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Posting Date: 03/20/2020
Social Security Income Ratios
Social Security Income Ratios Attention All Part A Inpatient Prospective Payment System Hospitals, Inpatient Rehabilitation Facilities and Long-Term Care Hospitals The federal fiscal year 2018 SSI ratios for IPPS hospitals, IRFs and LTCHs [...]
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Posting Date: 01/08/2020
New EDI Service Offering for the Part A/FQHC/HHH 276/277 Claim Status Inquiry and Response
New EDI Service Offering for the Part A/FQHC/HHH 276/277 Claim Status Inquiry and Response National Government Services is pleased to announce the availability of a ‘near’ real time response to claim status inquiries submitted to EDI with the [...]
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Posting Date: 11/30/2020
Don’t Forget the CMS-588 Electronic Funds Transfer Authorization Agreement
Don’t Forget the CMS-588 Electronic Funds Transfer Authorization Agreement The CMS-588 Electronic Funds Transfer Authorization Agreement is to be submitted for billing providers upon initial enrollment, change in bank information and during [...]
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Posting Date: 08/20/2020
Opioid Treatment Add-on Code G2078 and G2079 MUE Values
Opioid Treatment Add-on Code G2078 and G2079 MUE Values The July 2020 quarterly update for the NCCI added an MUE value of one for OTP HCPCS codes G2067-G2075 and G2078 and G2079. It was later determined by CMS that the incorrect MUE value was [...]
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Posting Date: 09/18/2020
October 2020 Release "Dark Days" for the Common Working File Hosts
October 2020 Release "Dark Days" for the Common Working File Hosts For the upcoming October 2020 Release: For Production, CWF will be observing dark days starting Friday, 10/2/2020 through Sunday, 10/4/2020 to accommodate the anticipated [...]
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Posting Date: 09/15/2020
October 2020 Fiscal Intermediary Standard System Direct Data Entry Screen Changes
October 2020 Fiscal Intermediary Standard System Direct Data Entry Screen Changes The DDE CWF Inquiry Screen (MAP175M) will display the ABPM and will include the technical and professional dates for HCPCS 93784. The MBI Eligibility FROM and [...]
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Posting Date: 06/24/2020
Registered Dietitians and COVID-19 Allowances for Billing
Registered Dietitians and COVID-19 Allowances for Billing National Government Services has received clarification from CMS in regard to registered dietitians/nutritionists billing. When CPT codes 98966‒98968 were originally opened to coverage [...]
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Posting Date: 05/07/2020
Radiopharmaceuticals Invoice or Acquisition Cost Submission Reminder
Radiopharmaceuticals Invoice or Acquisition Cost Submission Reminder National Government Services has identified situations where claims are being submitted for radiopharmaceuticals without an invoice or acquisition cost provided. For [...]
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Posting Date: 03/02/2020
Quality Innovation Networks - Quality Improvement Organizations Quality Initiatives
Quality Innovation Networks - Quality Improvement Organizations Quality Initiatives CMS leads a national health care quality improvement network of Quality Innovation Networks – Quality Improvement Organizations (QIN-QIOs). Locally, an [...]
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Posting Date: 08/28/2020
Providers' Obligation to Report and Refund Medicare Overpayments with Appropriate Forms
Providers' Obligation to Report and Refund Medicare Overpayments with Appropriate Forms Healthcare providers have an obligation to report and refund federal program overpayments and continue to do so, but National Government Services would [...]
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Posting Date: 10/07/2020
Provider Enrollment Reconsideration Request Reminders
Provider Enrollment Reconsideration Request Reminders National Government Services has been receiving reconsiderations of provider enrollment credentialing requests that do not fall into the appropriate criteria for reconsiderations due to the [...]
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Posting Date: 06/09/2020
Proper Billing for Telehealth Services Claims
Proper Billing for Telehealth Services Claims We have received a high volume of paper CMS-1500 claim forms for telehealth services with dates of service during the PHE that we have to reject because they are improperly coded with two different [...]
