Failure to Report a Change in Bank Account Information

Failure to Report a Change in Bank Account Information Providers who fail to report a change in bank account information will result in suspension of Medicare payment and termination of Medicare billing privileges. All changes initiated by [...]

Revocation

Revocation CMS may revoke a currently enrolled provider or supplier's Medicare billing privileges and any corresponding provider or supplier agreement for the following reasons: Abuse of billing privileges Failure to document or provide [...]

Failure to Report a Critical Change

Failure to Report a Critical Change Providers and suppliers enrolled in Medicare are required to ensure strict compliance with Medicare regulations by submitting updates and changes to enrollment information in accordance with specified [...]

Failure to Complete Revalidation

Failure to Complete Revalidation Avoid claims being rejected or termination of Medicare billing privileges by responding: by the revalidation due date timely to additional information requested Related Content Medicare Revalidation [...]

Global Period Services - HCPCS Code G0559

Global Period Services - HCPCS Code G0559 As of 1/1/2025, CMS has implemented HCPCS Code G0559 to capture work performed by a provider other than the performing surgeon during the global period associated with most surgical procedures. The [...]

Deactivation of Billing Privileges/Suspension of Payment

Reasons for Deactivation of Medicare Billing Privileges/Suspension of Payment (not all inclusive) Inactivity Failure to complete revalidation within required time frame Unreported provider address and/or bank information Inactivity [...]

Annual Wellness Visit Screening

Preventive Services Guide Annual Wellness Visit Screening Table of Contents Annual Wellness Visit Screening Coverage Criteria Two Types of AWV Elements Elements of Initial AWV Personalized Prevention Plan Services – [...]

Maine, Massachusetts, New Hampshire, Rhode Island and Vermont

Maine, Massachusetts, New Hampshire, Rhode Island, Vermont Member Name Professional Title Association Business Name/Address Email Bedard, Brenda Insurance Compliance & Training Supervisor Maine [...]

Medicare Change of Status Notice

Medicare Change of Status Notice Attention: Hospitals, including CAHs and other providers billing Medicare for inpatient services. The Medicare Change of Status Notice (MCSN) became effective 10/11/2024 and implemented 2/15/2025. Hospitals, [...]

Alcohol Misuse and Counseling

Preventive Services Guide Alcohol Misuse and Counseling Table of Contents Alcohol Misuse and Counseling Two-Part Benefit Cost Sharing Reimbursement Nonparticipating Providers Common Claim Denial Reasons Related Content [Return [...]

Initial Preventive Physical Examination

Preventive Services Guide Initial Preventive Physical Examination The IPPE is also known as the “Welcome to Medicare Preventive Visit.” The goals of the IPPE are health promotion and disease detection and prevention. Table of Contents [...]

MLN Connects® Newsletter: February 24, 2025

MLN Connects® Newsletter: February 24, 2025 Compliance Mechanical Ventilation: Bill Correctly for Inpatient Claims Claims, Pricers, & Codes Discarded Drugs & Biologicals: Orphan Drugs with Increased Applicable Percentage for [...]

Standard Companion Guides

Standard Companion Guides Standard Companion Guide Trading Partner Information (275) Standard Companion Guide Trading Partner Information (277) Standard Companion Guide Trading Partner Information (278/275) Standard Companion Guide Health [...]

Institutional Providers: Revised CMS-855A Version (09/24) Medicare Enrollment Application

Institutional Providers: Revised CMS-855A Version (09/24) Medicare Enrollment Application  Available now is the revised CMS-855A (09/24) paper application that includes a section for SNF to comply with the 2023 Final rule in reporting [...]

Accreditation of Advanced Diagnostic Imaging and FDA Mammography Equipment

Accreditation of Advanced Diagnostic Imaging and FDA Mammography Equipment Reminder, if a hospital, clinic/group or Independent Diagnostic Treatment Facility has ADI screening equipment, certification from a designated ADI accrediting [...]

Accreditation of Advanced Diagnostic Imaging and FDA Mammography Equipment

Reminder, if a hospital, clinic/group or Independent Diagnostic Treatment Facility has ADI screening equipment, certification from a designated ADI accrediting organization needs to be implemented or updated on the Medicare enrollment. The [...]

Audit and Reimbursement

Audit and Reimbursement Cost Report Filing State/Region Contact Information Jurisdiction 6 J6_cost_report_filing@anthem.com Jurisdiction K JK_cost_report_filing@anthem.com Provider Statistical [...]

Audit and Reimbursement

Audit and Reimbursement Cost Report Filing State/Region Contact Information Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont JK_Cost_Report_Filing@anthem.com FQHC (All), [...]

MLN Connects® Newsletter: February 28, 2025

MLN Connects® Newsletter: February 28, 2025 CMS Provider Education Message: Hospitals: Actions to Make Healthcare Prices Transparent Update: On February 25, the White House issued an Executive Order to empower patients with clear, accurate, [...]

National Correct Coding Initiative

National Correct Coding Initiative We recently introduced the NCCI Lookup Tool on our Part B Tools and Calculators page. This tool is designed to assist providers in identifying codes subject to automated prepayment edits, thereby facilitating [...]

