Prolonged Services: Comparative Differences of Face-to-Face/Non Face-to-Face CPT Codes

Prolonged Services: Comparative Differences Face-to-Face vs. Non Face-to-Face CPT Codes Face-to-Face ( CPT Codes 99354-99355, 99356-99357) Non Face-to-Face (CPT Codes 99358-99359) Have been [...]

Prolonged Services: Face-to-Face

Prolonged Services: Face-to-Face Coding Guidelines Counseling and Coordination of Care Office versus Hospital Setting Excluded Time Examples NGS JK MAC has noted an increase in claims representing face-to-face prolonged [...]

Tips to Ensure an Optimal NGSMedicare.com Experience

Tips to Ensure an Optimal NGSMedicare.com Experience Most of you are probably aware, but if not, on Friday, 5/14/2021, we launched our new combined homepage. These changes were a result of your feedback. You now only need to go to [...]

Skilled Nursing Facility Patient Driven Payment Model Billing For Noncovered Days With An Occurrence Span Code 76

Skilled Nursing Facility Patient Driven Payment Model Billing For Noncovered Days With An Occurrence Span Code 76 The CR 11992 updated the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 6, Sections 40.3.2 and 40.6 to [...]

FQHC PPS Calculator

There’s Still Time to Register – National Government Services Preventive Service Week

There’s Still Time to Register – National Government Services Preventive Service Week National Government Services Provider Outreach and Education Team is holding a Special Virtual Conference on Medicare Preventive Services. Join us on [...]

Testosterone Pellet Dosage

Testosterone Pellet Dosage The dosage approved by the US Food and Drug Administration for testosterone pellet replacement therapy in androgen-deficient males is 150 mg to 450 mg subcutaneously every 3-6 months. Effective for dates of [...]

Register for EDI

FISS/DDE

Fiscal Intermediary Standard System/Direct Data Entry DDE is a process that allows remote users online connectivity to the FISS, or mainframe, used by National Government Services to process Medicare claims. FISS/DDE connectivity will allow [...]

FISS/DDE

Fiscal Intermediary Standard System/Direct Data Entry DDE is a process that allows remote users online connectivity to the FISS, or mainframe, used by National Government Services to process Medicare claims. FISS/DDE connectivity will allow [...]

Congressional Offices

The Congressional Affairs Outreach and Education team at National Government Services, Inc. is committed to ensuring that congressional offices receive a timely response to your inquiries and helpful Medicare information. For your convenience, [...]

Appeals

Appeals Reopenings Telephone Reopening Unit Jurisdiction 6 Telephone Reopening Unit Contact Number Hours of Service Illinois 877-867-3418, Press 1 8:00 a.m.–4:00 p.m. CT Closed for training on the [...]

Applying for an Extended Repayment Schedule

DRG (Pricer/Grouper) (11)

Chapter IV: Inquiries Submenu (01) DRG (Pricer/Grouper) (11) Purpose This option will be used by the provider to research PPS information as it pertains to an inpatient stay. To access the DRG (Pricer/Grouper) option from the FISS Online [...]

RSNAT Pre-Pay Review

RSNAT Pre-Pay Review The RSNAT PA program has two components, PAR or prepayment review, which suppliers are able to use their discretion on the path that best suits their workflow. If a RSNAT supplier chooses to forgo the PA process for [...]

Billing and Coding Article Update for August 2023

Billing and Coding Article Update for August 2023 Billing and Coding: Non-Invasive Vascular Studies (A56758) Effective 8/31/2023, the following ICD-10-CM codes were added to the "ICD-10-CM Codes That Support Medical Necessity" section (Group [...]

MLN Connects® Newsletter: August 24, 2023

MLN Connects® Newsletter: August 24, 2023 News Seasonal Flu Vaccine Pricing for 2023–2024 Season Expanded Home Health Value-Based Purchasing Model: July 2023 Interim Performance Reports, Post-Event Materials, & Comment on CY 2024 [...]

Medicare Beneficiary Eligibility Checklist

Tip Sheet #1

National Government Services Office of Congressional Affairs Protocol: Tip Sheet #1 Medicare is changing and we live in a MAC world and this protocol explains the process to help you submit your Medicare constituent inquiries. Today, [...]

Multi-Factor Authentication

Multi-Factor Authentication Multi-factor authentication (MFA) is a second layer of security required by CMS to have online access to protected health information. The MFA screen will display every time you log in to NGSConnex. Each day [...]

View Remittance

View Remittance If you receive SPRs you will not be able to view remittance statements in NGSConnex. If you are signed up to receive an 835 ERAs or you have elected to view remittance statements through NGSConnex, you may view and print or [...]

Processing Drivers and System Claim Paths

Chapter I: Online System Terminology   Processing Drivers and System Claim Paths Purpose Claims that are filed through the FISS DDE Provider Online System follow a prescribed route referred to as a system claim path. Claim paths [...]

