Site Visits

Site Visits Site visits may be required for certain providers and will be unannounced; the contractor representatives must disclose to the provider appropriate identifying credentials and explain the purpose of the visit. The CMS has [...]

PECOS Self-Service Application Status

PECOS Self-Service Application Status You may run simple search queries to retrieve and view the status of your PECOS application. Individual ‒ View the enrollment application status of an individual provider in an organization or private [...]

Check Provider Enrollment Application Status

Check Provider Enrollment Application Status You may run simple search queries to retrieve and view the status of your CMS-855 application via two options. Case number/web tracker id NPI and TIN combination Related Content Check [...]

Interactive Voice Response System

Interactive Voice Response System You may check the status of your provider enrollment application (PECOS or paper) submissions via the IVR by: Case number/web tracker id or NPI and TIN combination Related Content Interactive Voice [...]

Approval or Denial

Approval or Denial Approval Once your application is approved, you will receive an emailed, faxed or mailed Medicare letter with PTAN. Review this letter to ensure that everything is accurate and if you have any questions, please contact the [...]

Approval or Denial

Approval or Denial Approval Once your application is approved, you will receive an emailed, faxed or mailed Medicare letter with PTAN. Review this letter to ensure that everything is accurate and if you have any questions, please contact the [...]

Requests for Additional Information

Requests for Additional Information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Sign and Submit the Application(s)

Credit Balance Reminder: Submissions For Quarter Ending 6/30/2024 Start Soon!

Credit Balance Reminder: Submissions For Quarter Ending 6/30/2024 Start Soon! CBR submissions can be submitted starting on 7/1/2024 and are due within 30 days to be considered timely. Remember, even if no monies are owed to Medicare for this [...]

Accelerated Payment Program Available for Providers Impacted by the Ascension Health Cyber Related Incident (CRI)

Accelerated Payment Program Available for Providers Impacted by the Ascension Health Cyber Related Incident Part A Providers experiencing cash flow problems related to Ascension Health CRI, which began on 5/8/2024, may be eligible for [...]

PECOS Enrollment Process and Advantages

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 25th Sessions!

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 25th Sessions! We’re wrapping up our Medicare Part B 2024 Spring/Summer Virtual Conference with education [...]

Provider Enrollment

Provider Enrollment The National Government Services Provider Customer Care Department has direct telephone lines available for provider enrollment inquiries. Who should I call for technical issues regarding PECOS, EUS Helpdesk or MAC? CMS [...]

Provider Enrollment

Provider Enrollment The National Government Services Provider Customer Care Department has direct telephone lines available for provider enrollment inquiries. Who should I call for technical issues regarding PECOS, EUS Helpdesk or MAC? CMS [...]

Opt Out and Private Contracting

Opt Out and Private Contracting Opt out does not require a physician or practitioner to initially enroll with Medicare or complete a CMS-855I application. Opting out of Medicare allows a physician or practitioner to render services to [...]

Renewal to the Medicare Opt-Out Law for Physicians and Practitioners

Renewal to the Medicare Opt-Out Law for Physicians and Practitioners Prior to enactment of the MARCA of 2015, physician or practitioner opt-out affidavits were only effective for two years. As a result of changes made by MACRA, valid opt-out [...]

Opt-Out Physician or Practitioner Providing Emergency or Urgent Care

Opt-Out Physician or Practitioner Providing Emergency or Urgent Care In an emergency or urgent situation, a physician or practitioner who opts out may treat a Medicare beneficiary with whom they do not have a private contract. In this [...]

Providers Not Eligible to Opt Out and Enter Into Private Contracts

Providers Not Eligible to Opt Out and Enter Into Private Contracts Providers Who May Not Opt Out of the Medicare Program Chiropractors Opt-out law does not define ‘physician’ to include chiropractors; therefore, they may not opt out of [...]

Instructions to File

Instructions to File The requirements to opting out of Medicare are included on the forms. First, at least one private contracting agreement form must be signed between the physician or practitioner and a beneficiary. Second, the physician [...]

Requirements of Medicare Private Contracting Agreement

Requirements of Medicare Private Contracting Agreement Amendment 4507 of the Balanced Budget Act of 1997 permits a physician or practitioner to “opt out” of Medicare and enter into private contracts with Medicare beneficiaries. Under the [...]