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Posting Date: 07/23/2020
Prior Authorization Request Reminders
Prior Authorization Request Reminders Effective for dates of service on or after 7/1/2020, a PAR is required for certain OPD services. For additional information on the Medicare Prior Authorization Program go to our website > log in to any [...]
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Posting Date: 06/04/2020
Prior Authorization Program Becomes Effective for Dates of Service on/after 7/1/2020
Prior Authorization Program Becomes Effective for Dates of Service on/after 7/1/2020 The CMS is implementing a prior authorization program for certain hospital outpatient department services effective for dates of service on or after 7/1/2020. [...]
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Posting Date: 01/16/2020
Reminder: Providers on Automatic Immediate Recoupments
Reminder: Providers on Automatic Immediate Recoupments If you are set up for automatic recoupments, please refrain from submitting checks and overpayment forms. Submitting receipts run the risk of money being offset and your check being [...]
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Posting Date: 12/17/2020
Physicians/Practitioners Medical Records Play a Vital Role in Ordering and Providing DMEPOS to Your Patients
Physicians/Practitioners: Medical Records Play a Vital Role in Ordering and Providing DMEPOS to Your Patients For any DMEPOS item to be covered by Medicare, the patient’s medical record must contain sufficient information about the patient’s [...]
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Posting Date: 06/09/2020
Update on Claims for COVID-19 Testing
Update on Claims for COVID-19 Testing As per CMS PHE guidelines, National Government Services is modifying internal claim editing to permit the following COVID-19-related procedure codes to process as potentially payable without ICD-10 [...]
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Posting Date: 12/14/2020
The CY 2021 MPFS Is Now Available
The CY 2021 MPFS Is Now Available The CY 2021 MPFS is now available. You can view the new fees using the Fee Schedule Lookup tool page on our website. Posted 12/14/2020
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Posting Date: 05/11/2020
Skin Substitutes and Wound Care Products Billing Reminder
Skin Substitutes and Wound Care Products Billing Reminder CMS provides pricing for some wound care products; however, there are many that do not have established pricing. If a skin substitute/wound care product does not have established [...]
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Posting Date: 04/15/2020
Request for Anticipated Payment Auto-Cancellation Extension
Request for Anticipated Payment Auto-Cancellation Extension Due to CMS guidelines during the Public Health Emergency, all RAPs processed during the PHE will have an additional 90 days from the date of the processed RAP to submit the claim for [...]
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Posting Date: 07/27/2020
Repayment of Accelerated and Advance Payments for Part B Providers Begins July 27
Repayment of Accelerated and Advance Payments for Part B Providers Begins July 27 Did you know that repayment period for the relief funds advanced payment begins 120 days after a provider received the payment? For the first 120 days, claims [...]
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Posting Date: 01/31/2020
Reminder: Hospitals Billing for the Appropriate Use Criteria for Advanced Diagnostic Imaging
Reminder: Hospitals Billing for the Appropriate Use Criteria for Advanced Diagnostic Imaging On 1/9/2020, CMS issued additional instructions in SE20002, Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging- Approval of Using the K3 [...]
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Posting Date: 05/12/2020
Reminder: 340B Hospital Survey Closes 5/15
Reminder: 340B Hospital Survey Closes 5/15 Reminder: the 340B hospital survey closes on Friday, 5/15/2020. This survey is for hospitals paid under the OPPS, that were enrolled in the 340B program during calendar year Q4 2018 and/or Q1 2019. [...]
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Posting Date: 09/09/2020
Reminder: Medicare Patient Equal Care Policy is the Law
Reminder: Medicare Patient Equal Care Policy is the Law It has come to our attention that some providers are refusing to offer certain services to Medicare patients that they make available to private-pay patients and patients who have other [...]
