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 [...]

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 [...]

MLN Connects® Newsletter: November 27, 2024

MLN Connects® Newsletter: November 27, 2024 News Opioid Treatment Programs: CY 2025 Updates HIV Screening & Prevention Claims, Pricers, & Codes Home Health Prospective Payment System Grouper: January Update Clotting Factor: [...]

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 Determine If the Provider Has an Active Enrollment Navigate to the Medicare Fee-For-Service Public Provider Enrollment [...]

The Utilization of the KX Modifier on Dental Claims

The Utilization of the KX Modifier on Dental Claims National Government Services wants to bring to your attention the usage of the KX modifier for the submission of Medicare claims for dental services that are inextricably linked to covered [...]

Rural Tobacco Disparity

Rural Tobacco Disparity Tobacco use and exposure to SHS are major causes of preventable disease, disability and mortality in the United States and are responsible for approximately 480,000 deaths annually; another 16 million people are living [...]

Behavioral Health Telehealth In-Person Requirements

Behavioral Health Telehealth In-Person Requirements National Government Services has been receiving questions regarding the behavioral health telehealth requirement that the initial telehealth service include an in person visit within the [...]

Report a Change of Ownership, Acquisition/Merger or Consolidation

Table of Contents Step 1: Determine You Are in the Right Place Step 2: Understand Type of CHOW Change of Ownership Acquisition/Merger Consolidation CHOW Reminders Step 3: Make Changes via Enrollment Application Change of [...]

December 2024

In This Issue National Government Services Articles for Part A and Part B Providers Two Weeks to Prepare to Use NGSConnex for Beneficiary Eligibility Information A/B DME MAC Collaborative Lower Limb Orthoses Webinar November is Lung [...]

Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2025

Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2025 Table of Contents Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2025 Advantages of Being a Medicare-Participating [...]

Medicare Participating Physician or Supplier Agreement Form (CMS-460)

Introduction

Medicare Part B 101 Manual: Introduction Medicare Program for Part B Providers Table of Contents Introduction Medicare Administrative Contractors Medicare Contracting Reform Providers Responsible for Knowing Guidelines Medicare Part A [...]

Terms and Services

National Government Services Terms and Services Compatible carriers include: AT&T, T-Mobile®, Verizon Wireless, Sprint, Boost, U.S. Cellular, Cellular One, MetroPCS, ACS/Alaska, Bluegrass Cellular, Cellular One of East Central Illinois, [...]

Get Help with Rejected/Denied Enrollment Application

Table of Contents Get Help with Rejected/Denied Enrollment Application Determine the Application Status Understand Rejection or Denial Related Content [Return to Top] Get Help with Rejected/Denied Enrollment Application The CMS IOM [...]

Get Help with Rejected/Denied Enrollment Application

Table of  Contents   Get Help with Rejected/Denied Enrollment Application Determine the Application Status Understand Rejection or Denial Related Content Get Help with Rejected/Denied Enrollment Application The CMS IOM [...]

Get Help with Rejected/Denied Enrollment Application

Table of Contents Get Help with Rejected/Denied Enrollment Application Determine the Application Status Understand Rejection or Denial Related Content  Get Help with Rejected/Denied Enrollment Application The CMS IOM Publication [...]

Requests for Additional Information

Table of Contents Requests for Additional Information Paper Application Submissions PECOS Application Submissions [Return to Top] Requests for Additional Information While processing the application(s), National Government [...]

MLN Connects® Newsletter: December 5, 2024

MLN Connects® Newsletter: December 5, 2024 News Clinical Laboratory Fee Schedule: CY 2025 Final Payment Determinations CMS Roundup (November 29, 2024) Advanced Primary Care Management Services: Get Information about Billing Medicare Flu [...]

Common Working File (CWF) Host Dark Days for January 2025 Release

Common Working File (CWF) Host Dark Days for January 2025 Release  For Production, 1/1/2025 – Observe Holiday – No Cycle, CWF will be observing the Gray Day on Thursday, 1/2/2025 and Dark Days starting Friday, 1/3/2025 through Sunday, [...]

Interactive Voice Response System

Interactive Voice Response System State IVR Hours Available* Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont 877-869-6504 Monday–Friday: 6:00 a.m.–7:00 p.m. ET Saturday: [...]

Interactive Voice Response System

Interactive Voice Response System Toll-Free Number 877-309-4290 Hours Available* Monday–Friday: 6:00 a.m.–7:00 p.m. ET Saturday: 7:00 a.m.–3:00 p.m. ET *IVR hours represent general availability for access to all menu options. The IVR is [...]

Interactive Voice Response System

Interactive Voice Response System State IVR Number Hours Available* Alaska, Arizona, California, Hawaii, Idaho, Nevada, Oregon, Washington, American Samoa, Guam, Northern Mariana Island 866-277-7287 [...]

Join Us to Learn About NGSConnex

Join Us to Learn About NGSConnex We’re hosting a series of webinars focused on our free, secure internet portal, NGSConnex. During each session, we’ll review what NGSConnex has to offer. We’ll discuss registration, access, navigation and [...]

