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Posting Date: 07/01/2025
New Recovery Audit Contractor
New Recovery Audit Contractor On 4/28/2025, CMS awarded Cotiviti GOV Services LLC the RAC contracts for Region 5 . Region 5 encompasses JA, JB, JC, JD, and the HHH MACs: J6, J15, JK, and JM. Performant previously managed Region 5 and will [...]
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Posting Date: 11/04/2015
Three-Day Qualifying Hospital Stay Required for Medicare-Covered SNF Stay
Three-Day Qualifying Hospital Stay Required for Medicare-Covered SNF Stay Medicare coverage of inpatient SNF services requires a qualifying, medically necessary inpatient hospital stay of at least three consecutive calendar days within 30 [...]
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Posting Date: 07/03/2025
Home Health Billing Coffee Break
Provider Outreach and Education is hosting a 30-minute coffee break to help answer your troublesome billing questions. This is a great opportunity to discuss areas of billing more in depth and review helpful guides and resources. Keep in mind [...]
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Posting Date: 07/03/2025
MLN Connects® Newsletter: July 3, 2025
MLN Connects® Newsletter: July 3, 2025 Proposed Payment Rules ESRD: CY 2026 Proposed Rule — Submit Comments by August 29 Home Health: CY 2026 Proposed Rule — Submit Comments by August 29 News CMS Launches New Model to Target Wasteful, [...]
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Posting Date: 07/03/2025
Medicare Secondary Payer: A Review of the Non-Group Health Plan MSP Provisions
In this webinar, we review the workers’ compensation, No-Fault (including medical-payment coverage) and the Liability Medicare Secondary Payer (MSP) provisions. Understanding these provisions will help your facility identify and bill the [...]
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Posting Date: 07/03/2025
Medicare Secondary Payer: Adjustment Claims
In this webinar, we will review how to prepare and submit adjustments (Type of Bill XX7) to change processed or rejected claims for Medicare Secondary Payer (MSP)-related reasons. We discuss adjusting Medicare primary, MSP, and cost-avoided [...]
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Posting Date: 07/03/2025
Medicare Secondary Payer: Payment and Beneficiary Responsibility
In this webinar, we review how Medicare determines if an Medicare Secondary Payer (MSP) payment is due on a claim, how the MSP payment module determines the amount of an MSP payment, how coding reported on MSP claims can impact payment, and how [...]
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Posting Date: 07/08/2025
Overpayment: How Should I Respond?
Table of Contents Overpayment: How Should I Respond? What Action Should I Take? Complete a Voluntary Refund Where Should I Send my Forms and Payments? [Return to Top] Overpayment: How Should I Respond? An overpayment may be [...]
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Posting Date: 07/08/2025
Request an Immediate Recoupment
National Government Services has implemented a standardized “immediate recoupment” process that gives you the option to avoid interest from accruing on claims overpayments when the debt is recouped in full prior to or by the 30th day from the [...]
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Posting Date: 07/08/2025
Complete a Voluntary Refund
A voluntary refund is when you have self-identified you have been overpaid and you need to refund the excess funds to Medicare. All checks are made payable to National Government Services. Whenever possible, the refund to Medicare should be [...]
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Posting Date: 09/16/2020
Pricing <5>
table, td, th table { border-collapse: collapse; width: 50%; } Pricing <5> When Pricing is selected, the IVR will play the following: "To obtain pricing information, visit NGSMedicare.com and use our fee schedule lookup tool, [...]
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Posting Date: 07/08/2025
Set Up an Extended Repayment Schedule
If repaying an overpayment would constitute a “hardship” on the provider, a request for an ERS should be submitted immediately. While you may request an ERS at any time during the debt-collection process, timely submission of a valid request [...]
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Posting Date: 12/19/2016
Payment Withholding Information
Payment Withholding Information What Is a Payment Withholding? Why Are Payments Withheld? Who Can I Contact for Further Assistance? What About Cost Report Interim and Final Settlement Withholdings? What Is a Payment Withholding? An [...]
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Posting Date: 07/08/2025
MSP Post-Pay Adjustments
If you have received an overpayment because Medicare paid as the primary insurer and another insurance carrier should be the primary payer, follow the instructions on the Part A voluntary refund form. A separate refund form is needed for [...]
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Posting Date: 12/19/2016
Refunds Due to Beneficiaries by Providers
Refunds Due to Beneficiaries by Providers In some situations, providers are responsible for refunding monies to beneficiaries that have paid for services providers have determined to be noncovered and nonpayable by Medicare. When an ABN has [...]
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Posting Date: 07/08/2025
Credit Balance Reporting
Table of Contents What is a Credit Balance? What Should I Do When I Have a Credit Balance? Additional Tips for a Successful Credit Balance Report Submission [Return to Top] What is a Credit Balance? Generally, when a provider [...]
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Posting Date: 09/16/2020
Appeal Status <7>
Appeal Status <7> When Appeal Status is selected, the IVR will request and collect the following information: NPI PTAN TIN HICN or MBI Refer to the Phonetic Alphabet for assistance with speaking alpha characters [...]
