NGSConnex: Beneficiary Eligibility, Look Up and MBI Look Up

Knowing if your patient is Medicare eligible is important for correct claims processing. Please join us for this NGSConnex webinar where we will review beneficiary eligibility and look up, help you understand the eligibility panels, learn how [...]

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 [...]

PCACE Full Install Text - ALOB

Version 6.7 (Institutional and Professional) PC-ACE users

PCACE Download Text - ALOB

The installation code to run the full install or the upgrade for PC-ACE is: NGSMAC1 Important Warning: For PC-ACE version 6.7 updated version: please be patient and allow the full install or update complete. It is important that you do not [...]

PCACE Upgrade Text - ALOB

Version 6.7 (Institutional and Professional) PC-ACE users

About PC-ACE

About PC-ACE The National Government Services PC-ACE free billing software is available for NGS J6 and JK providers only. If you are not a J6 or JK provider, the free billing software must be obtained from your MAC. PC-ACE is a [...]

About PC-ACE

About PC-ACE The National Government Services PC-ACE free billing software is available for NGS J6 and JK providers only. If you are not a J6 or JK provider, the free billing software must be obtained from your MAC. PC-ACE is a stand-alone [...]

Provider Enrollment: Reduce Development Requests for Additional Action

Provider Enrollment: Reduce Development Requests for Additional Action In an effort to reduce the request of additional information and/or documentation on provider enrollment applications, verify all required actions are complete prior to [...]

NGSConnex: Local Security Officer Overview, Access and Navigation

This webinar is geared toward all lines of business for those who will be a Local Security Officer (LSO) in the NGSConnex portal. Come join us and see how NGSConnex can make your life a little easier. We will review the responsibilities of an [...]

NGSConnex: Standard User Overview, Access and Navigation

This webinar is geared toward all lines of business for those who will be standard users in the NGSConnex portal. Come join us and see how NGSConnex can make your life a little easier. We will review what NGSConnex has to offer including [...]

NGSConnex: Additional Development Requests and Inquiries

This webinar is for current and future NGSConnex users who want to learn more about viewing and responding to additional development requests sent to you by National Government Services, and how to submit an electronic inquiry to our Provider [...]

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 [...]

Medicare Part B Drugs and Biologicals

Medicare Part B covers certain drugs and biologicals, which require specific billing guidelines. During this webinar, we’ll assist NGS Part B providers in navigating proper billing for these services. There will be time following the [...]

Prior Authorization Outpatient Department Exemption and ABN ADRs

Prior Authorization Outpatient Department Exemption and ABN ADRs National Government Services Prior Authorization initiated the process of issuing ADRs to 2025 exempt providers. Historically, claims await a provider’s response in FISS DDE [...]

Chronic Care Management

Chronic Care Management Table of Contents Billing Codes Chronic Pain Management and Treatment Codes Billing and Documentation Care management for chronic conditions Related Content [Return to Top] Billing Codes 99490: Provide at [...]

CERT Awareness Week Two - Steps to Take if You Get a CERT Documentation Request

CERT Awareness Week Two– 2025 CERT Documentation Deadline  The Part A, Part B, DME, home health and hospice, and Railroad Board MACs are working together to promote the importance of complying with CERT documentation requests. This is [...]

Proper Part B Claim Submissions

This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments or denials. We will guide you through the Centers for Medicare & Medicaid Services (CMS)-1500 [...]

Proper Part B Claim Submissions

This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments or denials. We will guide you through the Centers for Medicare & Medicaid Services (CMS)-1500 [...]

Steps to Claim Corrections

This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

Steps to Claim Corrections

This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

How to Avoid Duplicate Claims

Duplicate denials continue to be one of the top billing errors. Unnecessary duplicate filing of Medicare claims cost the provider's office valuable time and resources, as well as Medicare's time and money to process them. Please join us [...]

How to Avoid Duplicate Claims

Duplicate denials continue to be one of the top billing errors. Unnecessary duplicate filing of Medicare claims cost the provider's office valuable time and resources, as well as Medicare's time and money to process them. Please join us [...]

Utilizing Third Party Billing Companies

Medicare providers frequently outsource their billing, financial, and enrollment services. During this webinar, we’ll highlight the need to contract with Centers for Medicare & Medicaid Services (CMS)-approved entities and ensure these [...]

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 [...]

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 [...]

ADR Documentation List by Reason Code

How to Find and Respond to a Prior Authorization ADR Table of Contents How to Find and Respond to a PA Pre and Post Payment ADR Steps to View and Print ADRs from FISS/DDE Provider Online System Related Content [Return to Top] How to [...]

Exemption Process

Exemption Table of Contents Exemption Exemption Database Standard Review Cycle Process Exemption Cycle Process Ten Claim Sample Additional Documentation Requests (ADRs) How to Find and Respond to a Prior Authorization ADR Related [...]

