MLN Connects® Newsletter: June 12, 2025

MLN Connects® Newsletter: June 12, 2025 News Final National Coverage Determination: Noninvasive Positive Pressure Ventilation in Home for Treatment of Chronic Respiratory Failure Consequent to COPD Skilled Nursing Facility Value-Based [...]

Description of NPI and a Link to NPPES Registry

Description of NPI and a Link to NPPES Registry   As mandated by HIPAA, you should maintain (verify and update) your NPI data via NPPES on a regular basis. The NPI: is a ten-digit number and must be submitted on the enrollment form, [...]

Description of NPI and a Link to NPPES Registry

Description of NPI and a Link to NPPES Registry   As mandated by HIPAA, you should maintain (verify and update) your NPI data via NPPES on a regular basis. The NPI: is a ten-digit number and must be submitted on the enrollment form, [...]

Description of NPI and a Link to NPPES Registry

Description of NPI and a Link to NPPES Registry   As mandated by HIPAA, you should maintain (verify and update) your NPI data via NPPES on a regular basis. The NPI: is a ten-digit number and must be submitted on the enrollment form, [...]

Description of NPI and a Link to NPPES Registry

Description of NPI and a Link to NPPES Registry As mandated by HIPAA, you should maintain (verify and update) your NPI data via NPPES on a regular basis. The NPI: is a ten-digit number and must be submitted on the enrollment form, will [...]

Medicare Secondary Payer: A Review of the Disabled with a Large Group Health Plan Provision

In this webinar, we will review the criteria of the Disabled with a Large group health plan (LGHP), Medicare Secondary Payer (MSP) provision. Understanding this criteria will help your facility identify and bill the appropriate primary payer [...]

Eligible Physicians

Eligible Physicians Physicians who can enroll in Medicare: Doctor of: Medicine (MD) Osteopathy (DO) Chiropractic (DC) Dentistry (DMD) (DDS) Optometry (OD) Psychiatry (MD) Podiatry (DPM) Reviewed 6/12/2025

Eligible Nonphysicians

Eligible Nonphysicians Nonphysician Practitioners who can enroll in Medicare. Below you can find the definition, qualifications and supporting documentation for each specialty. Visit Obtain/Verify State License for assistance with license [...]

Eligible Part B Suppliers

Eligible Part B Suppliers Suppliers who can enroll in Medicare: Ambulance Service Supplier Ambulatory Surgical Centers (ASC) Clinic/Group Practices Hospital Department(s) Home Infusion Therapy (HIT) Independent Clinical Laboratory [...]

Eligible Part B Physicians and Nonphysicians to Enroll as Ordering and Referring Only

Eligible Part B Physicians and Nonphysicians to Enroll as Ordering and Referring Only Physician and nonphysician practitioners who can enroll in Medicare solely to order or refer: Doctors of medicine or osteopathy Doctors of dental surgery [...]

Jurisdiction 6 State Licensing and Certification Websites

Jurisdiction 6 State Licensing and Certification Websites The following list contains helpful links to websites of some organizations within J6 that can be used to verify your status. Table of Contents Illinois Minnesota [...]

Certified Provider and State Survey Agency

Certified Provider and State Survey Agency Table of Contents Certified Provider and State Survey Agency Certified Providers/Suppliers Certified Providers and Certified Suppliers That Enroll Via the Form CMS-855A Certified Suppliers That [...]

Jurisdiction K State Licensing and Certification Websites

Jurisdiction K State Licensing and Certification Websites The following list contains helpful links to websites of some organizations within JK that can be used to verify your status. Table of Contents Connecticut Maine [...]

State License and Registrations for Individuals and Organizations

State License and Registrations for Individuals and Organizations Prior to submitting a provider enrollment application to Medicare, ensure that all applicable state licensing and/or specialty certification requirements are current. Each state [...]

State License and Registrations for Individuals and Organizations

State License and Registrations for Individuals and Organizations Prior to submitting a provider enrollment application to Medicare, ensure that all applicable state licensing and/or specialty certification requirements are current. Each state [...]

Understanding the Submission Requirement for a Revalidation Application

Understanding the Submission Requirement for a Revalidation Application According to the 42 Code of Federal Regulations Section 424.515(b), providers and suppliers are required to submit a CMS-855 application with complete information for [...]

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction 6 Part B Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or [...]

Provider Enrollment: Completing the CMS-855A Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855A provider enrollment paper application.

Provider Enrollment: Completing the CMS-855I Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855I provider enrollment paper application for a group member, sole proprietor or sole owner and we’ll also focus on reassigning Medicare benefits.

Submitting Revalidation via PECOS

During this webinar, we’ll provide an understanding of how to utilize the Centers for Medicare & Medicaid Services (CMS) Internet-based Provider Enrollment Chain & Ownership System (PECOS) to be comfortable in navigating the system to [...]

