Prevent an MSP Rejection on a Medicare Primary Claim

Table of Contents Prevent an MSP Rejection on a Medicare Primary Claim Step 1 Step 2 Step 3 Related Content [Return to Top] Prevent an MSP Rejection on a Medicare Primary Claim If you submit a Medicare primary claim when there is [...]

Populating MSP Insurance Type Code on Electronic Claims

Table of Contents Populating MSP Insurance Type Code on Electronic Claims GHP NGHP Related Content [Return to Top] Populating MSP Insurance Type Code on Electronic Claims When you identify beneficiaries that have Medicare as the [...]

GlobalPeriodCalculator Bottom

Please refer to the Physician Fee Schedule Look up on the CMS Web site to determine whether the procedure in question has a 90 day global period.

Hospital-Issued Notices of Noncoverage

Inhalation Treatment CPT 94640 – Billing Errors

Inhalation Treatment CPT 94640 – Billing Errors The National Government Services Appeals Department has identified billing errors relevant to CPT code 94640 for inhalation treatment. When you bill more than one unit per episode of care, the [...]

DME CERT Physician's Corner

DME CERT Physician’s Corner In an effort to reduce the CERT claims error rate, CGS Jurisdiction B DME MAC, has created a Physician’s Corner page which is specifically designed for physicians and practitioners to provide detailed information [...]

Download Medicare Remit Easy Print

Download Medicare Remit Easy Print To download MREP, please select the external link below to navigate to the MREP portion of the CMS Website. Download Medicare Remit Easy Print

Hospice PIP Rate Review Form

Part A Ambulance Claims Not Retaining Fractional Units

Fractional Units are not being retained on ambulance mileage HCPCS entered via DDE. This results in reason code 32226 (Units required but not present).  

ESRD Claims Are Paying Incorrectly

National Government Services has been made aware of ESRD claims with HCPCS code 90999 processing at rates that are cents instead of hundreds of dollars. This is causing the claims to pay incorrectly. This issue appears to have started mid-July, 2023.

Home Health 32G Adjustment Issue for Separation Periods of < 60 Days

A segment of home health claims with 32G type of bills are incorrectly being re-coded to earlier periods during processing, instead of the correct later periods. This error is occurring when the separation between the two periods is 60 days or [...]

Hospice Informational Unsolicited Response Adjustments - Type of Bill 8XG

Due to original informational unsolicited responses (IURs) processing not occurring between the timeframe of 8/1/2017 and 4/1/2021, a significant volume of hospice IUR adjustments have been initiated by the common working file (CWF) to [...]

Optical Character Recognition Misreading Referring Provider Names

OCR software is misreading the referring/ ordering provider name (item 17) on some Part B claims.

Letter of Authorization for EDI

Letter of Authorization for EDI We’ve extended our Letter of Authorization PIN expiration period based on user feedback. Letter of Authorization PINs are now valid for 30 days and there is no limit on the number of times a PIN can be used. [...]

Interim Rate Review Documentation Request Form for Hospitals

Billing Overlap/Dispute Resolution Process Effective 3/1/2023

Billing Overlap/Dispute Resolution Process Effective 3/1/2023 An overlapping situation may occur between hospitals for inpatient stays, home health agencies, outpatient services and hospice agencies. Overlapping situations may also occur due [...]

Hospice Claims Edit Issue RC W7048

National Government Services has noted an increase in hospice claims editing incorrectly for RC W7048 following the July 2023 system release. This is occurring for revenue codes 0250 (non-injectable prescription drugs), 0290 and/or 0294 [...]

Guidelines for Submitting Prior Authorization Certain Hospital Outpatient Department

General PAR Documentation Requesters must include the following data elements in all PARs to avoid potential delays in processing. Your MAC may request additional, optional elements for submission of the PAR. Initial Submission Documentation: [...]

Dispute Request for Assistance (RFA) Form

CMS Links

  Administrative Simplification Overview Ambulatory Surgical Centers (ASC) Center  Clinical Laboratory Improvement Amendments (CLIA)  Beneficiary Notices Initiative (BNI)  CMS.gov Email Updates CMS.gov Open [...]

Proper Medicare Part B Claim Submissions Due to the Change Healthcare Security Incident

Proper Medicare Part B Claim Submissions Due to the Change Healthcare Security Incident With many providers submitting paper claims due to the Change Healthcare security incident, it is important to submit your claims correctly. Failure to do [...]