MLN Connects® Newsletter: July 10, 2025

MLN Connects® Newsletter: July 10, 2025 News Hospital Price Transparency: Respond to Accuracy & Completeness RFI by July 21 Alert: Medicare Fraud Scheme Involving Phishing Requests Via Fax and Other Means Transcatheter Edge-to-Edge [...]

Proper Part B Claim Submissions

This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments or denials. We will guide you through the CMS-1500 claim form and the electronic equivalent loops [...]

Steps to Claim Corrections

This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

Phonetic Alphabet

table, td, th table { border-collapse: collapse; width: 50%; } Phonetic Alphabet To assist you when speaking terms that are alpha-numeric, we've implemented the phonetic alphabet. When speaking an alpha character, please use the either [...]

Phonetic Alphabet

table, td, th table { border-collapse: collapse; width: 50%; } Phonetic Alphabet To assist you when speaking terms that are alpha-numeric, we've implemented the phonetic alphabet. When speaking an alpha character, please use the [...]

The Medicare Appeals Process: What You Need to Know

This informative session will help you navigate Medicare’s appeals process by providing information on what an appeal is, how to determine if a claim can be appealed, who may file an appeal, the appeal levels, timeframes and documentation [...]

Principal Care Management

Principal Care Management PCM is a model of care focused on patients with a single, high-risk chronic condition expected to last 6 months to 1 year or until the patient’s death and designed to improve health outcomes and reduce complications. [...]

IMPORTANT: Action Required for SNF Due Date of 8/1/2025

IMPORTANT: Action Required for SNF Due Date of 8/1/2025 For those SNFs that have not yet submitted their Form CMS-855A revalidation application or, as applicable, SNF Attachment, this is an important reminder that you must do so by [...]

Interactive Voice Response System Changes Coming Soon

Interactive Voice Response System Changes Coming Soon We’re making changes to our IVR system soon. You’ll still dial the same number, but you’ll hear a new voice. If the IVR doesn't recognize your voice, we recommend you switch to touch tone. [...]

LCD and Billing and Coding Articles Updates

LCD and Billing and Coding Articles Updates Local Coverage Determinations Drugs and Biologicals, Coverage of, for Label and Off-Label Uses (L33394) This LCD was released to Final on 5/29/2025 and will be effective 7/13/2025. The Indications [...]

Chiropractic Billing and Documentation

During this webinar, we will discuss chiropractic coverage, coding guidelines and the importance of documentation in order to support billing for these services.

How do we report unilateral vs. bilateral injections?

Have the payable diagnoses for IVIG and Rituximab changed? I don’t see all of the previously payable diagnoses in the applicable drug local coverage determinations (LCDs) and articles.

When did this go into effect?

Does anti-inflammatory steroid as named in the diagnostic injection mean an injected NSAID or corticosteroid?

Can chemotherapy be split into two doses on two different dates of service if the patient was unable to complete a full dose in one day? For example, the patient's port was not functioning properly.

Can SIJIs be performed under sedation? How about monitored anesthesia care (MAC)? Is “twilight” allowed?

Are the radiofrequency ablations allowed now until 3/20/2023, or are already noncovered?

If a SIJI is performed and a biological agent is added to the injected will the injection still be covered?

How can provider access post injection pain after the injection?

How many injections per calendar year?

Can SIJ ligaments be included in a therapeutic injection?

Are there more studies going on to get sacroiliac joint radiofrequencies to be a covered benefit?

Many patients have degeneration throughout the spine does that justify need for multiple procedures in same session?

Will prior authorization be required?

If a patient fails an initial diagnostic or therapeutic injection is there a certain criteria that must be fulfilled prior to considering it again, such as duration since the last injection (like over a year ago) or change in symptom character or location?

What is the expected duration of steroid effect for diagnostic injection?

Will RFA be an acceptable treatment?

CPT code 27096 includes “Image guidance,” what’s the necessary required documentation? Does the physician still need permanently recorded images? Because the fluoroscopy/CT is bundled into the procedure and therefore the fluoroscopy/CT will not be separately reported, would the image guidance in the Radiology section regarding guidance procedures still apply?

What is the time period between a therapeutic injection and repeat diagnostic? If the therapeutic injection has not been performed for an extended period of time does diagnostic need to be repeated?

Do hospitals bill a different CPT to receive compensation? Usually, the doctor’s office will bill 27096 on 1500 and we bill G0260 for facility claim (UB-04). Will PA need to have both CPTs? 27096 on Medicare fee schedule receives no compensation?

What is the purpose of a diagnostic injection, to select patients for fusion surgery only? Also, with diagnostic injections using anesthetic and steroid, what is the duration of effect expected for the steroid?