Billing Overlap/Dispute Resolution Process

Billing Overlap/Dispute Resolution Process Table of Contents Billing Overlap/Dispute Resolution Process Mailing Addresses and Fax Number JK: J6: General Inquiries JK: J6: [Return to Top] Billing Overlap/Dispute [...]

National Government Services: Raising Awareness About Care Management

National Government Services: Raising Awareness about Care Management According to the Center for Disease Control, six in ten adults in the U.S. have a chronic disease and four in ten adults have two or more. As your MAC for Jurisdiction 6 [...]

Overlapping Claim Tips for Resolution

Overlapping Claim Tips for Resolution Table of Contents Overlapping Claim Tips for Resolution Type of Bills Impacted Inpatient Hospital Overlap Tips Hospital Discharge Coding Hospital Overlapping with Home Health Care Hospital [...]

Medicare Beneficiary Identifier

The MBI is the patient identification number assigned to Medicare beneficiaries. Claims submitted to Medicare contractors must contain the MBI. In 2020, CMS removed the SSN based identifier from the Medicare card to protect beneficiaries and [...]

Exceptions

The official transition period for the new Medicare Number has ended. The MBI should be used for all of your transactions and inquires. CMS will continue to accept the HICN on the following data exchanges after 1/1/2020. These are the only [...]

Medicare Hospice Quick Reference Sheet

Medicare Hospice Quick Reference Sheet The codes listed below are only those most frequently applicable to hospice claims. For a complete list of codes, see the NUBC manual. The NUBC maintains the UB-04 data element specifications and revenue [...]

Education Partnership Request Form

A/B and DME Collaborative YouTube Video

A/B and DME Collaborative YouTube Video The A/B DME MACs are offering a YouTube video on General Documentation Requirements. This video provides guidance to assist providers and suppliers with a better understanding of the requirements for [...]

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Beginning June 4th!

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Beginning June 4th! Seats are filling up quickly for our 2024 Spring/Summer Virtual Conference: Mastering Medicare- Tuesday [...]

More Medicare Resources

More Medicare Resources Medicare.gov Your online Medicare resource Replace Your Medicare Card Learn how to replace your Medicare card

Attention All Providers, Billing Services and Clearinghouses Who Submit and Receive NGS EDI Transactions

Attention All Providers, Billing Services and Clearinghouses Who Submit and Receive NGS EDI Transactions As a reminder, when submitting the EDI Enrollment Application to National Government Services, only one form should be completed for any [...]

CPT 99459 Pelvic Examination Billing for Medicare

CPT 99459 Pelvic Examination Billing for Medicare National Government Services has received several inquiries regarding the use of CPT 99459, which was added to CPT coding for 2024 as an add-on code service. This means the code is only payable [...]

MLN Connects® Newsletter: May 23, 2024

MLN Connects® Newsletter: May 23, 2024 News Medicare Shared Savings Program: Apply by June 17 for January 1 Start Date Medicare Providers: Deadlines for Joining an Accountable Care Organization Institutional Providers: Medicare Enrollment [...]

JK Part A Immediate Recoupment Request Form

LCD and Article Updates May/June 2024

LCD and Article Updates May/June 2024 Billing and Coding Articles L37485 Prostate Rectal Spacers This policy is retired and is no longer in effect for services rendered on or after 5/1/2024. A52863 Billing and Coding: Pain Management - [...]

Recovery Audit Contractor Reminders

Recovery Audit Contractor Reminders Did you know that Performant is now the RAC for all of National Government Services Part A and Part B lines of business in Jurisdiction 6 and Jurisdiction K? As part of the audit process, Performant may [...]

MLN Connects® Newsletter: May 30, 2024

MLN Connects® Newsletter: May 30, 2024 News Hospice Interdisciplinary Team: Addition of Marriage and Family Therapists & Mental Health Counselors Revised Part B Inflation Rebate Guidance: Using the 340B Modifier — Reminder MLN [...]