PECOS: Manage Signatures and Additional Information Requests

During this webinar, we’ll give direction for the Provider Enrollment, Chain and Ownership System (PECOS) application on understanding how to manage signatures and respond to additional information request from submitted applications.

Part A Summit Let’s Chat: Prior Authorization for Certain Hospital Outpatient Department Services

This Let’s Chat session focuses on Prior Authorization for certain hospital outpatient department (OPD) services and is an informal opportunity for you to chat with our staff about the selected topic. During the session, you may ask us [...]

Federally Qualified Health Center Basic Billing and Reimbursement

Are you a federally qualified health center (FQHC) provider eager to deepen your understanding of billing and reimbursement under FQHC prospective payment system (PPS)? Whether you're new to the role or just need a refresher, this webinar [...]

Skilled Nursing Facility Consolidated Billing

Did you know that skilled nursing facilities (SNFs) are responsible for paying outside entities for most services provided to beneficiaries while they are in a covered Part A stay and for certain services for Part B beneficiaries? Streamline [...]

Outpatient Psychotherapy Services: A Focus on Coverage and Documentation Requirements

Outpatient psychotherapy services are being reviewed as part of our Part A Medical Review Targeted Probe and Educate program. This session will provide a high-level overview of outpatient psychotherapy services with a focus on coverage and [...]

NGSConnex- Account Management

Do you need assistance with login issues and account suspensions? Do you know who your Local Security Officer is and what they are responsible for? We will also review how to edit the user profile and updating access within the portal. After [...]

Provider Enrollment: Opioid Treatment Program

During this webinar, we’ll provide a brief overview of an Opioid Treatment Program (OTP) provider, an understanding of submitting the CMS-855A or CMS-855B paper application and how to complete the provider enrollment Internet-based Provider [...]

Telehealth for Hospice Face-to-Face Recertification Extended Through September 30, 2025

Telehealth for Hospice Face-to-Face Recertification Extended Through September 30, 2025 Hospice physicians and nurse practitioners may continue to conduct the face-to-face encounter required for recertification using telehealth (audio/video [...]

MLN Connects® Newsletter: May 8, 2025

MLN Connects® Newsletter: May 8, 2025 News Direct Graduate Medical Education: Get Annual Update Factors Compliance Walkers: Prevent Claim Denials Events HCPCS Public Meeting — June 2–3 Medicare Advisory Panel on Clinical [...]

CMS FQHC Booklet

Rural Health Clinic Billing Basics

This webinar will provide a detailed overview of the Medicare billing requirements for rural health clinics (RHC), including the definition of a qualifying visit, locations where billable RHC services can occur, claim coding guidelines and [...]

A/B and DME Collaborative YouTube Video

A/B and DME Collaborative YouTube Video The A/B DME MACs are offering a YouTube video on Urological Supplies. This DME video tutorial provides information about urological supply requirements. Posted 5/7/2025  

Provider Contact Center – Make the Most of Your Call

Provider Contact Center – Make the Most of Your Call As of 5/1/2025, the Provider Contact Center (PCC) will service one PTAN/NPI combination per call. Before calling the PCC, make the most of your call by ensuring you have all authentication [...]

Podiatry Services - Routine Foot Care and Debridement of Nails

While the Medicare Program generally excludes routine foot care services from coverage, there are specific indications or exceptions under which there are program benefits. Medicare payment may be made for routine foot care when the patient has [...]

Home Health Billing Coffee Break

Provider Outreach and Education is hosting a 30-minute coffee break to help answer your troublesome billing questions. This is a great opportunity to discuss areas of billing more in depth and review helpful guides and resources. Keep in mind [...]

Critical Care and Medicare Billing Compliance

While critical care codes did not change with the 2021 or 2023 AMA CPT updates, there are a lot of guidelines for billing these services. During this webinar, we'll discuss critical care coding, what is and is not critical care, how to [...]

Ambulance Services and Establishing Medical Necessity for Part B Providers

This webinar will help the ambulance community understand the importance of medical necessity as it pertains to Medicare’s coverage guidelines.

Understanding Medicare Fraud and Abuse

Learn about fraud and abuse affecting providers and your Medicare patients to increase your awareness of integrity issues and prevent potential fraudulent and abusive practices against the Medicare Program.

Reducing Unprocessable Claims

When claims are submitted with invalid, incomplete or incorrect information, our claims processing system will detect these errors and will reject claims as unprocessable. Our goal is to assist our providers in submitting claims correctly the [...]

Practitioners - Are You Ordering Surgical Dressings for Your Patients?

Practitioners - Are You Ordering Surgical Dressings for Your Patients? In order for a DME supplier to provide surgical dressings to your patients, there are actions you can take to make sure that all the required supporting medical record [...]

Clinicians: Are You Ordering Urological Supplies for Your Patients?

