About PA RSNAT Model

  About PA RSNAT Model Table of Contents About PA RSNAT Model Background How it Works Ambulance HCPCS Codes [Return to Top] About PA RSNAT Model The Centers for Medicare & Medicaid Services implemented a prior [...]

2020 Changes Driven by You – National Government Services Self-Service Tools

2020 Changes Driven by You – National Government Services Self-Service Tools We are committed to improving your experience while using our secure self-service tools which includes our NGSConnex portal, our NGSMedicare.com website and our IVR [...]

Hospice Certification and Recertification

Hospice Certification and Recertification We have experienced an increasing number of CERT errors due to documentation requirements not being met. Below is the documentation required for hospice certification and recertification. The hospice [...]

Top Tobacco Counseling Claim Errors - Tips to Avoid and Correct Claim Errors

Top Tobacco Counseling Claim Errors - Tips to Avoid and Correct Claim Errors National Government Services is committed to reducing provider burden associated with Medicare claim denials and claim submission errors. Don’t wait until you receive [...]

Avoid Return to Provider and Claim Rejections-Enhancing the Beneficiary Eligibility Verification Process

Avoid Return to Provider and Claim Rejections-Enhancing the Beneficiary Eligibility Verification Process Table of Contents Reason Codes T5052, N5052, U5210, U5220 and U5200 - Preventing RTP and Rejection Claims Why Is Beneficiary [...]

Identifying Payers Primary to Medicare

Section 4: Getting Ready to Bill Medicare Identifying Payers Primary to Medicare Information for All Providers Table of Contents Determine if Medicare is Primary Payer MSP Information Collection Requirements—Frequency Retirement [...]

Use Our Provider Self-Service Tools To Spend Less Time on the Phone

Use Our Provider Self-Service Tools To Spend Less Time on the Phone Did you know our PCC experiences high call volumes at the beginning and the ending of each month? To avoid experiencing prolonged hold times, you can use our provider [...]

Missing/Incomplete/Invalid Patient Identifier Remark Code N382

Missing/Incomplete/Invalid Patient Identifier Remark Code N382 If you receive a denial on your remittance with remark code ‘N382’ Missing/Incomplete/Invalid Patient Identifier, please use NGSConnex self-service option to verify the MBI number [...]

The CY 2025 Medicare Physician Fee Schedule Is Now Available

The CY 2025 Medicare Physician Fee Schedule Is Now Available The CY 2025 MPFS is now available. You can view the new fees using the Fee Schedule Lookup tool page on NGSMedicare.com. Posted 12/2/2024

Start Your Morning with a Podcast - Navigating Medicare: Part A Insights for Providers

Start Your Morning with a Podcast - Navigating Medicare: Part A Insights for Providers Did you know we have a podcast channel on both Spotify and Apple Podcasts that are just for our providers? On your way to work each day, listen to these [...]

All Part B Providers – Register Now!

All Part B Providers – Register Now! Don't miss your chance to attend! Don't miss your chance to attend the National Government Services Medicare Part B 2024 Preventive Services Virtual Conference! Registration is happening now, and seats are [...]

Request a Redetermination

Request a Redetermination The first level of appeal is carried out by the affiliated contractor/MAC. Time limit to initiate = 120 days from date of receipt of the initial determination notice Time limit to complete the review = 60 days [...]

Submit a Reconsideration

Submit a Reconsideration The second level of appeal is the reconsideration request and is carried out by the QIC. Time limit to initiate = 180 days from date of receipt of redetermination decision Time limit to complete the review = 60 [...]

Medicare Appeals Council Review

Medicare Appeals Council Review The fourth level of appeal is carried out by the MAC; this may also be referred to as the Department Appeals Board or DAB. Time limit to initiate = 60 days from date of receipt of ALJ decision Time limit to [...]

Reopenings for Minor Errors and Omissions

Reopenings for Minor Errors and Omissions Providers may request a reopening of the original claims processing decision by contacting the TRU. The TRU can be used when you wish to revise the initial determination of a specific service or [...]

Reopening Request Timeframes

Reopening Request Timeframes According to the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 34, Section 10.6.2, Timeframes for Party Requested Reopenings: A party may request a contractor reopen and revise its initial [...]

ALJ Hearing

ALJ Hearing The third level of appeal is an ALJ hearing. Time limit to initiate = 60 days from the date of receipt of reconsideration (QIC decision) Time limit to complete the review = 90 days Amount in controversy = The amount that must [...]

Federal Court Review

Federal Court Review The fifth level of appeal is carried out by the Federal District Court (U.S. District Court). Time limit to initiate = 60 days from date of receipt of Medicare Appeals Council decision Amount in Controversy = The [...]