Billing Protections for Qualified Medicare Beneficiaries

Correct a Beneficiary's MSP Record

Table of Contents Background Step 1: Provider Receives Information Indicating Medicare Is the Primary Payer for a Beneficiary's Services Step 2: Prepare and Submit a Medicare Primary Claim With the Reason Medicare Is the Primary Payer [...]

Overcoming Barriers to Tobacco Counseling

Overcoming Barriers to Tobacco Counseling Healthcare providers may face different challenges when implementing tobacco cessation counseling into a clinical practice routine. These various factors influence the healthcare professionals’ [...]

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 [...]

MLN Connects® Newsletter: December 12, 2024

MLN Connects® Newsletter: December 12, 2024 News FY 2024 Medicare Fee-for-Service Improper Payment Rate Revised Home Health Change of Care Notice Form Effective February 1 Skilled Nursing Facility Value-Based Purchasing Program: December [...]

Your Lunchtime Treat! Listen to the Navigating Medicare: Part A Insights for Providers Podcast

Your Lunchtime Treat! Listen to the Navigating Medicare: Part A Insights for Providers Podcast “Lunch, listen and learn” twice a month with Medicare Part A! We have more than 15 Part A podcasts geared toward our Part A providers and their [...]

Intermittent Issues with NGSMedicare.com on 12/15/2024

Intermittent Issues with NGSMedicare.com on 12/15/2024 We will experience intermittent outages with NGSMedicare.com on Sunday, 12/15/2024 due to maintenance. NGSMedicare.com will be fully operational on Monday, 12/16/2024. We apologize for [...]

HCPCS 82947 RTPs End-Stage Renal Dialysis Providers

As of 1/1/2024, Medicare has covered HbA1c tests for diabetic screening (HCPCS 82947) when billed with ICD-10 Z13.1. Some of these claims submitted by ESRD providers have been RTP'd in error.

End Stage Renal Disease Claims Returning to Providers with Reason Code 31773

Due to an issue with the October 2024 release, ESRD facility claims, type of bill 72X, are RTPing in error.

Claim Billing Guidance

Claim Billing Guidance With the end of the PHE, as of 5/11/2023, this information no longer applies. We will keep the information available for PHE-related services that occurred prior to the expiration date that have not yet been billed. [...]

Provider Enrollment Application Fee Amount for CY 2025

Provider Enrollment Application Fee Amount for CY 2025 The provider enrollment application fee for CY 2025 is $730. For more information, view MLN Connects® Newsletter: December 12, 2024. Posted 12/18/2024

Helpful Resources

Helpful Resources The absence of a local coverage determination (LCD) or Medical Policy Article does not indicate noncoverage, it means that currently, National Government Services (NGS) has not identified the service requires an associated [...]

Medicare Part B Drug Coverage

Medicare Part B Drug Coverage Medicare Part B may provide coverage for medically necessary drugs/biologicals that are furnished “incident to” a physician’s service. This coverage does not apply to drugs that are usually [...]

Allergen Immunotherapy: Coding and Billing CPT 95165

Allergen Immunotherapy: Coding and Billing CPT 95165 CPT 95165 is defined as “Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of [...]

[REVISED UPDATE] Hospice Claims Rejected with Reason Code 17729

Claim rejections for TOB 081X and 082X with RC 17729 have occurred due to a file error. These claims did comply with CMS-required entry of the correct certifying physician in the “Attending” field, which did match the PECOS Enrolled [...]

Reminder for Correcting Hospice Edits for Certifying Physicians (17729, 17730)

Reminder for Correcting Hospice Edits for Certifying Physicians (17729, 17730) Reason Codes 17729 and 17730: Refer to specific hospice claim edits related to certifying physicians. Adjustments: Should be submitted for correcting input [...]

Initiate Eligibility Lookup

Initiate Eligibility Lookup Click the Eligibility Lookup button from the NGSConnex homepage.   In the Select a Provider panel, click the Select button next to the applicable provider account.   In the Select a [...]

MLN Connects® Newsletter: December 19, 2024

MLN Connects® Newsletter: December 19, 2024 News MBI Lookup Tools: CMS Seeks Input by February 17 CMS Roundup (December 13, 2024) Long-Term Care Hospital Provider Preview Reports: Review by January 15 Inpatient Rehabilitation Facility [...]

Attention FQHCs: Who Is Your MAC?

Attention FQHCs: Who Is Your MAC? National Government Services serves as the CMS Jurisdiction 6 and K MAC for FQHCs in 44 states, Washington D.C. and the five United States Territories of American Samoa, Guam, Northern Mariana Islands, Puerto [...]

What is NGSConnex?

What is NGSConnex? NGSConnex is a free, secure, web-based application developed by National Government Services just for you! NGSConnex provides access to a wide array of self-service functions that save you time and money, such as: Obtain [...]

Billing Original Fee-for-Service Medicare? You Can Help STOP Assignment Violations!

Billing Original Fee-for-Service Medicare? You Can Help STOP Assignment Violations! Table of Contents Billing Original Fee-for-Service Medicare? You can Help STOP Assignment Violations! What is the Definition of Medicare Assignment? [...]

Part A Fall 2024 Virtual Conference Playback

Part A Fall 2024 Virtual Conference Playback As part of our efforts to educate our provider community, we have posted all 16 educational sessions from our recent Part A Fall 2024 Virtual Conference: Keeping Compliant with Medicare Starts [...]