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Posting Date: 09/03/2020
We Can Now Accept Electronic Appeal Requests Using the X12 275 Version 6020 Transaction
We Can Now Accept Electronic Appeal Requests Using the X12 275 Version 6020 Transaction National Government Services will now allow Medicare Part A and Part B providers to submit their claim appeal requests, including medical record [...]
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Posting Date: 11/20/2020
VBID Hospice Benefit Component Information Now Available
VBID Hospice Benefit Component Information Now Available Beginning on January 1, 2021, CMS is testing the inclusion of the Part A Hospice Benefit within the MA benefits package through the Hospice Benefit Component of the Value-Based Insurance [...]
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Posting Date: 12/15/2020
Updates to Nursing and Allied Health Education Medicare Advantage Payment Policies
Updates to Nursing and Allied Health Education Medicare Advantage Payment Policies Change Request 11642 Revised 12/15/2020 Revised 12/1/2020 Posted 8/24/2020
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Posting Date: 09/17/2020
Updated Future Effective LCD and Article
Updated Future Effective LCD and Article Fluid Jet System Treatment for LUTS/BPH (L38367) The Fluid Jet System Treatment for LUTS/BPH is now considered medically reasonable and necessary for 30-150 cc- sized prostates when the Indications of [...]
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Posting Date: 09/17/2020
Updated Future Effective LCD and Article
Updated Future Effective LCD and Article Fluid Jet System Treatment for LUTS/BPH (L38367) The Fluid Jet System Treatment for LUTS/BPH is now considered medically reasonable and necessary for 30-150 cc- sized prostates when the Indications of [...]
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Posting Date: 08/21/2019
Ambulance Fee Schedule and Medicare Transports Booklet
Ambulance Fee Schedule and Medicare Transports Booklet A new Ambulance Fee Schedule and Medicare Transports Booklet is available. Learn about coverage, billing and payment for ground and air ambulance transport benefits. Posted 8/21/2019
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Posting Date: 10/09/2019
Medicare’s 2020 Open Enrollment: October 15–December 7
Medicare’s 2020 Open Enrollment: October 15–December 7 Medicare Patients May Have Questions - A State Health Insurance Assistance Program Can Help What is the State Health Insurance Assistance Program? A SHIP is a free insurance counseling [...]
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Posting Date: 09/27/2019
Local Coverage Determination and Article Revisions September-October 2019
Local Coverage Determination and Article Revisions September‒October 2019 All medical policies and related articles can be found on the NGS Medical Policy Center. Bevacizumab and Biosimilars - Related to LCD L33394 (A52370) Bevacizumab-awwb [...]
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Posting Date: 11/01/2019
Local Coverage Determination and Article Revisions October-November 2019
Local Coverage Determination and Article Revisions October‒November 2019 The medical policies and related articles can be found in our Medical Policy Center. Updates Billing and Coding: Molecular Pathology Procedures (A56199) Added [...]
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Posting Date: 11/25/2019
LCD and Article Revisions: November/December 2019
Local Coverage Determination and Article Revisions November–December 2019 LCDs and Articles Revised in November and December: B-type Natriuretic Peptide (BNP) Testing (L33573) Consistent with Change Request 10901, all coding information, [...]
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Posting Date: 09/13/2019
276 Claim Status Inquiry Near Real-Time Response
276 Claim Status Inquiry Near Real-Time Response We are excited to announce a process change for our Part A providers that will return a 277 Claim Status Inquiry Response in “near real time.” Beginning in October, 2019, we will return the 277 [...]
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Posting Date: 08/14/2019
Medicare Beneficiary Identifier Monthly Tip
Medicare Beneficiary Identifier Monthly Tip Are you receiving claim rejections because of an invalid beneficiary identifier? It could be that you are using the wrong characters on the MBI. The new Medicare number will not include the letters [...]