Clinicians: Are You Ordering Urological Supplies for Your Patients? Urological supplies are covered as part of the prosthetic device benefit as outlined in the Social Security Act, Section 1861(s)(8). Prosthetic devices (other than dental) [...]

Meeting Minutes

Meeting Minutes Jurisdiction 6 Illinois, Minnesota, Wisconsin Jurisdiction K Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont Jurisdiction 6 and Jurisdiction K Combined Meeting 4/3/2025 12/5/2024 [...]

PECOS: View and Manage Reassignments through Group Enrollment

During this webinar, we’ll provide an understanding of how to view and manage reassignments through the group enrollment in Provider Enrollment, Chain and Ownership System (PECOS), including to add or terminate reassignments. Individual [...]

Helping Your Patients Stop Smoking

Helping Your Patients Stop Smoking Quitting Tobacco – Slips and Relapses Quitting smoking has health benefits at any age, no matter how long or how much you have smoked. If you slip or relapse, don’t be afraid to try and quit again. Each quit [...]

Submitting Revalidation via PECOS

During this webinar, we’ll provide an understanding of how to utilize the Centers for Medicare & Medicaid Services (CMS) Internet-based Provider Enrollment Chain & Ownership System (PECOS) to be comfortable in navigating the system to [...]

FQHC MAO Supplemental Payment Calculation Form

Register Now for the Spring 2025 Virtual Conference

Register Now for the Spring 2025 Virtual Conference Don’t miss the opportunity to register for the 2025 Spring Part B Virtual Conference: Understanding Medicare Compliance for Part B Providers! Enhance your understanding and apply what you [...]

Provider Enrollment: NGSMedicare.com Resources to Streamline CMS Enrollment Form Process

Provider Enrollment: NGSMedicare.com Resources to Streamline CMS Enrollment Form Process To eliminate the need for additional information requests, NGS offers a variety of provider enrollment resources on our website. These include valuable [...]

Benefits of Quitting Tobacco

Benefits of Quitting Tobacco Quitting tobacco use in any form is one of the most important actions people can take to improve their health. This is true regardless of their age or how long they have been using tobacco products. While quitting [...]

Provider Enrollment Revalidation Overview

During this webinar, learn about important changes in the revalidation process, how to determine Medicare enrollment revalidation due date and information to avoid disruption in Medicare billing.

Provider Enrollment: Resources from NGSMedicare.com to Streamline the CMS-855A Application Process

Provider Enrollment: Resources from NGSMedicare.com to Streamline the CMS-855A Application Process To eliminate the need for additional information requests, NGS offers a variety of provider enrollment resources on our website. These include [...]

Benefits of EDI

Prior Authorization for Certain Hospital Outpatient Department Services – The Exemption Process

In this webinar, the Exemption Team will compare the standard prior authorization review process to the exemption process with a focus on how to gain exemption status and remain exempt through the post pay claim review process.

Portable X-Ray Cost Analysis Survey

Portable X-Ray Cost Analysis Survey NGS, in collaboration with other MACs, has launched a crucial initiative to assess and update transportation allowances for portable X-ray services, as mandated by the CMS every five years. Given that [...]

Investigational Device Exemption Requests ‒ Renewals and Modifications

Investigational Device Exemption Requests ‒ Renewals and Modifications Effective for Category A and B IDE studies approved by the FDA on or after 1/1/2015, interested parties (i.e. study sponsors) seeking Medicare coverage must submit a [...]

Understanding the 2026 Cost Analysis Survey for Medicare Allowances on Portable X-Ray Transportation Codes R0070 and R0075

Understanding the 2026 Cost Analysis Survey for Medicare Allowances on Portable X-Ray Transportation Codes R0070 and R0075 Introduction Medicare plays a critical role in ensuring beneficiaries receive medically necessary diagnostic services, [...]

Changes to the Written General Inquiries Process at National Government Services, Inc.

Changes to the Written General Inquiries Process at National Government Services, Inc. Effective 5/27/2025, NGS will no longer accept inquiries submitted through the postal service to any of our P.O. Boxes or faxed to any of our fax lines. The [...]

MLN Connects® Newsletter: May 1, 2025

MLN Connects® Newsletter: May 1, 2025 News Clinical Laboratory Fee Schedule Preliminary Gapfill Rates: Submit Comments by June 28 Compliance Acute Care Hospital Outpatient Services for Hospice Enrollees: Reduce Improper Payments [...]

2024 Medicare Cost Report Due Dates

2024 Medicare Cost Report Due Dates FYE 12/31/2024 cost reports are due by 6/2/2025. We strongly encourage early filing of the cost report. Early-filed cost reports that are rejected will receive a grace period to resubmit prior to [...]

Colorectal Cancer Screening

Preventive Services Guide Colorectal Cancer Screening Screenings are performed to diagnose colorectal cancer or to determine a beneficiary’s risk for developing colorectal cancer. Colorectal cancer screening may consist of several different [...]