Return/Reject

Medicare Part B 101 Manual Return/Reject While it's easy to group processed claims as either approved or denied, there are differences in the way claims are returned unpaid by Medicare. Only claims that are filed with complete and correct [...]

Health Professional Shortage Area

Medicare Part B 101 Manual Health Professional Shortage Area What is a HPSA? What is the HPSA Incentive Bonus? Who is Eligible for the Incentive Bonus? How is the Bonus Billed? What Else You Should Know To Learn More [Return to [...]

Assignment of Benefits

Medicare Part B 101 Manual Assignment of Benefits Table of Contents Assignment of Benefits Mandatory Assignment Collecting from Medicare Patients on Assigned Claims Related Content [Return to Top] Assignment of Benefits An [...]

Advance Beneficiary Notice of Noncoverage for Not Reasonable and Necessary Denials

Medicare Part B 101 Manual Advance Beneficiary Notice of Noncoverage for Not Reasonable and Necessary Denials Table of Contents Limited Coverage Medical Necessity Expectations ICD-10-CM Coding Reasons for Noncoverage Beneficiary [...]

Set Up a Beneficiary's Medicare Secondary Payer Record

Table of Contents Background: Set Up a Beneficiary’s Medicare Secondary Payer Record Step 1: Provider Receives New MSP Information for a Beneficiary Step 2: Check for a Matching Medicare Secondary Payer Record for the Beneficiary in the [...]

Modifier 90 Reference to Outside Laboratory

Modifier 90: Reference to Outside Laboratory Modifier 90 is to be used when the billing laboratory refers a specimen to another laboratory for testing. In these cases, the billing laboratory is titled the “referring laboratory” while the [...]

Initiate Patient Status Lookup

Initiate Patient Status Lookup Click the Eligibility Lookup button from the NGSConnex homepage. In the Select a Provider panel, click the Select button next to the applicable provider account. In the Select a Beneficiary panel, [...]

Hospice Payment Rates

Cognitive Assessment and Care Plan Information

Cognitive Assessment and Care Plan Information Select Cognitive Assessment & Care Plan Information from the left-side navigation. The Cognitive Assessment & Care Plan information panel provides information for the following HCPCS [...]

Part B Deductible

Part B Deductible Select Part B Deductible from the left-side navigation. The information displayed in this section will provide the current year’s Part B deductible amount and if available up to four years of additional historical deductible [...]

Beneficiary Eligibility Information Panel

Beneficiary Eligibility Information Panel Table of Contents Beneficiary Eligibility Information Panel Printable View Initiate a New Search [Return to Top] Beneficiary Eligibility Information Panel The Beneficiary Eligibility [...]

Flu Vaccine

Flu Vaccine Select Flu Vaccine from the left-side navigation. You will find the patient's flu vaccination history in this section. The Medicare beneficiary must have active Part B coverage and must not have a date of death on file at the [...]

Hepatitis Screening

Hepatitis Screening Select Hepatitis Screening from the left-side navigation. The Hepatitis Screening panel provides information for the following HCPCS codes. 86704 ‒ Hepatitis B core antibody (HBcAb); total 86706 ‒ Hepatitis B surface [...]

Hospice Payment Rates

Hospice Payment Rates National Government Services publishes hospice rate sheets you can use to validate hospice payments based on your service location. Although FISS is the official payment made by the Medicare Program, you can use the rates [...]

Navigating Medicare Part B Insights for Providers Podcast

Navigating Medicare Part B Insights for Providers Podcast   Listen to our podcast, Navigating Medicare Part B Insights for Providers, on Spotify and Apple Podcasts! We will be posting a new episode on the 2nd and 4th Wednesday of each [...]

Initiate a Prior Authorization Request for OPD Services for Part A Facility

Initiate a Prior Authorization Request for OPD Services for Part A Facility Table of Contents Initiate a Prior Authorization Request Request Details Requestor’s Information Rendering Physician Information Attachments [...]

MLN Connects® Newsletter: October 17, 2024

MLN Connects® Newsletter: October 17, 2024 News Inpatient Psychiatric Facilities: Guidance on All-Inclusive Cost Reporting No-Pay Medicare Summary Notice Mailing Frequency Changed to Every 120 Days Health Literacy: Help Your Patients Get [...]

Interactive Voice Response System

Interactive Voice Response System CMS requires that Medicare contractors offer self-service options to their providers for general inquiries. CMS also requires providers to utilize those self-service options, such as the IVR. National [...]

Skilled Nursing Facility Consolidated Billing

Skilled Nursing Facility Consolidated Billing Back in 1997 as part of the Balanced Budget Act, Congress mandated that payment for the majority of services provided to beneficiaries in a Medicare-covered SNF stay be included in a bundled [...]

