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Posting Date: 12/20/2024
Fraud and Abuse_Part A_B_FQHC_HHH
Fraud & Abuse Fraud & Abuse Medicare fraud can cost the United States government hundreds of millions of dollars each year and the dollars lost increase the strain on the Medicare Trust Fund. CMS works with other government contractors and law [...]
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Posting Date: 12/20/2024
What Is Fraud_Part A_B_FQHC_HHH
What Is Fraud? What Is Medicare Fraud? Medicare Fraud is intentionally submitting false information to a government contractor to receive money or a benefit by knowingly and willfully executing a scheme to defraud this health care benefit [...]
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Posting Date: 12/20/2024
What Is Abuse_Part A_B_FQHC_HHH
What Is Abuse? What Is Abuse? Abuse describes incidents or practices that are: not medically necessary as defined by Medicare guidelines; or inconsistent with accepted sound medical, business or fiscal practices. Abuse occurs when individuals [...]
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Posting Date: 12/20/2024
How Do I Report Suspected Fraud_Part A_B_FQHC_HHH
How Do I Report Suspected Fraud? How Do I Report Suspected Fraud? Table of Contents How Do I Report Suspected Fraud? Department of Health and Human Services OIG CMS Fraud Prevention Tools Instructions for Accessing the Medscape Modules [Return [...]
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Posting Date: 06/02/2023
Billing Original Fee-for-Service Medicare? You Can Help STOP Assignment Violations!
Billing Original Fee-for-Service Medicare? You Can Help STOP Assignment Violations! Table of Contents Billing Original Fee-for-Service Medicare? You can Help STOP Assignment Violations! What is the Definition of Medicare Assignment? [...]
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Posting Date: 12/20/2024
Part A Fall 2024 Virtual Conference Playback
Part A Fall 2024 Virtual Conference Playback As part of our efforts to educate our provider community, we have posted all 16 educational sessions from our recent Part A Fall 2024 Virtual Conference: Keeping Compliant with Medicare Starts [...]
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Posting Date: 07/11/2023
Overcoming Barriers to Tobacco Counseling
Overcoming Barriers to Tobacco Counseling Healthcare providers do face several challenges when implementing tobacco cessation counseling into a clinical practice routine. These various factors influence the healthcare professionals’ [...]
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Posting Date: 01/30/2020
DX Proc Codes ICD-10 (1B)
Chapter IV: Inquiries Submenu (01) DX Proc Codes ICD-10 (1B) Purpose The purpose of the DX/PROC CODES ICD-10 option is to provide a reference of ICD-10 code(s) used to identify a specific or various diagnosis codes or inpatient surgical [...]
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Posting Date: 11/15/2022
Proper Billing for TEZSPIRE™ HCPCS Code J2356
Proper Billing for TEZSPIRE™ HCPCS Code J2356 Table of Contents Proper Billing for TEZSPIRE™ HCPCS Code J2356 Claim Completion Requirements Drug Wastage Appropriate Administration Coding Related Content [Return to Top] Proper [...]
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Posting Date: 12/31/2024
Virtual Multi-Jurisdictional Town Hall Meeting To Be Held 12/10/2024
Virtual Multi-Jurisdictional Town Hall Meeting To Be Held 12/10/2024 National Government Services, along with Novitas Solutions and First Coast Service Options, CGS Administrators, Noridian Healthcare Solutions, Palmetto GBA and WPS Government [...]
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Posting Date: 12/16/2021
Other Medicare Contacts
Other Medicare Contacts Organization Contact Information ALJ BP Tower & Garage 200 Public Square, Suite 1300 Cleveland, OH 44114-2316 American Medical Association Website [...]
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Posting Date: 12/16/2021
Other Medicare Contacts
Other Medicare Contacts Organization Contact Information ALJ BP Tower & Garage 200 Public Square, Suite 1300 Cleveland, OH 44114-2316 American Medical Association Website Phone: [...]
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Posting Date: 01/26/2021
Other Medicare Contacts
Other Medicare Contacts Organization Contact Information ALJ BP Tower & Garage 200 Public Square, Suite 1300 Cleveland, OH 44114-2316 American Medical Association Website Phone: [...]
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Posting Date: 01/02/2025
Magnetic Resonance Angiography (MRA)
Magnetic Resonance Angiography (MRA) gadolinium, contrast, imaging L33633 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33633 A56747 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56747 70544, [...]
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Posting Date: 01/02/2025
Who is My LSO?
Who is My LSO? Select the Manage Account button on the NGSConnex home page. Select User Profile and scroll down to the ‘System Access’ section. Select the Checkbox next to the provider record you want to determine the LSO for. [...]
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Posting Date: 07/18/2023
Medical Review: Targeted Probe and Educate Review Topics
Jurisdiction 6 Part A Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Nail Debridement 11719-11721 55B23– The service provided is not covered Medicare benefit. [...]
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Posting Date: 01/02/2025
LCD/Billing and Coding Article Updates – December 2024–January 2025
LCD/Billing and Coding Article Updates – December 2024–January 2025 Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG) (L39189) – Effective 12/15/2024 Under the Indications of Coverage, added the following language: "The use of [...]
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Posting Date: 07/15/2022
LSO Responsibilities
LSO Responsibilities The LSO is responsible for managing and monitoring access for other NGSConnex users within the organization. LSOs are responsible for approving access to users requesting data access to a specific provider account [...]
