Physicians or Practitioners Eligible to Enter Into Private Contracts

Physicians or Practitioners Eligible to Enter into Private Contracts Eligible physicians and practitioners Physicians Physician assistants Nurse practitioners Clinical nurse specialists Certified registered nurse anesthetists Certified [...]

LCD and Article Updates for June/July 2024

LCD and Article Updates for June/July 2024 Articles Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms A56867  Due to the quarterly CPT/HCPCS code update, PLA code 0204U was deleted from CPT/HCPCS Codes [...]

MLN Connects® Newsletter: June 27, 2024

MLN Connects Newsletter: June 27, 2024 News CY 2025 Home Health Prospective Payment System Proposed Rule PrEP Using Antiretroviral Therapy to Prevent HIV Infection: Technical FAQs for Pharmacies Claims, Pricers, & Codes Medicare [...]

July 2024

In This Issue National Government Services Articles for Part A and Part B Providers National Government Services Proposed LCDs for Comment - July 18, 2024 Improving Customer Experience New Version of PC-ACE: July 2024 Common Working File [...]

Medical Documentation Requirements

Medical Documentation Requirements When filing a claim to Medicare for payment, please include all applicable diagnosis codes to the highest level of specificity to establish the medical necessity of the services provided. National Government [...]

National Government Services Proposed LCDs for Comment - July 18, 2024

National Government Services Proposed LCDs for Comment - July 18, 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 6/27/2024 through [...]

Additional Development Request Letters Guide

Outpatient Institutional Providers Reimbursed Under MPFS: When to Split Claims for Updated Rates

Outpatient Institutional Providers Reimbursed Under MPFS: When to Split Claims for Updated Rates If you have monthly outpatient and/or inpatient ancillary claims with DOS 3/1/2024 – 3/31/2024, you may take the following steps to ensure correct [...]

2024 CMS Health Equity Services

2024 CMS Health Equity Services The 2024 Physician Fee Schedule Final Rule expanded Medicare coverage by adding four services to the Medicare program for coverage. These services are to help further address the priorities of reducing [...]

Reactivation of Billing Privileges

Reactivation of Billing Privileges To reactivate your individual and/or group billing privileges, please follow instructions within the deactivation letter. Assisting with Reactivation Instructions for Accessing PECOS For first-time user, [...]

MLN Connects® Newsletter: July 3, 2024

MLN Connects Newsletter: July 3, 2024 News ESRD Prospective Payment System CY 2025 Proposed Rule — Submit Comments by August 26 CMS Roundup (June 28, 2024) Improve Your Search Results for CMS Content Claims, Pricers, & Codes [...]

PECOS Enrollment Process and Advantages

Dental Services

Dental Services If you're a new or seasoned provider billing dental services to Fee-for-Service Medicare or Original Medicare, this article guides you through recently clarified payment provisions for dental services in 2023, the provider [...]

MLN Connects® Newsletter: July 11, 2024

MLN Connects® Newsletter: July 11, 2024 Proposed Rules Physician Fee Schedule CY 2025 Proposed Rule Hospital Outpatient Prospective Payment System & Ambulatory Surgical Center Payment System CY 2025 Proposed Rule Mitigating the Impact [...]

Hospice Quality Reporting Letters

Hospice Quality Reporting Letters CMS notified MACs of hospice providers that either chose not to participate in the Hospice QRP or failed to meet the Hospice QRP reporting requirements for the data collection period of 1/1/2023 to 12/31/2023 [...]

MLN Connects® Newsletter: July 18, 2024

MLN Connects® Newsletter: July 18, 2024 News Final Part Two Guidance to Help People with Medicare Prescription Drug Coverage Manage Prescription Drug Costs Medicare Ground Ambulance Data Collection System: Submit Comments by September [...]

A/B DME MAC Collaborative Webinar: Positive Airway Pressure Devices

A/B DME MAC Collaborative Webinar: Positive Airway Pressure Devices Physicians/Practitioners! Are you Ordering PAP Devices for Your Patients? This is your opportunity to hear directly from the Medicare contractors regarding Medicare’s [...]

Requests for Additional Information

Requests for Additional Information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Site Visits

Site Visits Site visits may be required for certain providers and will be unannounced; the contractor representatives must disclose to the provider appropriate identifying credentials and explain the purpose of the visit. CMS has implemented [...]

Requests for Additional Information

Requests for Additional Information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Site Visits

Site Visits Site visits may be required for certain providers and will be unannounced; the contractor representatives must disclose to the provider appropriate identifying credentials and explain the purpose of the visit. CMS has implemented [...]

