Search Results - NGSMEDICARE

Posting Date: 06/04/2025

Request an Immediate Recoupment

Forms You’ll Need These forms apply to providers that are NOT on Automatic Immediate Recoupments. Electronic Submissions JK or J6 Immediate Recoupment Request Form - Electronic/E-mail Paper Submissions Jurisdiction K [...]

Posting Date: 06/04/2025

Set Up an Extended Repayment Schedule

Forms you’ll need J6 Applying for an Extended Repayment Schedule JK Applying for an Extended Repayment Schedule If repaying an overpayment would constitute a “hardship” on the provider, a request for an ERS should be submitted [...]

Posting Date: 06/04/2025

Advanced Payments to Providers

A provider may request an accelerated/advance payment where delays in payments by an A/B MAC for covered services rendered to beneficiaries have caused financial difficulties for the provider. An accelerated/advance payment may also be made in [...]

Posting Date: 06/04/2025

Overpayment Rebuttal Process

You’ll need to know what the rebuttal process is before initiating and know that the outcome of the rebuttal may not change the National Government Services recoupment process. The overpayment rebuttal process is a protocol used when an [...]

Posting Date: 06/04/2025

MSP Post-Pay Overpayments

Forms You’ll Need Jurisdiction K CT-MA-ME-NH-NY-RI-VT Medicare Part B MSP Overpayment Request Form Jurisdiction 6 IL-MN-WI Medicare Part B MSP Overpayment Request Form JK or J6 Medicare Secondary Payer Part B Voluntary [...]

Posting Date: 06/03/2025

Overview of Evaluation and Management Services

Due to the overwhelming response for this session, we’re offering this as a repeat of the 6/3 virtual conference webinar. We've seen major changes to the evaluation and management code set over the last few years. In 2021, the AMA [...]

Posting Date: 06/03/2025

Home Health Billing Part One: The Notice of Admission

Provider Outreach and Education is hosting a two-part home health billing series. Part one will focus on what you need to know before billing, verifying eligibility, and the required fields to properly submit The Notice of Admission. This [...]

Posting Date: 06/03/2025

Home Health Billing Part Two: The Period of Care Claim

Part two of this home health billing series focuses on the period of care claim, how reimbursement is determined under the Patient Driven Groupings Model, and review of the key billing requirements for claim billing. This session is a great [...]

Posting Date: 06/03/2025

NGSConnex: Standard User Overview, Access and Navigation

This webinar is geared toward 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'll review what NGSConnex has to offer, including registration, logging in, [...]

Posting Date: 01/01/1970

AFH_How to Proactively Address Denials

How to Proactively Address Denials How to Proactively Address Denials Want to improve the Payment Error Rate for the next round of review? Be sure to learn about and understand claim denials before the end of round education with the Case [...]

Posting Date: 07/05/2022

Targeted Probe and Educate Review Topics

Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to supply medical [...]

Posting Date: 10/04/2022

Daily Treatment Notes Requirement for Inpatient SNF Services

Therapy Treatment Note Requirement for Inpatient SNF Services The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-2, Medicare Benefit Policy Manual, Chapter 15 is the primary source for therapy [...]

Posting Date: 07/05/2022

Targeted Probe and Educate Review Topics

Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to supply medical [...]

Posting Date: 07/05/2022

Medical Review: Targeted Probe and Educate Review Topics

Medical Review: Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to [...]

Posting Date: 02/09/2022

Targeted Probe and Educate Educational Videos

Targeted Probe and Educate Educational Videos Video Description Targeted Probe and Educate Learn more about the TPE Program. Additional educational information can be found on our Events page [...]

Posting Date: 02/09/2022

Targeted Probe and Educate Review Topics

Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to supply medical [...]

Posting Date: 06/04/2025

Let's Chat About Medicare Secondary Payer

During this session, you’ll have the opportunity to ask questions about all aspects of Medicare Secondary Payer. Answers will be provided by a panel of subject-matter experts. As this is a question-and-answer session, there is no presentation [...]