MLN Connects® Newsletter: April 11, 2024

MLN Connects® Newsletter: April 11, 2024 Proposed Payment Rules CMS Proposes New Policies to Support Underserved Communities, Ease Drug Shortages, and Promote Patient Safety News CMS Roundup (Apr. 5, 2024) Medicare Shared Savings [...]

NGSConnex Medicare Part B Remittances

NGSConnex Medicare Part B Remittances We’ve added an enhancement that offers providers the option to view/print remittance advices in NGSConnex for up to 24 months from the date of search. You are required to complete the EDI enrollment to [...]

Social Security Income Ratios

Social Security Income Ratios The federal fiscal year 2022 SSI ratios for IPPS hospitals, IRFs and LTCHs were posted on the CMS website. IPPS IRF LTCH We will update the latest published 2022 SSI ratios in the Provider Specific File of [...]

Reimbursing Place of Service 10 at the Nonfacility Rate for Medicare Telehealth Services

In CY 2024, CMS issued a change to processing for telehealth services billed with POS 10. As of 1/1/2024, these claims are to be paid at the nonfacility PFS rate. A system processing issue resulted in incorrect payments at the facility rate and [...]

Submit Supporting Documentation

Submit Supporting Documentation We encourage you to submit cost reports and supporting documentation electronically whenever possible. In addition to the environmental benefits of this approach, it is also more time and cost efficient. The [...]

Part B Top Claim Errors Updated

Part B Top Claim Errors Updated Using data analysis we update the Top Claim Errors on a quarterly basis and provide: the error reason code; a description of the error; the error type; details that include steps you can take to [...]

Hospice Pricer Tool

Hospice Pricer Tool The CMS Web Pricer will assist in evaluating your hospice claim reimbursement. Revised 4/18/2024

MLN Connects® Newsletter: April 18, 2024

MLN Connects® Newsletter: April 18, 2024 News PrEP for HIV: Prepare for Potential Medicare Part B Coverage Events Clinical Laboratory Fee Schedule Upcoming Meetings: Register to Present, Speak, or Attend in Person by June 1 [...]

Helpful Reminders on Advance Care Planning

Helpful Reminders on Advance Care Planning ACP billing codes: 99497: Advance care planning, including the first 30 minutes of face-to-face explanation and discussion (when performed) of advance directives such as standard forms. 99498: [...]

Reminders for the New Hospice Certifying Physician Claim Edit Effective 5/1/2024

Reminders for the New Hospice Certifying Physician Claim Edit Effective 5/1/2024 Effective for hospice claim "From" dates on or after 5/1/2024, CMS implemented edits to enforce a new rule that would deny hospice claims if the certifying [...]

Top Claim Errors Have Been Reviewed and Updated

Top Claim Errors Have Been Reviewed and Updated Our top claim errors are updated on a quarterly basis to reflect current information. Visit Top Claim Errors under Resources > Claims and Appeals to learn what you can do to avoid claim [...]

Receive and Respond to Audit and Reimbursement Correspondence via NGSConnex

Table of Contents Receive and Respond to Audit and Reimbursement Correspondence via NGSConnex What are the benefits? [Return to Top] Receive and Respond to Audit and Reimbursement Correspondence via NGSConnex National Government [...]

Home Office Cost Statements

A home office of a chain organization is a related organization to its participating providers. Home offices usually furnish central management and administrative services, e.g., centralized accounting, purchasing, personnel services, [...]

MLN Connects® Newsletter: April 25, 2024 (UPDATE)

MLN Connects® Newsletter: April 25, 2024 (UPDATE) Editor's Note: CMS updated a message because we delayed the effective date that physicians who certify hospice services must enroll in or opt-out of Medicare until 6/3/2024. You may have to [...]

LCD and Article Updates for April/May 2024

LCD and Article Updates for April/May 2024 Billing and Coding Articles Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin (A59311) [...]

Billing for Drug Wastage: JW and JZ Modifier

Billing for Drug Wastage: JW and JZ Modifier Properly billing for drug wastage and associated modifiers helps to prevent claims processing errors and denials while ensuring you receive correct reimbursement. Providers and suppliers are to [...]

National Government Services Proposed LCDs for Comment (4/25/2024-6/8/2024)

National Government Services Proposed LCDs for Comment (4/25/2024-6/8/2024) The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 4/25/2024 through [...]