MLN Connects® Newsletter: November 21, 2024

MLN Connects® Newsletter: November 21, 2024 News Medicare-Funded Physician Residency Positions CMS Roundup (November 15, 2024) Hepatitis B Vaccine: Billing Requirement Update Effective January 1 Hospitals: Use Renewed Beneficiary Notices [...]

Prolonged Preventive Services

Preventive Services Guide Prolonged Preventive Services Effective for claims with dates of service on or after 1/1/2018, prolonged preventive services will be payable by Medicare when billed as an add-on to an applicable preventive service [...]

Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)

Obtaining Beneficiary Eligibility Information Through NGSConnex

Obtaining Beneficiary Eligibility Information Through NGSConnex  As a reminder, our Customer Service Representatives aren’t permitted to share eligibility information because it’s available through NGSConnex. If you need help, we [...]

Practitioners: Are You Ordering Nebulizers and Inhalation Medication for Your Patient?

Practitioners: Are You Ordering Nebulizers and Inhalation Medication for Your Patient? Medicare will consider coverage of a nebulizer, compressor and related accessories when the patient’s medical record verifies that the patient has a [...]

Physicians: Are You Ordering Glucose Monitors and Supplies for Your Patients?

Physicians: Are You Ordering Glucose Monitors and Supplies for Your Patients? The CERT program has noted claim errors for glucose monitors. The following information is provided to assist you in reducing these types of errors. Medicare will [...]

Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)

Durable Medical Equipment, Prosthetics, Orthotics and Supplies To help providers and suppliers gain a better understanding of the roles of billing, coverage, documentation requirements and medical necessity when providing DMEPOS to Medicare [...]

Clinicians: Are You Ordering PAP Devices and Related Accessories for Your Patients?

Clinicians: Are You Ordering PAP Devices and Related Accessories for Your Patients? Medicare can make payment for PAP devices and related accessories when the patient’s medical record shows the patient has OSA and meets medical documentation, [...]

Practitioners: Are You Ordering Spinal Orthoses for Your Patient?

Practitioners: Are You Ordering Spinal Orthoses for Your Patients? The DME MACs are providing helpful guidance to assist the supplier in providing a spinal orthosis to your patient. Medicare must be able to verify there is supporting medical [...]

Clinicians: Are You Ordering Oxygen for Your Patient?

Clinicians: Are You Ordering Oxygen for Your Patient? Home use of oxygen and oxygen equipment is eligible for Medicare reimbursement only when a beneficiary meets all of the requirements set out in the CMS IOM, Publication 100-03, Medicare [...]

Clinicians: Are You Ordering Diabetic Shoes for Your Patients?

Clinicians: Are You Ordering Diabetic Shoes for Your Patients? The following section outlines roles of various practitioners that are involved in the decision-making and provision process for diabetic shoes: Certifying physician: The [...]

Physicians Ordering Oxygen and Oxygen Equipment - Quick Tips

Physicians Ordering Oxygen and Oxygen Equipment - Quick Tips The following is a quick reference guide for physicians and nonphysician practitioners concerning Medicare’s coverage of oxygen and oxygen equipment. For Medicare to consider [...]

Physicians: Are You Ordering DMEPOS for Your Patients?

Physicians: Are You Ordering DMEPOS for Your Patients? Physicians provide the foundation for correctly billing services and/or supplies to Medicare. DMEPOS suppliers rely on prescribing providers to substantiate the need for services and/or [...]

Physicians: Are You Ordering External Breast Prostheses for Your Patient?

Physicians: Are You Ordering External Breast Prostheses and Supplies for Your Patient? Following this guidance will help your patients and the Medicare Program by verifying there is medical documentation to support the provision of external [...]

Long-Term Care Hospital

Reminder: The Self-Service Pulse Has Ended

Reminder: The Self-Service Pulse Has Ended We sincerely thank you for being a loyal reader of our Self-Service Pulse each week. To continue receiving updates on our latest self-service tools and services, please subscribe to our general Email [...]

Health Equity Vaccination Efforts: Achieving the Highest Level of Health and Well-Being for Your Patients

Health Equity Vaccination Efforts: Achieving the Highest Level of Health and Well-Being for Your Patients Health equity is the concept that all people should have a fair and just chance to be as healthy as possible, regardless of their [...]

Who May File an Appeal?

Who May File an Appeal? Who May File an Appeal? Appointment of Representative Who May Be a Representative How to Make and Revoke an Appointment Attorney Representatives Required Elements When to Submit the Appointment Validity of an [...]

About Appeals

About Appeals Providers, suppliers and beneficiaries have the right to appeal claim determinations made by National Government Services. The purpose of the appeals process is to ensure the correct adjudication of claims. Appeals activities [...]

