Prior Authorization Requests Submitted by Exempt Providers Alert

Prior Authorization Requests Submitted by Exempt Providers Alert The National Government Services PA Department has observed an increase in submission of PAR for exempt providers. These submissions are from the HOPD and/or physician offices on [...]

2022 Gap-Fill Request for Information

2022 Gap-Fill Request for Information National Government Services, the MAC for JK and J6, is in receipt of the new laboratory test codes identified by the CMS to be gap-fill priced for 2022. The PAMA regulations instruct the MACs to establish [...]

January 2022 EDI Front End Quarterly Release

January 2022 EDI Front End Quarterly Release Please be advised that while the Centers for Medicare & Medicaid Services mandated release for January 2022 will be installed the weekend of 1/2/2022, the code set updates included with this [...]

Home Health Bill Type 32A Returning With Reason Code U537I

Home Health Bill Type 32A Returning With Reason Code U537I CMS implemented HH TOB 32A for the NOA effective for period of care claims on or after 1/1/2022. The NOA is required for all HH period of care claim billing, including demand billing [...]

Skilled Nursing Facility Consolidated Billing Services Reminder

Skilled Nursing Facility Consolidated Billing Services Reminder For Medicare beneficiaries in a covered Part A stay, these separately payable, or excluded, services include select items or services in the following categories: physician’s [...]

January and February 2022 LCD and Billing and Coding Article Updates

January and February 2022 LCD and Billing and Coding Article Updates Colon Capsule Endoscopy (CCE) (L38571) LCD revised effective 2/15/2022: coverage criteria expanded to include blood-based biomarker colorectal cancer screening test, [...]

2021 Calendar Year 1099 Form Information

2021 Calendar Year 1099 Form Information Medicare providers and beneficiaries, who are serviced by National Government Services, regardless of their location, will receive a single Part A and Part B combined Form 1099 from NGS for calendar [...]

Transvenous Phrenic Nerve Stimulation in the Treatment of Central Sleep Apnea (L37929)

Transvenous Phrenic Nerve Stimulation in the Treatment of Central Sleep Apnea (L37929) Currently, National Government Services has LCD Transvenous Phrenic Nerve Stimulation in the Treatment of Central Sleep Apnea (L37929) as well as a Draft [...]

How to Avoid Costly Appeals

How to Avoid Costly Appeals National Government Services has noticed an increase in requests for claim appeals. Upon review, we have found that many of the requests are not appropriate and/or necessary for a claim appeal submission. The [...]

MLN Connects® Special Edition for Thursday, May 6, 2021

MLN Connects® Special Edition for Thursday, May 6, 2021 CMS Increases Medicare Payment for COVID-19 Monoclonal Antibody Infusions New payment policy for at-home administration As part of the ongoing response to address the COVID-19 [...]

MLN Connects® Special Edition for Monday, December 6, 2021

MLN Connects® Special Edition for Monday, December 6, 2021 Provider Requirements Under the No Surprises Act Special ODF — December 8 Wednesday, December 8, 2021 from 2:00-3:00 p.m. eastern time ​​​CMS will host a Special Open Door Forum [...]

Medicare Part A and Part B Billing for the COVID-19 Vaccine and Monoclonal Antibody

Medicare Part A and Part B Billing for the COVID-19 Vaccine and Monoclonal Antibody Medicare Billing for COVID-19 Vaccine Shot Administration How to Bill for COVID-19 Shot Administration You’ll be able to bill on single claims for the [...]

National Government Services Billing VEKLURY™ (remdesivir) Antiviral Medication in Outpatient Settings

National Government Services Billing VEKLURY™ (remdesivir) Antiviral Medication in Outpatient Settings CMS created the new HCPCS code J0248 for VEKLURY™ (remdesivir) antiviral medication. This code is effective for dates of service on or after [...]