Requests for Additional Information

Requests for Additional Information While processing the application(s) National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

PECOS Self-Service Application Status

PECOS Self-Service Application Status You may run simple search queries to retrieve and view the status of your PECOS application. Individual View the enrollment application status of an individual provider in an organization or private [...]

Check Provider Enrollment Application Status

Check Provider Enrollment Application Status You may run simple search queries to retrieve and view the status of your CMS-855 application via two options. Case number/web tracker id NPI and TIN combination Related Content Check [...]

Interactive Voice Response System

Interactive Voice Response System You may check the status of your provider enrollment application (PECOS or paper) submission via the IVR by: Case number/web tracker id or NPI and TIN combination Related Content Interactive [...]

Dental Claim Cross Over

Dental Claim Cross Over Medicare contractors coordinate with the MSP Contractor, GHI, to automatically cross over claim payment information for their policyholders as a courtesy. An eligibility file furnished by the supplemental insurer is [...]

Three Ways to Protect Your Medicare Enrollment Information

Three Ways to Protect Your Medicare Enrollment Information Protect your enrollment information from Medicare fraud with these three steps: Keep your Medicare Provider Enrollment, Chain, and Ownership System (PECOS) user ID and password [...]

Help Prevent Bank Account Fraud

Help Prevent Bank Account Fraud The provider should be aware of the following to help prevent bank account fraud if no authorized individual from your entity submits a change to enrollment. Contact your MAC immediately if: remittances [...]

“Payer Only” Codes Submitted on Part A Medicare Claims

“Payer Only” Codes Submitted on Part A Medicare Claims This article is to inform Part A providers of an editing change impacting claims submitted with “payer only” codes. As of 7/3/2024, new edits cause claims to RTP when a “payer only” [...]

Provider Enrollment Appeals Process

Provider Enrollment Appeals Process Table of Contents Provider Enrollment Appeals Process Corrective Action Plans Requirements for CAP Submission Reconsiderations Requirements for Reconsideration Request Submission Related Content [...]

Rebuttal for Deactivation of Medicare Billing Privileges

Rebuttal for Deactivation of Medicare Billing Privileges Pursuant to 42 CFR, Section 424.545(b), a provider or supplier whose Medicare billing privileges have been deactivated may file a rebuttal in accordance with 42 CFR, Section 405.374. A [...]

Rebuttal for Deactivation of Medicare Billing Privileges

Rebuttal for Deactivation of Medicare Billing Privileges Pursuant to 42 CFR, Section 424.545(b), a provider or supplier whose Medicare billing privileges have been deactivated may file a rebuttal in accordance with 42 CFR, Section 405.374. A [...]

837D Edit Spreadsheet

Requests for Additional Information

Requests for Additional Information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Approval Pending Regional Office Review

Approval Pending Regional Office Review For ASC and PXRS: When credentialing, you will receive an approval pending regional office review status in PECOS, if there is a change processed that requires a tie-in notice (Centers for Medicare [...]

Approval Pending Regional Office Review

Approval Pending Regional Office Review For ASC and PXRS: When credentialing, you will receive an approval pending regional office review status in PECOS, if there is a change processed that requires a tie-in notice (Centers for Medicare [...]

National Government Services Will Send Email Updates from a New Email Address Beginning 8/7/2024

National Government Services Will Send Email Updates from a New Email Address Beginning 8/7/2024 Starting 8/7/2024, National Government Services will send email updates to you from a new email address, noreply@noreply.ngsmedicare.com instead [...]

MLN Connects® Newsletter: July 25, 2024

MLN Connects® Newsletter: July 25, 2024 News CMS Announces Resources & Flexibilities to Assist with Public Health Emergency in Texas CMS Oral Health Cross-Cutting Initiative Fact Sheet Doctors & Clinicians: Utilization Data on [...]

Health Benefits of Quitting Smoking and Helping Your Patients Kick the Habit

Health Benefits of Quitting Smoking and Helping Your Patients Kick the Habit Smoking leads to multiple diseases and potentially death, but it is preventable! Anyone at any age can benefit from quitting smoking. Medicare covers tobacco [...]

LCD and Article Updates for August 2024

LCD and Article Updates for August 2024 Articles L33394/A52423 – Drugs and Biologicals Provided off-label coverage of Infliximab for microscopic colitis and retirement of Bortezomib article, effective 8/1/2024. The article has been revised to [...]