National Government Services: Raising Awareness about Care Management

National Government Services: Raising Awareness about Care Management According to the CDC, six in ten adults in the U.S. have a chronic disease and four in ten adults have two or more. As your Medicare Contractor for Jurisdiction 6 and [...]

You Can Help Your Patients Quit Tobacco Use - The Great American Smokeout Is Coming!

You Can Help Your Patients Quit Tobacco Use - The Great American Smokeout Is Coming! Join us for our webinar series on Medicare’s preventative services, "Counseling to Prevent Tobacco Use" and “Telehealth and Tobacco Counseling.” Statistics [...]

National Government Services Proposed LCDs for Comment

National Government Services Proposed LCDs for Comment The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 5/30/2024 through 7/14/2024. These [...]

June 2024

In This Issue National Government Services Articles for Part A and Part B Providers Important Reminders for Your EDI Enrollment Save the Dates! CMS National Provider Enrollment Conference in San Diego: 8/28/2024-8/29/2024 A/B DME MAC [...]

Attention Illinois, Massachusetts and Rhode Island Providers: Senior Medicare Patrol Can Assist Medicare Providers!

Attention Illinois, Massachusetts and Rhode Island Providers: Senior Medicare Patrol Can Assist Medicare Providers! National Government Services is proud to announce a special project to assist our providers with your Medicare patients [...]

Attention Illinois, Massachusetts and Rhode Island Providers: Senior Medicare Patrol Can Assist Medicare Providers!

Supplemental Insurance

Section 2: Medicare Basics Supplemental Insurance Table of Contents Supplemental Insurance Medigap Plans Medigap Plans A–N Low-Income Beneficiaries Qualified Medicare Beneficiary Program Specified Low-Income Medicare [...]

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 11th Sessions!

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 11th Sessions! We’re gearing up for our second in the series of Medicare Part B 2024 Spring/Summer Virtual [...]

SNF PPS Web Pricer

MLN Connects® Newsletter: June 6, 2024

MLN Connects® Newsletter: June 6, 2024 News CMS Roundup (May 31, 2024) Quality Payment Program: 2022 Performance Information on Medicare.gov Compare Tool Skilled Nursing Facility Value-Based Purchasing Program: June Confidential Feedback [...]

Supporting Documentation Information

Supporting Documentation Information

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers on Tuesday, June 4th

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers on Tuesday, June 4th! Our first in our series of Medicare Part B 2024 Spring/Summer Virtual Conference Tuesdays is right around [...]

Home Health Claims Returned to Providers with Reason Code 31755

CMS reactivated RC 31755 effective 1/3/2023 and some HH claims are being RTP due to billing errors. These claims need to be corrected with the information provided in the Provider Action section of this article. Medicare is still receiving [...]

MLN Connects® Newsletter: June 13, 2024

MLN Connects® Newsletter: June 13, 2024 News Medicare Shared Savings Program: Apply for January 1 Start Date by June 17 Men’s Health: Encourage Your Patients to Prioritize Their Health Compliance Hospital Beds & Accessories: [...]

1-800-MEDICARE Authorization to Disclose Personal Health Information

Prior Authorization Request for Outpatient Services: Implanted Spinal Neurostimulators

Prior Authorization Request for Outpatient Services: Cervical Fusion

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 18th Sessions!

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 18th Sessions! Our third in the series of Medicare Part B 2024 Spring/Summer Virtual Conference Tuesday’s [...]

Medicare Information in Other Languages

Medicare Information in Other Languages Download Medicare & You in Spanish, 中文/Chinese, TIẾNG VIỆT/Vietnamese or 한국어/Korean. Español/Spanish  中文/Chinese  한국어/Korean  TIẾNG VIỆT/Vietnamese   Reviewed 6/13/2024

Approval or Denial

Approval or Denial Approval Once your application is approved, you will receive an emailed, faxed or mailed Medicare letter with PTAN. Review this letter to ensure that everything is accurate and if you have any questions, please contact the [...]