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Posting Date: 07/16/2024
Home Health Certifying Provider Change
Home Health Certifying Provider Change Home health certifying physician or NPP changes can occur anytime for a variety of reasons. Some examples may include practitioner retirement or vacation and patient choice. Regardless of the [...]
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Posting Date: 07/09/2025
Let's Chat About Provider Enrollment
During this session, you’ll have the opportunity to ask questions about all aspects of provider enrollment. Answers will be provided by a panel of subject-matter experts. As this is a question-and-answer session, there is no presentation available.
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Posting Date: 07/09/2025
Private Practice Physical/Occupational Therapy Billing
We invite you to join our informative webinar focused on billing guidelines for physical and occupational therapy in private practice. During this webinar, we'll review important topics such as the appropriate use of the KX modifier and the [...]
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Posting Date: 07/09/2025
Private Practice Physical/Occupational Therapy Billing
We invite you to join our informative webinar focused on billing guidelines for physical and occupational therapy in private practice. During this webinar, we'll review important topics such as the appropriate use of the KX modifier and the [...]
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Posting Date: 07/09/2025
NGSConnex: Beneficiary Eligibility, Look Up and MBI Look Up
Knowing if your patient is Medicare eligible is important for correct claims processing. Please join us for this NGSConnex webinar where we will review beneficiary eligibility and look up, help you understand the eligibility panels, learn how [...]
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Posting Date: 07/09/2025
NGSConnex: Local Security Officer Overview, Access and Navigation
This webinar is geared toward all lines of business for those who will be a Local Security Officer (LSO) in the NGSConnex portal. Come join us and see how NGSConnex can make your life a little easier. We will review the responsibilities of an [...]
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Posting Date: 07/09/2025
NGSConnex: Standard User Overview, Access and Navigation
This webinar is geared toward all lines of business for those who will be standard users in the NGSConnex portal. Come join us and see how NGSConnex can make your life a little easier. We will review what NGSConnex has to offer including [...]
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Posting Date: 07/09/2025
NGSConnex: Additional Development Requests and Inquiries
This webinar is for current and future NGSConnex users who want to learn more about viewing and responding to additional development requests sent to you by National Government Services, and how to submit an electronic inquiry to our Provider [...]
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Posting Date: 07/09/2025
Podiatry Services - Routine Foot Care and Debridement of Nails
While the Medicare Program generally excludes routine foot care services from coverage, there are specific indications or exceptions under which there are program benefits. Medicare payment may be made for routine foot care when the patient has [...]
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Posting Date: 01/03/2024
PCACE Full Install Text - ALOB
Version 6.7 (Institutional and Professional) PC-ACE users
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Posting Date: 01/03/2024
About PC-ACE
About PC-ACE The National Government Services PC-ACE free billing software is available for NGS J6 and JK providers only. If you are not a J6 or JK provider, the free billing software must be obtained from your MAC. PC-ACE is a stand-alone [...]
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Posting Date: 01/03/2024
PCACE Download Text - ALOB
The installation code to run the full install or the upgrade for PC-ACE is: NGSMAC1 Important Warning: For PC-ACE version 6.7 updated version: please be patient and allow the full install or update complete. It is important that you do not [...]
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Posting Date: 01/03/2024
About PC-ACE
About PC-ACE The National Government Services PC-ACE free billing software is available for NGS J6 and JK providers only. If you are not a J6 or JK provider, the free billing software must be obtained from your MAC. PC-ACE is a [...]
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Posting Date: 01/03/2024
PCACE Upgrade Text - ALOB
Version 6.7 (Institutional and Professional) PC-ACE users
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Posting Date: 09/30/2024
Provider Enrollment: Reduce Development Requests for Additional Action
Provider Enrollment: Reduce Development Requests for Additional Action In an effort to reduce the request of additional information and/or documentation on provider enrollment applications, verify all required actions are complete prior to [...]
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Posting Date: 01/03/2024
Download PC Print
Download PC Print Please select from the two available versions of PC Print below. PC Print 7.1.5 PC Print 9.3.2 For the most current CARC/RARC code sets with full narrative and business scenarios, please download PC Print 9.3.2. and [...]
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Posting Date: 06/14/2022
Documentation Information
Documentation Information It is recommended that PARs are submitted at least seven calendar days prior to the expected date of service to allow National Government Services (NGS) the full standard timeframe to receive and review requests. [...]
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Posting Date: 07/09/2025
Medicare Global Surgery
Global surgery policy was introduced into Medicare over thirty years ago and still today some of the concepts can be confusing. During this webinar, we'll go through the global surgery policy as it stands today, and cover when the global [...]
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Posting Date: 10/14/2021
Requesting an Exception to Timely Filing
Requesting an Exception to Timely Filing Table of Contents Requesting an Exception to Timely Filing No Appeal Rights for Claims Denied Based on Timely Filing Limit Provider Liability Exceptions that May Allow the Time Limit to be [...]
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Posting Date: 10/20/2021
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 [...]
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Posting Date: 10/20/2021
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 [...]
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Posting Date: 07/07/2025
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 [...]
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Posting Date: 07/09/2025
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 [...]
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