MSP Overpayments

MSP Overpayments If you are appealing or correcting a claim that you have received an overpayment on because Medicare paid as the primary insurer and another insurance carrier should be the primary payer, follow the instructions on the [...]

What Documents are Needed

What Documents are Needed? What Documents are Needed? Medical Records to Support an Appeal Anesthesia Biofeedback Blepharoplasty Cardiac Rehabilitation Services Chiropractic Services Concurrent Care Cosmetic [...]

Submit an Appeal Electronically with NGSConnex

Submit an Appeal Electronically with NGSConnex You can submit redetermination or reopening requests electronically through NGSConnex. To determine if your appeal qualifies as a reopening or redetermination, access the About Appeals page. All [...]

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 [...]

Get Help Submitting a Appeal Hard Copy

Get Help Submitting a Appeal Hard Copy All levels of appeals may be submitted by mail. The only types of appeals submitted to National Government Services are reopening and redetermination requests. For information on other types of appeals, [...]

How to Avoid Costly Appeals

How to Avoid Costly Appeals This table includes helpful information to help avoid costly appeals. Use the initial submission tips and resources to help reduce claim denials and improve revenue cycle workflow issues within your office. [...]

How to Prevent Duplicate Appeal and Clerical Error Reopening Requests in NGSConnex

How to Prevent Duplicate Appeal and Clerical Error Reopening Requests in NGSConnex Do you currently submit your appeal requests and reopening requests through NGSConnex? If so, did you know you are required to verify whether a request was [...]

Five Levels of Appeals

Levels of Appeals and Time Limits for Filing Table of Contents Five Levels of Appeals: Overview Level One – Redetermination Level Two – Reconsideration (QIC) Level Three – Administrative Law Judge (ALJ) Level Four – Medicare [...]

Medical Review Portal in NGSConnex

Medical Review Portal in NGSConnex If you submit fee-for-service claims to National Government Services and you are a registered NGSConnex account holder, you can respond to Medical Review ADRs and submit supporting documentation [...]

Medical Documentation Signature Requirements

Medical Documentation Signature Requirements Table of Contents Medical Documentation Signature Requirements Missing Signature Illegible Signature Signatures for Amendments, Corrections and Delayed Entries Related Content [Return to [...]

Address Corrections for Providers

Address Corrections for Providers An ADR is sent to the provider’s or physician’s address that is listed in PECOS. This is the last address that was submitted to the MAC’s Provider Enrollment Department and approved by CMS. Questions [...]

Additional Developmental Request Letters Overview

Additional Development Request Letters Overview National Government Services may require additional information in order to appropriately process claims submitted to the Medicare Program. These requests for additional information letters are [...]

How to Find and Respond to TPE ADR

How to Find and Respond to TPE ADR Once you receive notification your facility is being placed on medical review, you’ll receive instructions on how to find the ADR. The ADR is a request to submit documentation for review to ensure proper [...]

Results Letters

Results Letters After National Government Services reviews the requested claims for your facility/office, you’ll receive a Results Letter with results from that round of TPE review. The Results Letter will contain the number of claims that [...]

Appeals

Appeals Appeals Overview Providers, suppliers and beneficiaries may appeal claim determinations made by National Government Services. The appeals process aims to ensure the correct adjudication of claims. The CMS governs appeals activities [...]

LCD and Article Updates for November 2024

LCD and Article Updates for November 2024 Local Coverage Determinations and Billing and Coding Articles The following Local Coverage Determinations and Billing and Coding Articles have been finalized and will become effective on the specific [...]

Get Help Completing My Enrollment Application

Since your organization can apply for Medicare enrollment in two ways, online through the PECOS system and on paper, it is important to know where to go to learn about the expected processes and guidelines. There are two main areas where you [...]

Get Help Completing My Enrollment Application

Since your organization can apply for Medicare enrollment in two ways, online through the PECOS system and on paper, it is important to know where to go to learn about the expected processes and guidelines. There are two main areas where you [...]

Initiate Part B Reopenings or Non-MSP Overpayment Adjustments in NGSConnex

Initiate Part B Reopenings or Non-MSP Overpayment Adjustments in NGSConnex Did you know that you can save time and money by requesting a Part B clerical error reopening electronically via NGSConnex? You will save time because electronic [...]

How to Determine if the Provider is Active and Get the Provider Enrolled in Medicare Part B

How to Determine if the Provider is Active and Get the Provider Enrolled in Medicare Part B Table of Contents Determine if the Provider Has an Active Enrollment How to Enroll the Provider in Medicare Part B [Return to Top] Determine [...]