MLN Connects® Newsletter: January 5, 2023

MLN Connects® Newsletter: January 5, 2023 News COVID-19: Updated Vaccines for Children Ages Six Months – Five Years Advisory Panel on Hospital Outpatient Payment: Request for Nominations Certificates of Medical Necessity and DME [...]

MLN Connects® Newsletter: December 15, 2022

MLN Connects® Newsletter: December 15, 2022 News Opioid Treatment Programs: New Information for 2023 Part B Immunosuppressive Drug Benefit: Check Medicare Eligibility Home Health Quality Reporting Program: Get Final OASIS-E Instrument [...]

MLN Connects® Newsletter: December 1, 2022

MLN Connects® Newsletter: December 1, 2022 News CMS Urges Timely Patient Access to COVID-19 Vaccines, Therapeutics Quality Payment Program: Preview Your Performance Information by December 20 Clinical Laboratory Fee Schedule: CY 2023 [...]

MLN Connects® Newsletter: November 23, 2022

MLN Connects® Newsletter: November 23, 2022 News Colorectal Cancer Screening Test: Reduced Coinsurance for Related Procedures Begins January 1 Ambulance Fee Schedule: CY 2023 Inflation Factor & Productivity Adjustment Medicare [...]

Provider Enrollment: Reminder for Open Enrollment and Participation Agreement

Provider Enrollment: Reminder for Open Enrollment and Participation Agreement The 2023 Annual Participation Open Enrollment Period is approaching for another year. While this is an important time (from mid-November to December 31) for [...]

Billing New Monkeypox Vaccine and Laboratory Codes

Billing New Monkeypox Vaccine and Laboratory Codes On 7/23/2022, the WHO declared monkeypox a PHE. The HHS issued a statement regarding the Biden-Harris Administration’s actions to make vaccines, testing and treatments available. The AMA CPT [...]

The Medicare Essentials Virtual Conference

The Medicare Essentials Virtual Conference Are you new to working with Medicare or just need a refresher? The Medicare Essentials Virtual Conference, offers two pre-virtual sessions and eight sessions which provide a strong base for [...]

Home Health and Hospice Targeted Probe and Educate Resources

Home Health and Hospice Targeted Probe and Educate Resources It is imperative to keep up-to-date with all National Government Services JK and J6 HH+H TPE audit focus areas. This information can be located on the NGS website by first clicking [...]

National Government Services CAC Meeting Notice on Botulinum Toxins

National Government Services CAC Meeting Notice on Botulinum Toxins Information has been posted on our website in regards to the National Government Services l Contractor Advisory Committee Meeting regarding Botulinum Toxins to be [...]

MLN Connects® Newsletter: September 7, 2023

MLN Connects® Newsletter: September 7, 2023     News New Version of CMS.gov HHS Proposes Minimum Staffing Standards to Enhance Safety and Quality in Nursing Homes CMS Announces Resources and Flexibilities to Assist with [...]

5010 Bottom Page

Additional 5010 Resources Companion Document for 5010 Transactions: The standard companion guide trading partner information which provides instructions related to transactions based on ASC X12 Implementation Guides, version 005010. [...]

CMS Forms

Reporting Multiple Qualifying Visits on the Same Date of Service for FQHC Reimbursement

Reporting Multiple Qualifying Visits on the Same Date of Service for FQHC Reimbursement FQHC providers are reimbursed based on a PPS, which pays the facility for all services provided during a qualifying visit. In addition to reporting the [...]

Ambulance Rural ZIP Code Search

Ambulatory Surgical Center Approved HCPCS Codes and Payment Rates

Beneficiary Notices Initiatives

Medicare Monthly Review

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Helpful Contacts

Medicare Helpful Contacts and Partner Resources Medicare Helpful Contacts Medicare Partner Resources

Submit an Appeal Electronically via esMD

Submit an Appeal Electronically via esMD CMS developed a mechanism for contractors to receive first level appeals electronically from providers via a secure gateway known as Electronic Submission of Medical Documentation, or esMD. Some [...]

Submit an Appeal Electronically via esMD

Submit an Appeal Electronically via esMD CMS developed a mechanism for contractors to receive first level appeals electronically from providers via a secure gateway known as Electronic Submission of Medical Documentation, or esMD. Some [...]

Submit an Appeal Electronically via esMD

Submit an Appeal Electronically via esMD CMS developed a mechanism for contractors to receive first level appeals electronically from providers via a secure gateway known as Electronic Submission of Medical Documentation, or esMD. Some [...]