Home Health and Hospice December Educational Videos are Now Available On-Demand

Home Health and Hospice December Educational Videos are Now Available On-Demand The National Government Services Home Health and Hospice Provider Outreach & Education team “On-Demand Video Library” offers providers the ability to watch or [...]

Removal of HCPCS Code

Removal of HCPCS Code Prior Authorization Update Effective immediately, for claims with dates of service on or after 1/7/2022, the Centers for Medicare & Medicaid Services is removing current procedural terminology code 67911 (correction [...]

Coronavirus Resources for Home Care and Hospice

Coronavirus Resources for Home Care and Hospice At National Government Services, the health and well-being of our beneficiary and provider communities is our top priority. The Centers for Medicare & Medicaid Services’ COVID-19 web page is [...]

Home Health Bill Type 32A Returning with Reason Code 32114

Home Health Bill Type 32A Returning with Reason Code 32114 The Centers for Medicare & Medicaid Services implemented new home health bill type 32A effective 1/1/2022. An issue with ZIP codes submitted on EMC claims has been identified, [...]

December 2021-January 2022 LCD and Billing and Coding Article Updates

December 2021-January 2022 LCD and Billing and Coding Article Updates Billing and Coding: Autonomic Function Testing (A57024) Due to the annual CPT/HCPCS code updates, effective 1/1/2022, CPT code 95943 has been deleted from the CPT/HCPCS [...]

MLN Connects® Newsletter for Thursday, November 18, 2021

MLN Connects® Newsletter for Thursday, November 18, 2021 COVID-19: Changes to Nursing Home Visitation & Survey Activities   News CMS Repeals MCIT/R&N; Will Consider Other Coverage Pathways to Enhance Access to Innovative [...]

MLN Connects® Newsletter for Thursday, November 4, 2021

MLN Connects® Newsletter for Thursday, November 4, 2021 COVID-19: Changes for Medicare Advantage Plan Claims Starting January 1   News COVID-19 Vaccines for Children COVID-19 Vaccine & Monoclonal Antibody Products: Changes for [...]

MLN Connects® Special Edition for Friday, September 24, 2021

MLN Connects® Special Edition for Friday, September 24, 2021 CMS Will Pay for COVID-19 Booster Shots, Eligible Consumers Can Receive at No Cost Coverage without cost-sharing available for eligible people with Medicare, Medicaid, CHIP, and [...]

MLN Connects® Newsletter for Thursday, September 30, 2021

MLN Connects® Newsletter for Thursday, September 30, 2021 Flu Season is Here: Protect Your Patients, Yourself, & Your Loved Ones View this edition as a: Webpage | PDF News Flu Season is Here: Protect Your Patients, Yourself, [...]

MLN Connects® Special Edition for Monday, September 20, 2021

MLN Connects® Special Edition for Monday, September 20, 2021 Help CMS Improve Your Experience with Provider Resources CMS is conducting a study to help us improve your experience with resources about the Medicare program and correct billing. [...]

MLN Connects® Newsletter for Thursday, August 19, 2021

MLN Connects® Newsletter for Thursday, August 19, 2021 COVID-19: Vaccinate Your Patients View this edition as a: Webpage | PDF News Immunization: Medicare Covers Vaccines Compliance Chiropractic Services: Comply with Medicare [...]

MLN Connects® Newsletter for Thursday, August 26, 2021

MLN Connects® Newsletter for Thursday, August 26, 2021 Health Care Code Sets: ICD-10 — Revised View this edition as a: Webpage | PDF News Impact of the PHE on Telehealth: Comparative Billing Report in August COVID-19 Monoclonal [...]

MLN Connects® Newsletter for Thursday, September 9, 2021

MLN Connects® Newsletter for Thursday, September 9, 2021 SNF: WBT & COVID-19 Reminder View this edition as a: Webpage | PDF    News PEPPERs for Short-term Acute Care Hospitals Outpatient Clinic Visit Services at [...]