Covered Medicare Part B Drugs/Biologicals

Covered Medicare Part B Drugs/Biologicals Each drug and biologic that can be considered for coverage under Medicare Part B has its own set of coverage guidelines. Below are examples of covered Medicare Part B drugs and biologicals, which may [...]

Maximum Payment Limits for Rural Health Centers

Maximum Payment Limits for Rural Health Centers Payment Limit Annual Adjustment Period Covered $190.00 TBD 1/1/2028–12/31/2028 $178.00 TBD 1/1/2027–12/31/2027 $165.00 TBD [...]

2024 Medicare Cost Report Due Dates

2024 Medicare Cost Report Due Dates FYE 12/31/2023 cost reports are due by 5/31/2024. We strongly encourange early filing of the cost report. Early-filed cost reports that are rejected will receive a grace period to re-submit prior to [...]

Vaccines

Vaccines Medicare covers some preventive vaccines at no cost to the beneficiary. CMS and National Government Services provide detailed educational and billing information for providers. Medicare also covers vaccines that are directly related [...]

EDI Guided Enrollment Form

MLN Connects® Newsletter: May 2, 2024

MLN Connects® Newsletter: May 2, 2024 News CMS Statement on Proposed Local Coverage Determination for Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers Quality in [...]

May 2024

In This Issue National Government Services Articles for Part A and Part B Providers LCD and Article Updates for April/May 2024 National Government Services Proposed LCDs for Comment (4/25/2024-6/8/2024) Top Tobacco Counseling Claim Errors [...]

Important Reminders for Your EDI Enrollment

Important Reminders for Your EDI Enrollment When completing the EDI Enrollment application, it’s important that the entity name and address you enter on the EDI enrollment form matches exactly to the information contained in the CMS-855/PECOS [...]

Join Us for ‘Real Time” with CMS Chicago

Join Us for ‘Real Time' with CMS Chicago The CMS Chicago LEA would like to invite you to our “Real Time” with CMS Chicago, a bi- weekly webinar that occurs on the 2nd & 4th Wednesday of every Month at 9 a.m. CT. These 30-minute calls are [...]

Billing Reminder: When a Skilled Nursing Facility Payment Ban is in Effect

Billing Reminder: When a Skilled Nursing Facility Payment Ban is in Effect CMS may impose a DPNA against the SNF when the facility is not in compliance with the requirements of participation under the Social Security Act at Sections 1819(h) [...]

PS&R/Cost Report Crosswalk

PS&R/Cost Report Crosswalk Did you know you have access to crosswalks between the PS&R Summary Report and the Medicare cost report? Our Medicare Audit and Reimbursement Department created crosswalk tools for hospitals and [...]

Save the Dates! National Government Services 2024 Spring/Summer Virtual Conference

Save the Dates! National Government Services 2024 Spring/Summer Virtual Conference Mastering Medicare: Tuesday Tutorials for Part B Providers Coming to you soon on 6/4/2024, 6/11/2024, 6/18/2024 and 6/25/2024, four full days of virtual [...]

Save the Dates! CMS National Provider Enrollment Conference in San Diego: 8/28/2024-8/29/2024

Save the Dates! CMS National Provider Enrollment Conference in San Diego: 8/28/2024-8/29/2024 Wednesday, 8/28/2024 and Thursday, 8/29/2024 from 8:00 a.m.–5:00 p.m. PT Register for the CMS National Provider Enrollment Conference at the San [...]

SNFs: Missing Medicare Health Insurance Claim Number on Minimum Data Set Can Cause Potential Claim Denials

SNFs: Missing Medicare Health Insurance Claim Number on Minimum Data Set Can Cause Potential Claim Denials Our Medical Review department has noted many cases where the HIC number is missing from the MDS that is in the repository. MDS Overview [...]

Get Your PS&R Reports

Table of Contents Get Your PS&R Reports Register to Receive the PS&R Report Instructions on How to Use Redesign Detail Reports [Return to Top] Get Your PS&R Reports The PS&R report is a tool used by Part A providers [...]

Get Your PS&R Reports

The PS&R report is a tool used by Part A providers and MACs to prepare and process Medicare cost reports. Table of Contents Register to Receive the PS&R Report Instructions on How to Use Redesign Detail Reports [Return to Top] [...]