Who Needs to Pay Application Fees

Who Needs to Pay Application Fees Institutional providers or suppliers must submit an application fee or hardship exception when initially enrolling, revalidating their enrollment or adding a new Medicare practice location. Physicians, [...]

Who Needs to Pay Application Fees

Who Needs to Pay Application Fees Institutional providers or suppliers must submit an application fee or hardship exception when initially enrolling, revalidating their enrollment or adding a new Medicare practice location. Physicians, [...]

LCD and Billing and Coding Article Updates – 2025

LCD and Billing and Coding Article Updates – 2025 January Psychiatric Partial Hospitalization Programs L33626 Effective 1/1/2024, in the Coverage Indications, Limitations and/or Medical Necessity section, the third list under Limitations has [...]

National AB Medicare Administrative Contractor Ambulance Provider/Supplier Coalition

National AB Medicare Administrative Contractor Ambulance Provider/Supplier Coalition Attention Ambulance Providers In response to numerous and continued requests from the ambulance community, the AB MACs have put together a National AB MAC [...]

Hospital-Based Ambulance Basic Billing Guidelines

Hospital-Based Ambulance Basic Billing Guidelines For hospital-based ambulance billing under Medicare, services should be billed on the UB-04 form using the ambulance service-specific NPI, not the acute hospital NPI, and claims for inpatient [...]

MLN Connects® Newsletter: June 26, 2025

MLN Connects® Newsletter: June 26, 2025 News Alert: Medicare Fraud Scheme Involving Phishing Fax Requests Medicare Diabetes Prevention Program: CY 2025 Payment Rates Compliance Commodes, Bed Pans & Urinals: Prevent Claim Denials [...]

Self-Administered Drug Exclusion (J6 and JK)

Self-Administered Drug Exclusion Update (J6 and JK) Medications that are self-administered more than 50% of the time for all Medicare beneficiaries are excluded from Medicare Part B coverage.  At the direction of CMS, each MAC shall [...]

Eligible Method II Providers

Eligible Method II Providers If a CAH wants to become a Method II biller, email the request to A&R at ngsreimbursement@anthem.com.  Suppliers who can enroll as a Method II Biller Reassignment. Doctor of Medicine (MD) Doctor of [...]

Electronic Funds Transfer Form and Instructions

Table of Contents Electronic Funds Transfer Form and Instructions CMS-588 EFT Completion Tips for Sole Proprietors, Sole Owners, Clinic/Groups, Organizations, Providers and Suppliers [Return to Top] Electronic Funds Transfer Form and [...]

Verify Bank Account Information

National Government Services receives numerous electronic funds transfer banking rejections each year due to frozen or closed bank accounts. To prevent interruption in Medicare payment, billing providers verify an active bank account is [...]

Electronic Funds Transfer

Electronic Funds Transfer EFT allows for claim payments to be electronically transferred to your bank in place of a hard copy check mailed to the facility. Medicare payments due a provider or supplier of services may be sent to a bank (or [...]

Electronic Funds Transfer

EFT allows for claim payments to be electronically transferred to your bank in place of a hard copy check mailed to the facility. Medicare payments due a provider or supplier of services may be sent to a bank (or similar financial institution) [...]

Lets Chat about Federally Qualified Health Center Billing and Reimbursement

Need answers on FQHC billing and reimbursement without attending a full training? Join our 30-minute "Let's Chat" session. This informal discussion allows providers to engage with our Provider Outreach and Education team. You are [...]

Fee Schedule Assistance

Fee Schedule Assistance Connecticut Illinois Locality/Area and County Information Maine, Massachusetts, New Hampshire, Rhode Island, Vermont Locality/Area and County Information New York Locality/Area and County Information Locate and [...]

The Incident To Provision for Medicare

Do you have nonphysician practitioners that are, or could be, providing services incident to the physicians in the practice? Are you following the Centers for Medicare & Medicaid Services (CMS) regulations for this program? Staying [...]

Learn Over Lunch – NGSConnex Inquiries

Effective 5/27/2025, National Government Services will no longer accept inquiries submitted through the postal service to any of our P.O. Boxes or faxed to any of our fax lines. Are you prepared? Join this session to learn how to efficiently [...]

Claim Denials for Medically Unnecessary Ambulance Transports: Avoiding Reason Code 55B10

Claim Denials for Medically Unnecessary Ambulance Transports Table of Contents Claim Denials for Medically Unnecessary Ambulance Transports Medical Necessity and Coverage Guidelines for Ambulance Transport Avoiding Reason Code 55B10 [...]

July 2025 EDI Front End Quarterly Release

July 2025 EDI Front End Quarterly Release Please be advised that while the CMS mandated release for July 2025 will be installed the weekend of 7/6/2025, the code set updates included with this release will not be effective in the EDI Front-End [...]