Paper Enrollment Process

Paper Enrollment Process Paper-based enrollment applications are available. Submitting your enrollment via paper is an option, but PECOS is the preferred method to process the application with streamlining features. Determine which CMS 855 [...]

For First Time Users: Request a User ID and Connection

For First Time Users: Request a User ID and Connection Instructions for accessing PECOS: If you are unsure if you have a user ID, select “Forgot User ID?” from PECOS. Connect to the Identity & Access (I&A) Management [...]

Make Necessary Changes to the Existing Enrollment In PECOS

Make Necessary Changes to the Existing Enrollment In PECOS Instructions for accessing and submitting existing enrollment information in PECOS: Login to PECOS Select My Associates Scroll down under Existing Associates Select “View [...]

Review and Update All Topics

Review and Update All Topics Instructions for making changes to your PECOS enrollment topics: Select the ‘Topic View’ tab and verify information in every topic Note: EFT topic must be completed by: groups suppliers sole owner group [...]

Upload Supporting Documents

Upload Supporting Documents Instructions for PECOS to upload required supporting documentation: Select the ‘Topic View’ tab Select “Required and/or Supporting Documents” Upload documents Mandatory for all provider/supplier types: [...]

Resolve All Errors and Verify Warnings

Resolve All Errors and Verify Warnings Instructions for resolving all errors and warnings: Select the ‘Errors/Warning Check’ Tab. Correct all errors identified and verify any warnings. Related Content Resolving PECOS Common Errors and [...]

Sign and Submit the Application(s)

Sign and Submit the Application(s) In order to send your application, after resolving all errors, you must select “Begin Submission” which is available from any of the tabs (Topic View, Fast Track View, Error/Warning Check). Instructions for [...]

Verify and Manage Signature(s)

Verify and Manage Signature(s) Verify signatures on all application(s) submitted including applications that were “Return for Corrections”, by returning to the enrollment box in PECOS. Important: The reassignments are viewed by selecting [...]

Physicians or Nonphysician Practitioners With/Without Private Practice

Physicians or Nonphysician Practitioners With/Without Private Practice Download CMS-855I. Complete the CMS-855I section 1A by selecting “You are reporting a change to your Medicare enrollment information,” then in section 1B, check all that [...]

Provider Clinics/Group Practices and Other Suppliers

Provider Clinics/Group Practices and Other Suppliers Download CMS-855B. Complete the CMS-855B section 1A by selecting “You are reporting a change to your Medicare enrollment Information,” then in section 1B, check all that apply and [...]

Supporting Documents

Supporting Documents Attach required supporting documentation for individuals or organizations. Submit applicable documents. CMS-588 EFT Authorization Agreement and voided check or bank confirmation letter IRS document confirming your [...]

Supporting Documents

Supporting Documents Attach required supporting documentation for individuals or organizations. Submit applicable documents: CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement and voided check or bank confirmation letter IRS [...]

Electronic Funds Transfer Agreement

Electronic Funds Transfer Agreement Download and complete the CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement. Physicians and nonphysician practitioners who are reassigning all of their payments to another entity are not [...]

Verify and Manage Signature(s)

Verify and Manage Signature(s) Verify signatures on all application(s) submitted including applications that were “Return for Corrections”, by returning to the enrollment box in PECOS. Important: The reassignments are viewed by selecting [...]

Resolve All Errors and Verify Warnings

Resolve All Errors and Verify Warnings Instructions for resolving all errors and warnings: Select the ‘Errors/Warning Check’ Tab.  Correct all errors identified and verify any warnings.   Related Content: Resolving PECOS [...]

Upload Supporting Documents

Upload Supporting Documents Instructions for PECOS to upload required supporting documentation: Select the ‘Topic View’ tab Select “Required and/or Supporting Documents” Upload documents Mandatory for all provider/supplier types: [...]

Review and Update All Topics

Review and Update All Topics To access PECOS Topics: Select the ‘Topic View’ tab and verify information in every topic Note: EFT topic must be completed by groups, suppliers, incorporated sole owners’ group enrollment and individuals’ [...]

Revalidate Enrollment In PECOS

Revalidate Enrollment In PECOS Instructions for accessing and submitting existing enrollment information in Provider Enrollment, Chain and Ownership System (PECOS): Login to PECOS Select My Associates Scroll down under Existing Associates [...]

For First Time Users: Request a User ID and Connection

For First Time Users: Request a User ID and Connection Instructions for accessing PECOS: If you are unsure if you have a user ID, select “Forgot User ID?” from PECOS. Connect to the Identity & Access (I&A) Management [...]