Standard Companion Guides

Standard Companion Guides Standard Companion Guide Trading Partner Information (275) Standard Companion Guide Trading Partner Information (277) Standard Companion Guide Trading Partner Information (278/275) Standard Companion Guide Health [...]

New Medicare Part B Redetermination Notice Initiative – Implementation Delayed

New Medicare Part B Redetermination Notice Initiative - Implementation Delayed As we’ve communicated recently, National Government Services will be starting a new initiative for providers who submit Medicare Part B Redetermination requests [...]

Modifier/Code List

Modifier/Code List CMS established a new modifier, AB, for audiologists to use that describes: audiology service furnished personally by an audiologist without a physician/NPP order for non-acute hearing assessment unrelated to disequilibrium, [...]

FQHC PPS Calculator

FQHC PPS Calculator 4/1/2025-12/31/2025 1/1/2025-3/31/2025 1/1/2024-12/31/2024 2023 2022 2021 2020 2019 Revised 3/5/2025

Privacy Notice Policy

Privacy Notice Policy National Government Services, Inc. (NGS) is a contractor with the Centers for Medicare & Medicaid Services (CMS) under the authority granted in Sections 1842, 1862(b) and 1874 of Title XVIII of the Social Security Act [...]

Contractor Advisory Committee Meeting Records

Contractor Advisory Committee (CAC) Meeting Records Jurisdiction 6 and Jurisdiction K CAC Meeting Records Meeting Date Audio Transcript Key Questions Bibliography 2/3/2025 - Topic: Peripheral Nerve Blocks [...]

Home Health Billing When a New MBI is Assigned

Home Health Billing When a New MBI is Assigned A patient’s MBI number is required on all home health billing submitted to Medicare. CMS will issue a new MBI when an original MBI may have been, or has been compromised. There are times a home [...]

MLN Connects® Newsletter: March 6, 2025

MLN Connects® Newsletter: March 6, 2025 News Therapy Services: Get Updates for CY 2025 Hospitals: Apply for Additional Residency Positions by March 31 Compliance Oral Anticancer & Antiemetic Drugs: Prevent Claim Denials Claims, [...]

ASC Claim Hold Until 1/28/2025

Due to a January 2025 fee schedule pricing correction, CMS has instructed Part B MACs to hold Part B ASC claims impacted by CBSA updates until 1/28/2025. ASC claims not impacted by CBSA updates may be impacted by a 10-day hold. 

Understanding the Strength of Medical Evidence

Immunization Roster Billing

Immunization Roster Billing Table of Contents Immunization Roster Billing Claim Submission Options for Roster Billing Electronic Claim Submissions Paper Claim Submissions Vaccine Billing and Coding Resources [Return to Top] [...]

Hepatitis B Virus Vaccine and Administration

Preventive Services Guide Hepatitis B Virus Vaccine and Administration Hepatitis B is a virus that can damage the liver; it is spread through contact with infected blood or body fluids and can be transmitted through sex with an infected [...]

Part A Incorrect Dialysis Payments

We have recently become aware of an issue which began on 7/15/2024 where ESRD claims with demo code 94P were finalizing with incorrect payment amounts (overpayments as well as underpayments). The incorrect payment amount is a result of FISS [...]

Understanding the Strength of Medical Evidence In the pursuit of evidence-based medical practice, it is essential to evaluate the quality and strength of scientific research thoroughly. The table below provides a comprehensive ranking of [...]

New York

New York Member Name Professional Title Association Business Name/Address Email Auster, Morris Vice President Division of Socio-Medical Economics Medical Society of the State of New York P. O. Box 5404 [...]

Save the Date! National A/B MAC Ambulance Provider/Supplier Coalition

Save the Date! National A/B MAC Ambulance Provider/Supplier Coalition Attention Ambulance Providers As the MACs celebrate and honor the dedication and contributions to healthcare made by those who provide frontline lifesaving services to our [...]

Transitional Care Management

Transitional Care Management Table of Contents Billing Codes Billing Information Documentation Related Content [Return to Top] Billing Codes 99495: Moderate complexity F2F 7 to 14 days 99496: High complexity F2F 7 days [...]

Medicare Part B Redetermination Notice Initiative Coming Soon

Medicare Part B Redetermination Notice Initiative Coming Soon National Government Services will discontinue issuing paper MRNs for Medicare Part B redetermination requests that are submitted electronically through our portal, NGSConnex. [...]

Claims for Drugs Without a Product-Specific Code Assigned

Claims for Drugs Without a Product-Specific Code Assigned National Government Services has noticed that when a claim RTPs for additional information to be added to the Remarks field concerning certain drugs, some providers attempt to provide [...]

Denials for HCPCS G2211

NCCI editing for HCPCS G2211 code was updated on 12/05/2024 to require HCPCS G0463 as the primary code for G2211 add-on code. This has resulted in denials of claims for the add-code G2211 when billed with CPTs 99202-99205 and 99211-99215. [...]