July 2025 EDI Front End Quarterly Release

July 2025 EDI Front End Quarterly Release Please be advised that while the CMS mandated release for July 2025 will be installed the weekend of 7/6/2025, the code set updates included with this release will not be effective in the EDI Front-End [...]

Improving Customer Experience

Improving Customer Experience We are committed to improving your experience. Please watch this two-minute video that explains how each day we review comments from providers who submit surveys to let us know what is working well and how we can [...]

Ambulance Services and Establishing Medical Necessity for Part B Providers

This webinar will help the ambulance community understand the importance of medical necessity as it pertains to Medicare’s coverage guidelines.

Bone Mass Measurement: 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 [...]

ASCA Requirements for Paper Claim Submissions

Table of Contents ASCA Requirements for Paper Claim Submissions Submitting Electronic Claims Submitting Paper Claims ASCA Exception Criteria Related Content [Return to Top] ASCA Requirements for Paper Claim Submissions [...]

EDI Enrollment JK

Helpful Resources Approved Entities Network Service Vendors EDI Application Status Search Tool NPI/PTAN Crosswalk Contact the EDI Help Desk: 888-379-9132 Available by phone or email Monday–Friday* 8:00 a.m.–5:00 p.m. ET 7:00 a.m.–4:00 p.m. [...]

EDI Enrollment J6

Helpful Resources Approved Entities Network Service Vendors EDI Application Status Search Tool NPI/PTAN Crosswalk Contact the EDI Help Desk: 877-273-4334 Available by phone or email Monday–Friday* 8:00 a.m.–5:00 p.m. ET 7:00 a.m.–4:00 p.m. [...]

Administrative Simplification Compliance Act Waiver Request Form

July 2025 Release "Dark Days" for the Common Working File Hosts

July 2025 Release "Dark Days" for the Common Working File Hosts For the Upcoming July 2025 Release: For Production, CWF will be observing the Gray Day on Wednesday, 7/2/2025 and Dark Days starting Thursday, 7/3/2025 (including July 4th [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Business Function State Mailing Address Additional Documentation Requests CT, MA, ME, NH, NY, RI, VT National Government Services, Inc. P.O. Box 7108 Indianapolis, IN [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Business Function Mailing Address Additional Development Requests National Government Services, Inc. Attn: Medical Review P.O. Box 6474 Indianapolis, IN 46206-6474 [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Business Function State Mailing Address Appeals AK, AZ, CA, HI, ID, NV, OR, WA, American Samoa, Guam, Northern Mariana Island, MI, MN, NJ, NY, WI, Puerto Rico, Virgin Islands [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Business Function State Mailing Address Additional Documentation Requests CT, MA, ME, NH, NY, RI, VT National Government Services, Inc. P.O. Box 7108 Indianapolis, IN [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Business Function Mailing Address Additional Development Requests National Government Services, Inc. Attn: Medical Review P.O. Box 6474 Indianapolis, IN 46206-6474 [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses Business Function State Mailing Address Additional Documentation Requests CT, MA, ME, NH, NY, RI, VT National Government Services, Inc. P.O. Box 7108 Indianapolis, IN [...]

New Recovery Audit Contractor

New Recovery Audit Contractor On 4/28/2025, CMS awarded Cotiviti GOV Services LLC the RAC contracts for Region 5 . Region 5 encompasses JA, JB, JC, JD, and the HHH MACs: J6, J15, JK, and JM. Performant previously managed Region 5 and will [...]

Counseling to Prevent Tobacco Use

In an effort to raise awareness and increase utilization of tobacco use counseling, we’ll focus on the effects of nicotine dependence including affected health consequences during this webinar. Medicare coverage, coding, billing and [...]

Counseling to Prevent Tobacco Use

In an effort to raise awareness and increase utilization of tobacco use counseling, we’ll focus on the effects of nicotine dependence including affected health consequences during this webinar. Medicare coverage, coding, billing and [...]

Counseling to Prevent Tobacco Use

In an effort to raise awareness and increase utilization of tobacco use counseling, we’ll focus on the effects of nicotine dependence including affected health consequences during this webinar. Medicare coverage, coding, billing and [...]

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 [...]

Repetitive Scheduled Non-Emergent Ambulance Transports Prior Authorization

Attention All Independent Ambulance Suppliers! If you are providing repetitive, scheduled, non-emergent ambulance transports (RSNAT), you'll want to attend this webinar. Join us to learn everything you need to know about the RSNAT program.

Preventive Vaccines for FQHCs and RHCs Guidance

Preventive Vaccines for FQHCs and RHCs Guidance Effective 7/1/2025, FQHCs and RHCs will bill and receive payment for all four types of Part B preventive vaccines (pneumococcal, influenza, COVID-19 and hepatitis B) and their administration at [...]

Counseling to Prevent Tobacco Use

In an effort to raise awareness and increase utilization of tobacco use counseling, we’ll focus on the effects of nicotine dependence including affected health consequences during this webinar. Medicare coverage, coding, billing and [...]