Sign and Submit the Application(s)

Credit Balance Reminder: Submissions For Quarter Ending 6/30/2024 Start Soon!

Credit Balance Reminder: Submissions For Quarter Ending 6/30/2024 Start Soon! CBR submissions can be submitted starting on 7/1/2024 and are due within 30 days to be considered timely. Remember, even if no monies are owed to Medicare for this [...]

Accelerated Payment Program Available for Providers Impacted by the Ascension Health Cyber Related Incident (CRI)

Accelerated Payment Program Available for Providers Impacted by the Ascension Health Cyber Related Incident Part A Providers experiencing cash flow problems related to Ascension Health CRI, which began on 5/8/2024, may be eligible for [...]

PECOS Enrollment Process and Advantages

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 25th Sessions!

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 25th Sessions! We’re wrapping up our Medicare Part B 2024 Spring/Summer Virtual Conference with education [...]

Provider Enrollment

Provider Enrollment The National Government Services Provider Customer Care Department has direct telephone lines available for provider enrollment inquiries. Who should I call for technical issues regarding PECOS, EUS Helpdesk or MAC? CMS [...]

Provider Enrollment

Provider Enrollment The National Government Services Provider Customer Care Department has direct telephone lines available for provider enrollment inquiries. Who should I call for technical issues regarding PECOS, EUS Helpdesk or MAC? CMS [...]

Opt Out and Private Contracting

Opt Out and Private Contracting Opt out does not require a physician or practitioner to initially enroll with Medicare or complete a CMS-855I application. Opting out of Medicare allows a physician or practitioner to render services to [...]

Renewal to the Medicare Opt-Out Law for Physicians and Practitioners

Renewal to the Medicare Opt-Out Law for Physicians and Practitioners Prior to enactment of the MARCA of 2015, physician or practitioner opt-out affidavits were only effective for two years. As a result of changes made by MACRA, valid opt-out [...]

Opt-Out Physician or Practitioner Providing Emergency or Urgent Care

Opt-Out Physician or Practitioner Providing Emergency or Urgent Care In an emergency or urgent situation, a physician or practitioner who opts out may treat a Medicare beneficiary with whom they do not have a private contract. In this [...]

Providers Not Eligible to Opt Out and Enter Into Private Contracts

Providers Not Eligible to Opt Out and Enter Into Private Contracts Providers Who May Not Opt Out of the Medicare Program Chiropractors Opt-out law does not define ‘physician’ to include chiropractors; therefore, they may not opt out of [...]

Instructions to File

Instructions to File The requirements to opting out of Medicare are included on the forms. First, at least one private contracting agreement form must be signed between the physician or practitioner and a beneficiary. Second, the physician [...]

Requirements of Medicare Private Contracting Agreement

Requirements of Medicare Private Contracting Agreement Amendment 4507 of the Balanced Budget Act of 1997 permits a physician or practitioner to “opt out” of Medicare and enter into private contracts with Medicare beneficiaries. Under the [...]

Approval or Denial

Approval or Denial Once your affidavit is approved, you will receive an approval letter of opt-out status along with the opt-out effective date. Review this letter to ensure that everything is accurate and if you have any questions, please [...]

Requests for Additional information

Requests for Additional information While processing the affidavit, 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 from [...]

Organizations That Furnish Physician or Practitioner Services

Organizations That Furnish Physician or Practitioner Services Opt-out regulations apply to all items or services the physician or practitioner furnishes to Medicare beneficiaries, regardless of the location where such services are furnished. [...]

Early Termination for First Time Opt-Out Providers

Early Termination for First Time Opt-Out Providers Opt-out affidavits are effective for two years and cannot be terminated early unless during the first time opt-out period and within 90 days of the effective date of the affidavit. A request [...]

2024 DMEPOS HCPCS Jurisdiction Listing