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Posting Date: 01/03/2025
All LOBs - Customer Xperience
Thank You For Your Feedback! /web/ngs/news-article-details?selectedArticleId=11220579
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Posting Date: 01/03/2025
12/12/2024 Part B POE Advisory Group Meeting
12/12/2024 Part B POE Advisory Group Meeting Meeting Minutes Meeting Time: 10:00 a.m.‒12:00 p.m. ET Member Attendees: Elizabeth Aldrich, Dawson Ballard, Doris Barnes, Sheila Bembeneck, Madelon Berger, Louise Bertrand, Kimberly Bischel, [...]
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Posting Date: 01/03/2025
Billing and Coding: Bevacizumab and Biosimilars
Billing and Coding: Bevacizumab and Biosimilars drug, retinal A52370 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=52370 C9257, J3590, J9035, Q5107, Q5118, Q5126, Q5129, 67028
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Posting Date: 01/03/2025
Cardiac Catheterization and Coronary Angiography
Cardiac Catheterization and Coronary Angiography heart, circulatory L33557 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33557 A52850 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=52850 36140, [...]
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Posting Date: 01/03/2025
Facet Joint Interventions for Pain Management
Facet Joint Interventions for Pain Management Radiofrequency, Neurotomy, pain, cervical, lumbar, thoracic L35936 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdId=35936 A57826 [...]
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Posting Date: 01/03/2025
Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms
Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms N/A L37810 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=37810 A56867 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=5686[...]
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Posting Date: 01/03/2025
Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor
Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor N/A L37421 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=37421 A57435 https://www.cms.gov/medicare-coverage-database/view/article.aspx?art[...]
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Posting Date: 01/03/2025
Molecular Pathology Procedures
Molecular Pathology Procedures genetic testing, genetic counseling, gene, Tier 1, Tier 2 L35000 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=35000 A56199 https://www.cms.gov/medicare-coverage-database/view/article.aspx?arti[...]
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Posting Date: 01/03/2025
Noninvasive Vascular Studies
Noninvasive Vascular Studies NonInvasive, leg, clot, plethysmography, duplex scan, Doppler, cerebrovascular, arterial, venous, hemodialysis L33627 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33627 A56758 [...]
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Posting Date: 01/03/2025
Off-Label Use of Intravenous Immune Globulin (IVIG)
Off-Label Use of Intravenous Immune Globulin (IVIG) L39314 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39314 A59105 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=59105 A59251 [...]
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Posting Date: 01/03/2025
Outpatient Physical and Occupational Therapy Services
Outpatient Physical and Occupational Therapy Services maintenance, restorative, skilled, modality, therapeutic, exercise, manual, cast, splint, biofeedback L33631 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33631 A56566 [...]
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Posting Date: 01/03/2025
Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane)
Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™) drug A52450 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=52450 J9264, J9267
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Posting Date: 01/03/2025
Psychiatric Partial Hospitalization Programs
Psychiatric Partial Hospitalization Programs mental illness, family counseling, vocational training L33626 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33626 A56850 [...]
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Posting Date: 01/03/2025
Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)
Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) ionizing, stereotactic guidance, robotic L35076 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=35076 A56874 [...]
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Posting Date: 01/03/2025
Self-Administered Drug Exclusion List - Medical Policy Article (Jurisdiction 6 Only)
Self-Administered Drug Exclusion List - Medical Policy Article (Jurisdiction 6 Only) SAD A53022 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=53022 C9399, J0129, J0139, J0270, J0364, J0593, J0599, J0630, J0801, [...]
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Posting Date: 01/03/2025
Self-Administered Drug Exclusion List - Medical Policy Article (Jurisdiction K Only)
Self-Administered Drug Exclusion List - Medical Policy Article (Jurisdiction K Only) SAD A53021 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=53021 C9399, J0129, J0139, J0270, J0364, J0593, J0599, J0630, J0801, [...]
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Posting Date: 01/06/2025
Time Requirements to Notify Medicare of Changes
Report Changes to Your Enrollment Records You must report changes of information in your Medicare enrollment records within 30 days for: Change(s) in ownership or control, including changes in authorized officials(s) All other changes to [...]
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Posting Date: 01/02/2025
Proper Submission of Reopening Requests
Proper Submission of Reopening Requests National Government Services has identified an issue where providers are submitting reopening requests to change or add diagnosis codes on paid claims. These reopening requests do not impact the outcome [...]
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Posting Date: 01/08/2025
Fourth Quarter Top Ten EDI Institutional Edits
Fourth Quarter Top Ten EDI Institutional Edits Using data analysis, we’ve updated the Top Ten EDI Edits for the 2024 fourth quarter. Visit Quarterly Top Ten EDI Institutional Edits to view the edits, their description and learn what you can [...]
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Posting Date: 01/07/2025
Using Nicotine Replacement Therapy for Smoking Cessation
Using Nicotine Replacement Therapy for Smoking Cessation Healthcare providers may choose to offer quit smoking medications to help reduce withdrawal symptoms and cigarette cravings, effectively doubling the chances of quitting successfully. [...]
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Posting Date: 05/06/2016
Inpatient Admission Prior to Medicare Entitlement Job Aid
Inpatient Admission Prior to Medicare Entitlement Job Aid Pre-Entitlement Quick Steps Pre-entitlement is when a beneficiary is admitted as an inpatient to an acute care hospital prior to the beneficiary's Medicare entitlement effective date [...]
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