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Posting Date: 07/25/2019
Changes to National Government Services Local Coverage Determination Process
Changes to National Government Services Local Coverage Determination Process In accordance with Section 4009 of H.R. 34-21st Century Cures Act (Public Law No: 114-255), CMS is updating the “Medicare Program Integrity Manual” with detailed [...]
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Posting Date: 07/19/2019
Attention PIP Hospitals – Delay in Periodic Interim Payment (PIP) Payments
Attention PIP Hospitals – Delay in Periodic Interim Payment (PIP) Payments We have been informed that the biweekly PIP/Pass-Through payment cycle did not initiate as scheduled last night. Therefore, the biweekly payments will be delayed by one [...]
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Posting Date: 06/10/2019
Reminder: ZIP Code Needed on Claims with Flu Vaccine Codes
Reminder: ZIP Code Needed on Claims with Flu Vaccine Codes Medicare Part B requires the location where the service(s) are rendered to be included on the claim for every service payable under the MPFS. In Box 32 on the CMS-1500 claim form, [...]
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Posting Date: 06/13/2019
MLN Connects® for Thursday, June 13, 2019
MLN Connects® for Thursday, June 13, 2019 MLN Connects® for Thursday, June 13, 2019 View this edition as a PDF News DMEPOS Competitive Bidding - Round 2021: Register Now Medicare Shared Savings Program: Submit Notice of Intent to [...]
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Posting Date: 06/11/2019
EDI Front End Rejection Code Lookup Tool
EDI Front End Rejection Code Lookup Tool The EDI Front End Rejection Code Lookup Tool is a simple to use tool that provides a clear and understandable description of edit codes returned on the 277 Claims Acknowledgement (277CA). Using this [...]
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Posting Date: 10/10/2019
Center for Medicare and Medicaid Innovation Payments
Center for Medicare and Medicaid Innovation Payments Section 1115A of the Social Security Act established the CMMI within the CMS to test innovative payment techniques and service delivery models. This payment model is outside the normal [...]
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Posting Date: 08/23/2019
Local Coverage Determination and Article revisions August‒September 2019
Local Coverage Determination and Article revisions August‒September 2019 Please note that consistent with Change Request 10901, all coding information, national coverage provisions and Associated Information (Documentation Requirements, [...]
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Posting Date: 09/11/2019
Important Update for Skilled Nursing Facilities - CMS Updated the SNF PDPM Web Page
Important Update for Skilled Nursing Facilities - CMS Updated the SNF PDPM Web page The SNF PPS PDPM was implemented on 10/1/2019 to replace the Resource Utilization Group, Version IV (RUG-IV) for the SNF PPS. SNF PDPM will improve [...]
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Posting Date: 07/02/2019
Genetic Testing Fraud Scam Directed at Medicare Beneficiaries
Genetic Testing Fraud Scam Directed at Medicare Beneficiaries The U.S. Department of Health and Human Services Office of Inspector General is alerting the public about a fraud scheme involving genetic testing. Please review the Fraud Alert: [...]
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Posting Date: 12/16/2019
Ensure Referral Forms Include the MBI
Ensure Referral Forms Include the MBI Providers have expressed concern regarding referral forms that do not include the new Medicare number, the MBI, they receive from providers who have referred a Medicare beneficiary to them for services. [...]
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Posting Date: 06/14/2019
July 2019 Release Dark Days for the Common Working File Host
July 2019 Release Dark Days for the Common Working File Host For the upcoming July 2019 Release, CWF will be observing dark days starting Friday, 6/28/2019, through Sunday, 6/30/2019 to accommodate the anticipated duration of this activity and [...]
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Posting Date: 06/13/2019
July 2019 Fiscal Intermediary Standard System Direct Data Entry Screen Changes
July 2019 Fiscal Intermediary Standard System Direct Data Entry Screen Changes The following updates will be made to existing screens and implemented on 7/1/2019. MAP1716 Claim page (6) – INIT DRG field will be displayed this is a 4-byte [...]
