper payments. [...]
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Posting Date: 06/23/2025
Description of Application Fee
The application fee is imposed on institutional providers and suppliers to cover enrollment costs. The application fee for calendar year 2025 is $730. Related Content Federal Register Notice ‒ information about how the fee was calculated [...]
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Posting Date: 01/05/2021
Description of Application Fee
Description of Application Fee The application fee is imposed on institutional providers and suppliers to cover enrollment costs. The application fee for calendar year 2025 is $730. Related Content Federal Register Notice ‒ information [...]
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Posting Date: 01/05/2021
Description of Application Fee
Description of Application Fee The application fee is imposed on institutional providers and suppliers to cover enrollment costs. The application fee for calendar year 2025 is $730. Related Content Federal Register Notice ‒ information [...]
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Posting Date: 01/05/2021
Description of Application Fee
Description of Application Fee The application fee is imposed on institutional providers and suppliers to cover enrollment costs. The application fee for calendar year 2025 is $730. Related Content Federal Register Notice ‒ information [...]
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Posting Date: 04/14/2022
How to Submit a Hardship Request
How to Submit a Hardship Request To request a hardship consideration, submit with a letter and any supporting documentation describing the hardship and why it justifies the exception for your application. Your hardship request will not be [...]
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Posting Date: 04/14/2022
How to Submit a Hardship Request
How to Submit a Hardship Request To request a hardship consideration, submit with a letter and any supporting documentation describing the hardship and why it justifies the exception for your application. Your hardship request will not be [...]
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Posting Date: 04/14/2022
How to Submit a Hardship Request
How to Submit a Hardship Request To request a hardship consideration, submit with a letter and any supporting documentation describing the hardship and why it justifies the exception for your application. Your hardship request will not be [...]
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Posting Date: 06/23/2025
How to Submit a Hardship Request
To request a hardship consideration, submit with a letter and any supporting documentation describing the hardship and why it justifies the exception for your application. Your hardship request will not be considered if it is received [...]
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Posting Date: 06/23/2025
How to Obtain a Refund
A refund will only be granted in the following instances: The application fee was not required for the application submitted A hardship request was subsequently approved and a fee was paid An application was rejected prior to the screening [...]
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Posting Date: 08/21/2018
How to Obtain a Refund
How to Obtain a Refund A refund will only be granted in the following instances: The application fee was not required for the application submitted A hardship request was subsequently approved and a fee was paid An application was [...]
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Posting Date: 04/27/2021
How to Obtain a Refund
How to Obtain a Refund A refund will only be granted in the following instances: The application fee was not required for the application submitted A hardship request was subsequently approved and a fee was paid An application was [...]
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Posting Date: 04/27/2021
How to Obtain a Refund
How to Obtain a Refund A refund will only be granted in the following instances: The application fee was not required for the application submitted A hardship request was subsequently approved and a fee was paid An application was [...]
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Posting Date: 10/28/2021
Other Audit Contractor ADRs
Other Audit Contractor Additional Development Requests Origins Facts Identification Comprehensive Error Rate Testing (CERT) Office of Inspector General (OIG) Recovery Auditor Contractors (RAC) [...]
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Posting Date: 07/18/2023
Medical Review: Targeted Probe and Educate Review Topics
Jurisdiction 6 HH+H Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Home Health Services - Medical Necessity ICD-10 Z47-Z47.89 N/A 55H3V – The documentation did [...]
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Posting Date: 06/17/2025
Holding MSP Claims Receiving CWF Edit 6802
Certain MSP claims are incorrectly rejected against CWF edit 6802. On 4/24/2025, CMS directed MACs to hold all MSP claims editing with 6802 while CWF works to correct the issue.
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Posting Date: 10/15/2021
Home Health Referrals
Home Health Referrals Table of Contents Home Health Referrals Order for Home Health Services Documentation to Support Homebound Status Documentation to Support the Need for Skilled Services Documentation Regarding the Face-to-Face [...]
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Posting Date: 01/27/2015
Home Health Forms – Which is Required?
Home Health Forms – Which is Required? The Advance Beneficiary Notice/Home Health Change of Care Notice/Notice of Medicare Noncoverage Scenario ABN HHHCN NOMNC Patient met goals under the POC and is being [...]
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Posting Date: 06/07/2021
Eligibility Criteria for Face-to-Face Encounters
Eligibility Criteria for Face-to-Face Encounters National Government Services is reminding home health providers that a face-to-face encounter form is not adequate documentation to support that a face-to-face encounter occurred. [...]
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Posting Date: 02/08/2021
Wound Care Under the Medicare Home Health Benefit
Wound Care Under the Medicare Home Health Benefit Wound care treatment typically involves three skilled nursing interventions, which may be performed at the same time or separately from each other. The three services are: Performing the [...]
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Posting Date: 05/11/2020
Home Health Plans of Care: NPs, CNSs and PAs Allowed to Certify
Home Health Plans of Care: Nurse Practitioners, Clinical Nurse Specialists and Physician Assistants Allowed to Certify Section 3708 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. No. 116-136) amended sections [...]
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Posting Date: 11/30/2020
Homebound Status
Homebound Status A Medicare beneficiary must be confined to the home in order to use their Medicare home health benefit. CMS defines homebound status in the CMS IOM Publication 100-02, Medicare Benefit Policy [...]
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Posting Date: 04/12/2022
Home Health: The Definition of an Allowed Practitioner
Home Health: The Definition of an Allowed Practitioner As per MM12615 the “Definition of an Allowed Practitioner” has been revised to read as follows (CR 12615): Medicare Benefit Policy Manual Chapter 7 Section 30.2.1 – Definition of an [...]
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Posting Date: 06/18/2025
MLN Connects® Newsletter: June 18, 2025
MLN Connects® Newsletter: June 18, 2025 News 2023 Doctors & Clinicians Preview Period Open Until June 25 Hospital Price Transparency: Respond to Accuracy & Completeness RFI by July 21 Medicare Part B Discarded Drug Program: Get [...]
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Posting Date: 05/05/2021
Description of NPI and a Link to NPPES Registry
Description of NPI and a Link to NPPES Registry As mandated by HIPAA, you should maintain (verify and update) your NPI data via NPPES on a regular basis. The NPI: is a ten-digit number and must be submitted on the enrollment form, [...]
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Posting Date: 05/05/2021
Description of NPI and a Link to NPPES Registry
Description of NPI and a Link to NPPES Registry As mandated by HIPAA, you should maintain (verify and update) your NPI data via NPPES on a regular basis. The NPI: is a ten-digit number and must be submitted on the enrollment form, will [...]
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Posting Date: 05/05/2021
Description of NPI and a Link to NPPES Registry
Description of NPI and a Link to NPPES Registry As mandated by HIPAA, you should maintain (verify and update) your NPI data via NPPES on a regular basis. The NPI: is a ten-digit number and must be submitted on the enrollment form, [...]
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