Local Coverage Determination

Local Coverage Determination LCDs are developed by the local Medicare contractor in the absence of a national Medicare payment policy. These policies describe specific criteria which determine whether an item or service is covered by Medicare [...]

ABN Modifiers

ABN Modifiers Modifier Description GA Waiver of liability statement issued, as required by payer policy, individual case GX Notice of liability issued, voluntary under payer policy GY Item [...]

American Medical Association and Current Procedural Terminology

American Medical Association and Current Procedural Terminology The AMA is your trusted source for official CPT. The most widely accepted medical nomenclature used to report medical procedures and services under public and private health [...]

CMS Forms and Publications

CMS Forms and Publications CMS publishes and maintains numerous Medicare forms that are used daily by the provider community. Some commonly used forms are: Provider Enrollment CMS-855 forms (CMS-855B, CMS-855I and CMS-855O) Medicare [...]

CMS Regional Offices

CMS Regional Offices CMS has ten RO reorganized in a Consortia structure based on the agency’s key lines of business: Medicare Health Plans Operations Financial Management and Fee-for-Service Operations Medicaid and Children’s Health [...]

Clinical Lab Improvement Amendment 

Clinical Lab Improvement Amendment  CMS regulates all laboratory testing (except research) performed on humans in the U.S. through the CLIA. The objective of the CLIA program is to ensure quality laboratory testing. Although all [...]

Comprehensive Error Rate Testing

Comprehensive Error Rate Testing The CERT program was established by CMS to monitor the accuracy of claim payment in the Medicare FFS Program. The intent of the CERT program is to protect the Medicare Trust Fund by identifying errors and [...]

Electronic Prescribing

Electronic Prescribing In 2013, the eRx Incentive Program for participating and reporting in the Medicare Electronic Prescribing (eRx) Incentive Program ended. The six-month 2014, eRx payment adjustment reporting period began on 1/1/2013 and [...]

Evaluation and Management Documentation Guidelines

Evaluation and Management Documentation Guidelines Health care professionals may use the most current documentation guidelines for the date of service performed. Refer to these resources for guidance: CMS Evaluation and Management AMA [...]

Federal Register

Federal Register The OFR provides access to the official text of: Federal laws Presidential documents Administrative regulations and notices The ACFR oversees the functions of the Federal Register publications system.   For more [...]

Health Insurance Portability and Accountability Act of 1996

Health Insurance Portability and Accountability Act of 1996 The HIPAA was signed in to law to improve and simplify the administration of the Medicare Program under title XVIII of the Social Security Act, the Medicaid program under title XIX [...]

Limitation of Liability (Advance Beneficiary Notice of Noncoverage)

Limitation of Liability (Advance Beneficiary Notice of Noncoverage) Services denied as not reasonable and medically necessary, under section 1862(a) (1) of the Social Security Act, are subject to the Limitation of Liability (ABN) provision. [...]

Medically Unlikely Edits

Medically Unlikely Edits In January 2007, CMS developed MUEs to reduce the paid claims error rate for Part B claims. An MUE for a HCPCS /CPT code is the maximum units of service that a provider would report under most circumstances for a [...]

Medicare Coverage Database

Medicare Coverage Database The Medicare Coverage Database is an administrative and educational tool to assist providers, physicians and suppliers in submitting correct claims for payment. The Medicare Coverage Database features LCDs developed [...]

Medicare Electronic Data Interchange

Medicare Electronic Data Interchange Information about how providers can communicate electronically with the Medicare Program can be found on the CMS website at Medicare Electronic Billing & EDI Transactions. This web page contains EDI [...]

Medicare Fraud and Abuse

Medicare Fraud and Abuse As the CMS MAC for J6 and JK, National Government Services fully supports the CMS initiative for program safeguards and shares the following information for your use: Fraud is the intentional deception or [...]

Medicare Learning Network®

Medicare Learning Network® You will see the MLN logo on our website. The MLN is a registered trademark of the CMS and the brand name for official information health care professionals can trust. CMS’ Catalog of products is available on the [...]

Medicare Provider-Supplier Enrollment with NGS

Medicare Provider-Supplier Enrollment with NGS A Medicare enrollment application would follow the NPI application.   CMS is responsible for NPI application processes and NGS is responsible for processing enrollment applications for [...]

NGS Internet Resources

NGS Internet Resources The NGSMedicare.com website was established by National Government Services in response to the increased usage of the internet as a learning resource for health care professionals. This website is designed to provide [...]

NGSConnex: Overview, Access, Navigation and Eligibility Look Up

NGSConnex: Overview, Access, Navigation and Eligibility Look Up As we’ve communicated, beginning 11/18/2024, Beneficiary Eligibility information will not be offered on the IVR. This includes all beneficiary eligibility information that was [...]