Posting Date: 02/04/2022

Targeted Probe and Educate Educational Videos

Targeted Probe and Educate Educational Videos Video Description MAC Medical Review Best Practices: Updating Your Contact Information Did you know providers can now designate a separate [...]

Posting Date: 01/01/1970

Targeted Probe and Educate

Targeted Probe and Educate Targeted Probe and Educate Table of Contents Targeted Probe and Educate Key Elements of TPE Provider Tips Related Content [Return to Top] National Government Services restarted targeted probe and educate reviews on [...]

Posting Date: 02/04/2022

Medical Review: Targeted Probe and Educate Review Topics

Medical Review: Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to [...]

Posting Date: 01/01/1970

B_How to Proactively Address Denials

How to Proactively Address Denials How to Proactively Address Denials Want to improve the Payment Error Rate for the next round of review? Be sure to learn about and understand claim denials before the end of round education with the Case [...]

Posting Date: 06/04/2025

Some Claims Editing for Reason Code U537I, HH Claim Falls Outside of an HH Admission Period for the Same Provider

Note: This issue was originally reported and resolved in April 2025. The issue has returned so we have reopened the alert. The CWF can only hold the 36 most recent periods of care for any beneficiary. CWF also contains the indicator of when [...]

Posting Date: 06/04/2025

Observance of Juneteenth Holiday

Observance of Juneteenth Holiday In observance of Juneteenth, the National Government Services offices will be closed on Thursday, 6/19/2025. This includes the following departments: EDI Help Desk* Provider Contact Center Provider [...]

Posting Date: 06/05/2025

Rural Emergency Hospital Basics

Do you know what a Rural Emergency Hospital (REH) is and what services can be provided? Part A facilities, including Critical Access Hospitals and small rural hospitals, are eligible to enroll as a REH. Join this session to learn more about the [...]

Posting Date: 08/15/2023

Medicare Part B Coverage and Billing Guidance for Breast Ultrasound

Medicare Part B Coverage and Billing Guidance for Breast Ultrasound Breast ultrasound uses sound waves to produce pictures of the inside of the breast and can show changes that are more difficult to see on a mammogram. Breast ultrasound is not [...]

Posting Date: 09/04/2024

Psychotherapy Services

Psychotherapy Services Medicare Regulations Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 6, Section 70.1 Local Coverage Determination (LCD): [...]

Posting Date: 06/05/2025

Part A Summit - NGSConnex: User Pain Points Examples/Solutions

Are you experiencing issues while utilizing NGSConnex? Join this informative session to learn what user pain points are and how to resolve these issues from an NGSConnex Agile Product Owner. This session will encompass issues with [...]

Posting Date: 06/05/2025

Part A Summit – How to Submit an Appeal Request

Join us for a comprehensive session focused on understanding the appeal submission process within National Government Service. This presentation is designed to guide participants through each step of submitting an appeal, ensuring clarity and [...]

Posting Date: 06/05/2025

Part A Summit- Skilled Nursing Facility: Coverage and Documentation

During this collaborative education session between Case Management and Medical Review, attendees will learn documentation requirements for skilled nursing facility (SNF) coverage, how to properly respond to Additional Documentation Requests [...]

Posting Date: 06/05/2025

Part A Summit- Navigating Billing and Documentation for Behavioral Health Services in Federally Qualified Health Centers

Unlock the secrets to effective billing and documentation for behavioral health services within Federally Qualified Health Centers. This collaborative webinar will include insights from Medical Review and is designed to help healthcare [...]

Posting Date: 06/09/2025

Medicare Secondary Payer: A Review of the Working Aged with an Employer Group Health Plan Provision

In this webinar, we will review the criteria of the Working Aged with an Employer group health plan (EGHP), Medicare Secondary Payer (MSP) provision. Understanding this criteria will help your facility identify and bill the appropriate primary [...]

Posting Date: 06/09/2025

Colorectal Cancer Screening: Promoting Good Health Through Disease Prevention and Detection

Medicare covers many preventive services to keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep your patients from getting certain diseases. Register today for an [...]