MLN Connects® Special Edition for Friday, August 13, 2021

MLN Connects® Special Edition for Friday, August 13, 2021 COVID-19 Vaccine Additional Dose Medicare stands ready to pay for administering an additional dose of COVID-19 vaccine consistent with the FDA EUA. We’ll pay the same amount to [...]

MLN Connects® Newsletter for Thursday, July 15, 2021

MLN Connects® Newsletter for Thursday, July 15, 2021 View this edition as a: Webpage | PDF News Cognitive Assessment: Resources for Providers CMS Opens National Coverage Determination Analysis on Treatment for Alzheimer’s Disease [...]

MLN Connects® Newsletter for Thursday, July 29, 2021

MLN Connects® Newsletter for Thursday, July 29, 2021 Hospital Price Transparency Stakeholder Webinar — August 11 View this edition as a: Webpage | PDF Compliance Ambulance Services & SNF Consolidated Billing Requirements: Avoid [...]

MLN Connects® Special Edition for Tuesday, July 13, 2021

MLN Connects® Special Edition for Tuesday, July 13, 2021 CMS Proposes Physician Payment Rule to Improve Health Equity, Patient Access CMS is proposing changes to address the widening gap in health equity highlighted by the COVID-19 Public [...]

MLN Connects® Special Edition for Monday, July 19, 2021

MLN Connects® Special Edition for Monday, July 19, 2021 CMS Proposes Rule to Increase Price Transparency, Access to Care, Safety & Health Equity CMS is proposing actions to address the health equity gap, ensure consumers have the [...]

Laboratory Date of Service Policy

MLN Connects® Newsletter for Thursday, March 24, 2022

MLN Connects® Newsletter for Thursday, March 24, 2022 ICD-10: Comment on Proposed Procedure and Diagnosis Codes News Additional Residency Positions: Apply by March 31 Long-term Care Hospitals: March Preview Period Ends April 6 [...]

Award of Medicare Administrative Contractor Contract for Jurisdiction K

Award of Medicare Administrative Contractor Contract for Jurisdiction K CMS selected National Government Services to retain the JK MAC contract. As a result, there will be no changes to your service or the support we provide you. NGS looks [...]

April 2022 LCD and Billing and Coding Article Updates

April 2022 LCD and Billing and Coding Article Updates LCDs Effective 4/1/2022 Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) (L33559/A56737) The LCD was returned for comment from 6/3/2021 through [...]

MLN Connects® Special Edition for Wednesday, March 30, 2022

MLN Connects® Special Edition for Wednesday, March 30, 2022 Fiscal Year 2023 Hospice Payment Rate Update Proposed Rule - Comment by May 31 On March 30, CMS issued a proposed rule (CMS-1773-P) that would provide routine updates to [...]

New Evaluation and Management Frequently Asked Questions for Prolonged Services

New Evaluation and Management Frequently Asked Questions for Prolonged Services We’ve added new frequently asked questions to the Prolonged Services section of our E/M FAQs to clarify proper billing for CPT codes 99354-99356, 99358-99359, and [...]

MLN Connects® Special Edition for Monday, April 4, 2022

MLN Connects® Special Edition for Monday, April 4, 2022 Biden-Harris Administration Announces a New Way for Medicare Beneficiaries to Get Free Over-the-Counter COVID-19 Tests On April 4, The Biden-Harris Administration announced that more [...]

MLN Connects® Special Edition for Wednesday, April 6, 2022

MLN Connects® Special Edition for Monday, April 6, 2022 Eligible Individuals Can Receive Second COVID-19 Booster Shot at No Cost On April 6, CMS announced it will pay for a second COVID-19 booster shot of either the Pfizer-BioNTech or Moderna [...]

Prior Authorization Process for Repetitive Scheduled Nonemergent Ambulance Transport

Prior Authorization Process for Repetitive Scheduled Nonemergent Ambulance Transport The Repetitive, Scheduled Nonemergent Ambulance Transport Prior Authorization Model establishes a process through which a request for provisional affirmation [...]