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Posting Date: 05/31/2019
July 2019 EDI Front-End Quarterly Release
July 2019 EDI Front-End Quarterly Release Please be advised that while the CMS-mandated quarterly release for July 2019 will be installed the weekend of 6/30/2019, the code set updates included with this release will not be effective in the [...]
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Posting Date: 12/10/2019
January 2020 Release "Dark Days" for the Common Working File Hosts
January 2020 Release "Dark Days" for the Common Working File Hosts For the upcoming January 2020 Release: New Year’s Day holiday – observed Wednesday, January 1st – No cycles (onlines available). CWF will be observing dark days starting [...]
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Posting Date: 10/01/2019
Center for Medicare and Medicaid Innovation Remittance Remark
Center for Medicare and Medicaid Innovation Remittance Remark Attention providers: If you are receiving a remark stating "CMMI" payment on your remittance this is regarding a QPP payment. Please direct any questions regarding QPP to [...]
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Posting Date: 10/01/2019
October is National Breast Cancer Awareness Month
October is National Breast Cancer Awareness Month Breast Cancer Screening and Mammography Breast cancer is one of the most common kinds of cancer in women. According to the U.S. Department of Health and Human Services, about one in eight [...]
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Posting Date: 08/07/2019
Important News from CGS, Jurisdiction B DME MAC: Prior Authorization Condition of Payment for Certain Power Mobility Devices
Important News from CGS, Jurisdiction B DME MAC: Prior Authorization Condition of Payment for Certain Power Mobility Devices If you have Medicare patients who are seeking prior authorization of a power mobility devices, please review the CGS [...]
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Posting Date: 10/18/2019
Coding for Sinuva™ Claims
Coding for Sinuva™ Claims This notice is a coding instruction, and not an indication of coverage. FDA labels should be consulted for indications and usage. Claims submitted to National Government Services for endoscopic placement of Sinuva™ [...]
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Posting Date: 12/02/2019
MLN Connects® Special Edition for Monday, December 2, 2019
MLN Connects® Special Edition for Monday, December 2, 2019 HHAs: Get Help Registering for iQIES by December 23 Avoid payment delays. You need access to the upgraded Internet Quality Improvement and Evaluation System (iQIES) to submit [...]
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Posting Date: 06/06/2019
MLN Connects® Special Edition - Thursday, June 6, 2019
MLN Connects® Special Edition - Thursday, June 6, 2019 CMS Seeks Public Input on Patients over Paperwork Initiative to Further Reduce Administrative, Regulatory Burden to Lower Healthcare Costs On June 6, CMS issued a Request for Information [...]
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Posting Date: 09/30/2019
MLN Connects® Special Edition - Monday, September 30, 2019
MLN Connects® Special Edition - Monday, September 30, 2019 New HCPCS Code J0642 for Levoleucovorin Injection For dates of service on or after October 1, use HCPCS code J0642 for levoleucovorin injection products marketed under the brand name [...]
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Posting Date: 11/14/2019
MLN Connects® for Thursday, November 14, 2019
MLN Connects® for Thursday, November 14, 2019 New Medicare Card: If an MBI Changes MLN Connects® for Thursday, November 14, 2019 View this edition as a PDF News New Medicare Card: If an MBI Changes Medicare Shared Savings [...]
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Posting Date: 05/28/2019
Local Coverage Determination and Article Revisions: May–June 2019
Local Coverage Determination and Article Revisions: May–June 2019 All medical policies and related articles can be found on the NGS Medical Policy Center. Intravenous Immune Globulin (IVIG) - Related to LCD L33394 (A52446) Corrected product [...]
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Posting Date: 06/26/2019
Local Coverage Determination and Article Revisions: June–July 2019
Local Coverage Determination and Article Revisions: June–July 2019 All medical policies and related articles can be found on the NGS Medical Policy Center. LCD Revisions for June 2019 Psychiatric Partial Hospitalization Programs [...]
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