September 2023

In This Issue National Government Services Articles for Part A and Part B Providers Introducing PECOS 2.0 Duplicate Claim Editing Information Two Interactive Voice Response System Features Ending 9/30/2023 October 2023 Release "Dark [...]

August 2023

In This Issue National Government Services Articles for Part A and Part B Providers CR13220 - Technical Revisions Only to the National Coverage Determination (NCD) Manual, Publication (Pub) 100-03 Tip Sheet for Medicare Providers on [...]

July 2023

In This Issue National Government Services Articles for Part A and Part B Providers Billing and Coding Article Updates for July 2023 National Government Services Proposed LCDs for Comment (6/22/2023-8/5/2023) End of the Public Health [...]

June 2023

In This Issue National Government Services Articles for Part A and Part B Providers Tobacco Cessation Counseling Doesn’t Have To Be Lengthy or Intimidating EDI Enrollment Spotlights Packet Completion Times Upcoming Change to the [...]

Outpatient Department Prior Authorization UTN Alert

Each UTN is Valid for One-Time Use The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient department procedures: Panniculectomy, Rhinoplasty, Vein Ablation, Blepharoplasty [...]

Outpatient Department Prior Authorization Type of Bill Alert

Providers Who Submit a Type of Bill 13X Are Required to Submit a Prior Authorization Request for the OPD PA Services The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient [...]

UTN Alert: Implanted Spinal Neurostimulator Trial and Permanent UTN

UTN Alert: Implanted Spinal Neurostimulator Trial and Permanent UTN The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient department procedures: Panniculectomy, [...]

Type of Bill Code is a Requirement for All Prior Authorization Requests

Type of Bill Code is a Requirement for All Prior Authorization Requests The National Government Services PA Department has seen an increase in cases that are submitted without a TOB code. PA staff conducts outreach to obtain this code; [...]

Outpatient Department Prior Authorization Implanted Spinal Neurostimulators Alert

Outpatient Department Prior Authorization Implanted Spinal Neurostimulators Alert Implanted Spinal Neurostimulator Prior Authorization National Government Services Medical Review initiated a prior authorization review outpatient department [...]

MLN Connects® Newsletter: September 14, 2023

MLN Connects® Newsletter: September 14, 2023     News Inflation Reduction Act Continues to Lower Out-of-Pocket Prescription Drug Costs for Drugs with Price Increases Above Inflation CMS Roundup (Sept 8, 2023) New Provider [...]

Billing for Originating Site

Billing for Originating Site Originating Site An originating site is the location of an eligible Medicare beneficiary at the time the telehealth services is being furnished via a telecommunications system. Medicare beneficiaries are eligible [...]

Distant Site

Distant Site The term “distant site” means the site where the physician or practitioner providing the professional service is located at the time the service is provided via a telecommunications system. Medicare distant site practitioners who [...]

General Information

General InformationTelehealth services require use of an interactive audio and video telecommunications system that permits real-time communication between the provider at the distant site and the Medicare beneficiary at the originating [...]

Originating Site

Originating Site An originating site is the location of an eligible Medicare beneficiary at the time the telehealth services is being furnished via a telecommunications system. Medicare beneficiaries are eligible for telehealth services only [...]

Facility Fee for Originating Site

Facility Fee for Originating Site The originating site facility fee is a separately billable Part B payment. The payment amount to the originating site is the lesser of 80 percent of the actual charge or 80 percent of the originating site [...]

Billing and Payment for Distant Site Professional Fee

Billing and Payment for Distant Site Professional Fee Claims for distant site telehealth services are submitted to the Part B MAC that processes claims for the performing physician/practitioner’s service area. Physicians/practitioners submit [...]

List of Covered Medicare Telehealth Services

List of Covered Medicare Telehealth Services Several conditions must be met for Medicare to make payments for telehealth services under the Physician Fee Schedule. The service must be on the list of Medicare telehealth services and meet [...]

G0 Modifier Required for Telehealth for Individuals with Acute Stroke

G0 Modifier Required for Telehealth for Individuals with Acute Stroke Effective for claims with dates of service on and after 1/1/2019, Medicare will accept HCPCS modifier G0 to identify telehealth services furnished for purposes of diagnosis, [...]

GT Modifier

GT Modifier Effective 10/01/2018, the GT modifier (via interactive audio and video telecommunications systems) is only required on institutional claims for distant site services billed under CAH Method II (claim type 085X). The GT modifier is [...]