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 [...]

Repetitive Scheduled Non-Emergent Ambulance Transports Prior Authorization

Attention All Independent Ambulance Suppliers! If you are providing repetitive, scheduled, non-emergent ambulance transports (RSNAT), you'll want to attend this webinar. Join us to learn everything you need to know about the RSNAT program.

Preventive Vaccines for FQHCs and RHCs Guidance

Preventive Vaccines for FQHCs and RHCs Guidance Effective 7/1/2025, FQHCs and RHCs will bill and receive payment for all four types of Part B preventive vaccines (pneumococcal, influenza, COVID-19 and hepatitis B) and their administration at [...]

New Recovery Audit Contractor

New Recovery Audit Contractor On 4/28/2025, CMS awarded Cotiviti GOV Services LLC the RAC contracts for Region 5 . Region 5 encompasses JA, JB, JC, JD, and the HHH MACs: J6, J15, JK, and JM. Performant previously managed Region 5 and will [...]

Three-Day Qualifying Hospital Stay Required for Medicare-Covered SNF Stay

Three-Day Qualifying Hospital Stay Required for Medicare-Covered SNF Stay Medicare coverage of inpatient SNF services requires a qualifying, medically necessary inpatient hospital stay of at least three consecutive calendar days within 30 [...]

Home Health Billing Coffee Break

Provider Outreach and Education is hosting a 30-minute coffee break to help answer your troublesome billing questions. This is a great opportunity to discuss areas of billing more in depth and review helpful guides and resources. Keep in mind [...]

MLN Connects® Newsletter: July 3, 2025

MLN Connects® Newsletter: July 3, 2025 Proposed Payment Rules ESRD: CY 2026 Proposed Rule — Submit Comments by August 29 Home Health: CY 2026 Proposed Rule — Submit Comments by August 29 News CMS Launches New Model to Target Wasteful, [...]

Medicare Secondary Payer: A Review of the Non-Group Health Plan MSP Provisions

In this webinar, we review the workers’ compensation, No-Fault (including medical-payment coverage) and the Liability Medicare Secondary Payer (MSP) provisions. Understanding these provisions will help your facility identify and bill the [...]

Medicare Secondary Payer: Adjustment Claims

In this webinar, we will review how to prepare and submit adjustments (Type of Bill XX7) to change processed or rejected claims for Medicare Secondary Payer (MSP)-related reasons. We discuss adjusting Medicare primary, MSP, and cost-avoided [...]

Medicare Secondary Payer: Payment and Beneficiary Responsibility

In this webinar, we review how Medicare determines if an Medicare Secondary Payer (MSP) payment is due on a claim, how the MSP payment module determines the amount of an MSP payment, how coding reported on MSP claims can impact payment, and how [...]

Overpayment: How Should I Respond?

Table of Contents Overpayment: How Should I Respond? What Action Should I Take? Complete a Voluntary Refund Where Should I Send my Forms and Payments? [Return to Top] Overpayment: How Should I Respond? An overpayment may be [...]

Request an Immediate Recoupment

National Government Services has implemented a standardized “immediate recoupment” process that gives you the option to avoid interest from accruing on claims overpayments when the debt is recouped in full prior to or by the 30th day from the [...]

Complete a Voluntary Refund

A voluntary refund is when you have self-identified you have been overpaid and you need to refund the excess funds to Medicare. All checks are made payable to National Government Services. Whenever possible, the refund to Medicare should be [...]

Pricing <5>

table, td, th table { border-collapse: collapse; width: 50%; } Pricing <5> When Pricing is selected, the IVR will play the following: "To obtain pricing information, visit NGSMedicare.com and use our fee schedule lookup tool, [...]

Set Up an Extended Repayment Schedule

If repaying an overpayment would constitute a “hardship” on the provider, a request for an ERS should be submitted immediately. While you may request an ERS at any time during the debt-collection process, timely submission of a valid request [...]

Payment Withholding Information

Payment Withholding Information What Is a Payment Withholding? Why Are Payments Withheld? Who Can I Contact for Further Assistance? What About Cost Report Interim and Final Settlement Withholdings? What Is a Payment Withholding? An [...]

MSP Post-Pay Adjustments

If you have received an overpayment because Medicare paid as the primary insurer and another insurance carrier should be the primary payer, follow the instructions on the Part A voluntary refund form. A separate refund form is needed for [...]

Refunds Due to Beneficiaries by Providers

Refunds Due to Beneficiaries by Providers In some situations, providers are responsible for refunding monies to beneficiaries that have paid for services providers have determined to be noncovered and nonpayable by Medicare. When an ABN has [...]

Credit Balance Reporting

Table of Contents What is a Credit Balance? What Should I Do When I Have a Credit Balance? Additional Tips for a Successful Credit Balance Report Submission [Return to Top] What is a Credit Balance? Generally, when a provider [...]