Search Results - NGSMEDICARE

Posting Date: 07/24/2025

Appeals Redeterminations are Only Accepted Once

Appeals Redeterminations are Only Accepted Once National Government Services has seen a large increase in provider submissions of redetermination requests after a redetermination has been requested or completed. Please be aware, once a [...]

Posting Date: 07/24/2025

MLN Connects® Newsletter: July 24, 2025

MLN Connects® Newsletter: July 24, 2025 News 2025 Quality Conference Highlights July 2025 Provider Specific Data for Public Use Files Compliance Remote Patient Monitoring: Use & Bill Correctly Publications & Multimedia [...]

Posting Date: 07/24/2025

Medicare Part B Top 10 Claim Denials

Each quarter, we host this webinar to address the top claim denials we receive. We research and identify common errors and offer solutions to prevent them, which has effectively reduced errors. There will be time following the presentation to [...]

Posting Date: 07/25/2025

Care Management: Principal Care Management Services

As part of a continued series, we’re raising awareness of the benefits of care management. During this webinar, we’ll focus on principal care management services for patients with a single chronic condition. We’ll provide resources and share [...]

Posting Date: 07/25/2025

Care Management: Chronic Care Management

As part of a continued series, we’re raising awareness of the benefits of care management. During this webinar, we’ll focus on chronic care management services for patients with chronic conditions. We’ll share resources and review proper [...]

Posting Date: 07/25/2025

Care Management: Transitional Care Management

As part of a continued series, we’re raising awareness of the benefits of care management. During this webinar, we’ll focus on transitional care management services for Medicare patients. When a physician discharges a Medicare patient from an [...]

Posting Date: 07/25/2025

Care Management: Cognitive Assessment

As part of a continued series, we’re raising awareness of the benefits of care management. During this webinar, we’ll focus on cognitive assessment, which is a separate service that may be billed for patients when you have recognized potential [...]

Posting Date: 07/25/2025

Care Management: Advanced Care Planning

As part of a continued series, we’re raising awareness of the benefits of care management. During this webinar, we’ll focus on advanced care planning (ACP) services for patients with chronic conditions. We’ll share resources and review proper [...]

Posting Date: 07/25/2025

Care Management: Behavioral Health Integration and Psychiatric Collaborative Care Management

As part of a continued series, National Government Services is raising awareness on the benefits of care management. During this webinar, we’ll discuss behavioral health integration and psychiatric collaborative care management. This service [...]

Posting Date: 03/27/2025

Ambulance Billing Guidance

Ambulance Billing Guidance Table of Contents Ambulance Billing Ambulance Billing HCPCS Codes How to Bill Units with Transpiration HCPCS Codes Using Ambulance Modifiers When Billing Transportation Indicators Related Content [Return [...]

Posting Date: 07/25/2025

Acute Care Hospitals: A Peek Inside the Three-Day Payment Window

To prevent return to provider (RTP) claims, join us for this webinar in which we will review the three-day payment window policy (aka bundling, preadmission services, diagnosis-related group (DRG) window, 72-hour rule) and provide billing [...]

Posting Date: 07/25/2025

Part A Fundamentals of Medicare

Provide an understanding of the fundamentals of the Original Medicare Program.

Posting Date: 07/26/2025

Call Center Planned Outage Status

Call Center Planned Outage Offline Friday, 8/8/2025

Posting Date: 07/28/2025

CERT Awareness Week Four – We Appreciate Your Efforts

CERT Awareness Week Four – We Appreciate Your Efforts 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 the final in [...]

Posting Date: 07/24/2025

Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE)

Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE) L39226 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39226 A58963 https://www.cms.gov/medicare-coverage-database/view/article.aspx?article[...]

Posting Date: 10/04/2024

Cervical Fusion

Cervical Fusion L39770 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39770 A59632 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=59632 A59772 [...]

Posting Date: 07/28/2025

Provider Enrollment: Opioid Treatment Program

During this webinar, we’ll provide a brief overview of an Opioid Treatment Program (OTP) provider, an understanding of submitting the CMS-855A or CMS-855B paper application and how to complete the provider enrollment Internet-based Provider [...]

Posting Date: 07/28/2025

Method II CAH Claims Not Paying Professional Services with Revenue Codes 096x-098x

Certain CAH claims (TOB 85X) with professional service revenue codes 096x – 098X did not process for payment because the fee amount was not correctly retrieved during processing. The affected claims have receipt/processed dates in October 2024.

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 [...]

Posting Date: 07/29/2025

Automated CMS System for Tracking Audit and Reimbursement Calculated Tentative

Automated CMS System for Tracking Audit and Reimbursement Calculated Tentative Beginning with cost reports received on or after 7/14/2025, all hospital cost reports will process through the automated CMS STAR Calculated Tentative. With this [...]

Posting Date: 07/29/2025

Tobacco Cessation Counseling Doesn’t Have To Be Lengthy or Intimidating

Tobacco Cessation Counseling Doesn’t Have To Be Lengthy or Intimidating Did you know that tobacco cessation counseling is a covered Medicare service? Brief tobacco counseling provides substantial health benefits while producing cost savings. [...]