Approval or Denial

Approval or Denial Once your affidavit is approved, you will receive an approval letter of opt-out status along with the opt-out effective date. Review this letter to ensure that everything is accurate and if you have any questions, please [...]

Requests for Additional information

Requests for Additional information While processing the affidavit, National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days from [...]

Organizations That Furnish Physician or Practitioner Services

Organizations That Furnish Physician or Practitioner Services Opt-out regulations apply to all items or services the physician or practitioner furnishes to Medicare beneficiaries, regardless of the location where such services are furnished. [...]

Early Termination for First Time Opt-Out Providers

Early Termination for First Time Opt-Out Providers Opt-out affidavits are effective for two years and cannot be terminated early unless during the first time opt-out period and within 90 days of the effective date of the affidavit. A request [...]

2024 DMEPOS HCPCS Jurisdiction Listing

MLN Connects® Newsletter: June 20, 2024

MLN Connects Newsletter: June 20, 2024 News CMS Preparing to Close Program that Addressed Medicare Funding Issues Resulting from Change Healthcare Cyber-Attack Federal Study Examines Care Following Nonfatal Overdose Among Medicare [...]

Medicare Coverage Exclusion: Dental Services

Medicare Coverage Exclusion: Dental Services It is imperative that our providers are educated regarding the exclusion of dental services from the Medicare Program. Medicare generally does not cover dental services. Since the inception of [...]

Medicare Coverage Exclusion: Dental Services

Medicare Coverage Exclusion: Dental Services Table of Contents Medicare Coverage Exclusion: Dental Services Dental Services Excluded Under Medicare Part B Exceptions to Dental Service Exclusion Inpatient Services in Connection With [...]

Standard Companion Guide Health Care Claim: Dental (837D)

ADR Documentation List by Reason Code

The Exemption Process: Additional Documentation Request Suggested list of documentation for all services to submit to National Government Services Note: Please remember, this is not an all-inclusive list Blepharoplasty, Eyelid Surgery, Brow [...]

People with Medicare

Welcome! Please note that the Medicare website at https://www.medicare.gov is the official U.S. government site for the Medicare Program and your primary source for Medicare information. However, National Government Services also includes links [...]

Medicare Plan Choices

Medicare Plan Choices Your Medicare Health Plan Options Medicare Part D (Prescription Drug Coverage) Medigap Rates and Insurers Find your states’ Department of Insurance What's Medicare Supplement (Medigap) Insurance?

Common Working File (CWF) Host Dark Days for July 2024 Release

Common Working File (CWF) Host Dark Days for July 2024 Release For the upcoming July 2024 Release: For Production, CWF will be observing the Gray Day on Thursday, 6/27/2024 and Dark Days starting Friday, 6/28/2024 through Sunday, 6/30/2024 to [...]

Enrolling in Medicare

Enrolling in Medicare To be eligible to bill and receive direct payment for professional services under Medicare Part B, the medical professional and dentist must be enrolled in Medicare and meet all other requirements for billing under the [...]

Dental Services

Dental Services If you're a new or seasoned provider billing dental services to Fee-for-Service Medicare or Original Medicare, this article guides you through recently clarified payment provisions for dental services in 2023, the provider [...]

New Medicare Provider

New Medicare Provider To assist you in understanding the Medicare Program, visit our New Provider Center and review our Medicare Part B 101 Manual; which will provide you with an overview and additional resources. The Part B Provider Outreach [...]

Inpatient Services in Connection With Dental Procedures

Inpatient Services in Connection With Dental Procedures When a patient is an inpatient of a hospital for a dental procedure and the dentist's service is covered under Part B, the inpatient hospital services furnished are covered under Part [...]

Modifier GY

Modifier GY Providers should be aware of the guidelines for submitting the noncovered outpatient dental service for a denial when the patient has supplemental insurance or if a denial is needed for any other reason. Modifier GY is reported [...]

Attention Clearinghouses and Vendors!

Attention Clearinghouses and Vendors! National Government Services is ready to accept Medicare Part B dental claims from your dental providers using the 837D dental claim transaction. Dental providers have the following options for submission [...]

Opt Out Search

Opt Out Search Doctors/practitioners included in the opt out database are those who have elected to “opt out” of the Medicare Program and enter into private contracts with Medicare beneficiaries if specific requirements are met. By “opting [...]