Claim Status and Location Codes

Chapter I: Online System Terminology Claim Status and Location Codes Purpose The purpose of the status and location is to route claims through FISS. The status describes the general condition of the claim (i.e., whether paid, denied, [...]

Main Menu

Chapter II: Online Menu Functions Overview FISS/DDE Main Menu Purpose The FISS/DDE MAIN MENU offers the following four submenu options: 01 – Inquiries 02 – Claims/Attachments 03 – Claims Correction 04 – Online Reports View [...]

Inquiries Submenu

Chapter II: Online Menu Functions Overview Inquiries Submenu Purpose The INQUIRIES submenu allows providers to perform research through various file options, such as the following: Beneficiary/CWF information Claim status DRG [...]

HCPCS Codes (14)

Chapter IV: Inquiries Submenu (01) HCPCS Codes (14) Purpose The purpose of the HCPC CODES option is to provide access to details related to the HCPCS codes available to be reported on a claim. HCPCS codes are five-digit alphanumeric [...]

DX/Proc Codes ICD-9 (15)

Chapter IV: Inquiries Submenu (01) DX/Proc Codes ICD-9 (15) Purpose The purpose of the DX/PROC CODES ICD-9 option is to provide a reference of ICD-9-CM code(s) used to identify a specific or various diagnosis codes or inpatient surgical [...]

Adjustment Reason Codes (16)

Chapter IV: Inquiries Submenu (01) Adjustment Reason Codes (16) Purpose An adjustment reason code is a two-digit alphanumeric code reported on a claim adjustment to identify the specific reason the claim is being adjusted. This option [...]

Reason Codes (17)

Chapter IV: Inquiries Submenu (01) Reason Codes (17) Purpose FISS reason codes are five-digit alphanumeric codes that indicate the outcome of claim editing and processing. The REASON CODE option provides details to indicate why the claim [...]

Claim Count Summary (56)

Chapter IV: Inquiries Submenu (01) Claim Count Summary (56) Purpose The CLAIM COUNT SUMMARY option provides a review of the total claim count and total dollar amount for claims pending in a specific location. This information is updated in [...]

Invoice Number/DCN Translator (88)

Chapter IV: Inquiries Submenu (01) Invoice Number/DCN Translator (88) Purpose The purpose of the Invoice Number/DCN Translator screen is to allow the provider to identify a claim’s Invoice Number when the DCN is known. This option also [...]

Community Mental Health Centers Services Payment Totals (1C)

Chapter IV: Inquiries Submenu (01) Community Mental Health Centers Services Payment Totals (1C) Purpose The purpose of the CMHC Payment Totals screen (MAP1D61) is to display the CMHC payment and outlier totals for current year and one [...]

Provider Practice Address Query (1D)

Chapter IV: Inquiries Submenu (01) Provider Practice Address Query (1D) Purpose The purpose of the Provider Practice Address Query screen is to display the additional practice addresses for a facility; this includes off-campus, outpatient, [...]

New HCPCS Screen (1E)

Chapter IV: Inquiries Submenu (01) New HCPCS Screen (1E) Purpose The purpose of the New HCPCS Screen (1E) is to provide information related to HCPCS pricing and allowable revenue codes related to HCPCS. HCPCS codes are five-digit [...]

New Fiscal Intermediary Shared System Consistency Edit to Validate Attending Physician National Provider Identifier

New Fiscal Intermediary Shared System Consistency Edit to Validate Attending Physician National Provider Identifier Effective 5/16/2023, CMS implemented a new FISS consistency edit to validate the attending provider NPI. The attending provider [...]

Part B Mass Adjustments Resulting in Overpayments

Part B Mass Adjustments Resulting in Overpayments In May 2023, the OIG released the final report titled “Medicare Paid Millions More for Physician Services at Higher Nonfacility Rates Rather Than at Lower Facility Rates While Enrollees Were [...]

October 2023 Release "Dark Days" for the Common Working File Hosts

October 2023 Release "Dark Days" for the Common Working File Hosts For the upcoming October 2023 Release: For Production, CWF will be observing the Gray Day on Thursday, 9/28/2023 and Dark Days starting Friday, 9/29/2023 through Sunday, [...]

Opioid Use Disorder (OUD) Demo 99 (1F)

Chapter IV: Inquiries Submenu (01) Opioid Use Disorder (OUD) Demo 99 (1F) Purpose The purpose of the OUD DEMO option is to provide claim information such as CAP (maximum number of claims that can be billed by the provider with HCPCS G2172), [...]

Roster Bill Entry (87)

Chapter V: Claims/Attachments Submenu (02) Roster Bill Entry (87) Purpose Roster billing is a streamlined process for submitting Medicare claims for a large group of beneficiaries for influenza virus or pneumococcal vaccinations. Up [...]