Posting Date: 01/14/2022

Meeting Schedule for Home Health and Hospice

Meeting Schedule for Home Health and Hospice Jurisdiction 6 (Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Jersey, New York, Northern Mariana Island, Oregon, Puerto Rico, U.S. Virgin [...]

Posting Date: 06/09/2025

[RESOLVED] Fiscal Intermediary Standard System and Multi Carrier System Experiencing Outages

[RESOLVED] Fiscal Intermediary Standard System and Multi Carrier System Experiencing Outages The FISS and MCS are now available and Part A and Part B providers can check claim status in NGSConnex and the IVR system. We apologize for any [...]

Posting Date: 06/10/2025

Part A Summit - Maintaining Your Provider Files

This virtual webinar will aid in maintaining accurate provider enrollment files for the internet-based Centers for Medicare & Medicaid Services systems: Identity & Access Management System, National Plan & Provider Enumeration [...]

Posting Date: 06/10/2025

Part A Summit- Navigating NGS and CMS Websites

Join us for this informative session where we will review how to find helpful Medicare references and resources on the National Government Services website (www.NGSMedicare.com) and the Centers for Medicare & Medicaid Services website [...]

Posting Date: 01/04/2022

Meeting Schedules

Meeting Schedules Jurisdiction 6: Illinois, Minnesota, Wisconsin Jurisdiction K: Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont Meeting Date/Time Provider Type Chairpersons [...]

Posting Date: 02/04/2022

Medical Review: Targeted Probe and Educate Review Topics

Medical Review: Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to [...]

Posting Date: 06/11/2025

Preventive Services: Screening for STIs/HIBC to Prevent STIs, Hepatitis B, Hepatitis C Virus and HIV including HIV PrEP

This webinar is the latest in a series of Medicare preventive services webinars. During this session, we’ll review the Medicare coverage, coding and billing guidelines for screening for sexually transmitted infections (STIs)/high intensity [...]

Posting Date: 06/11/2025

Alcohol Misuse, Counseling to Prevent Tobacco Use and Lung Cancer Screening

During this webinar, we’ll review the coverage, coding and billing guidelines for the Medicare Part B preventive services benefits of alcohol misuse, counseling to prevent tobacco use and lung cancer screening.

Posting Date: 02/17/2025

Medicare Secondary Payer: Preparing and Submitting Conditional Claims (Examples) – Part 2

Join us for Part 2 of a two-part webinar. In Part 2, we will briefly recap the conditional claim coding and billing instructions we reviewed in Part 1 (on 2/26/2025). We will then focus on reviewing examples of conditional claims. A conditional [...]

Posting Date: 02/12/2025

Quarterly Review of Top Part A Claim Errors

Do you struggle with your claim denials, rejections and return to provider (RTP) claims? Do you want to be proactive in preventing unnecessary errors? Join us in a review of top claim errors for your provider type based on recent data analysis [...]

Posting Date: 06/06/2025

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 [...]

Posting Date: 11/16/2021

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 [...]

Posting Date: 04/15/2022

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 [...]

Posting Date: 08/21/2018

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 [...]

Posting Date: 08/21/2018

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 [...]

Posting Date: 01/17/2017

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 [...]

Posting Date: 12/05/2016

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

Posting Date: 12/05/2016

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 [...]

Posting Date: 08/21/2018

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 [...]

Posting Date: 04/08/2021

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 [...]

Posting Date: 01/01/1970

Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE)

Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE) L39226 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39226 A58963 https://www.cms.gov/medicare-coverage-database/view/article.aspx?article[...]

Posting Date: 06/12/2025

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 [...]

Posting Date: 08/24/2022

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, [...]

Posting Date: 05/05/2021

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, [...]

Posting Date: 05/05/2021

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, [...]

Posting Date: 05/05/2021

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 [...]

Posting Date: 06/12/2025

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.

Posting Date: 06/12/2025

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.