CMS Is Using Multi-Factor Authentication Process for Online Provider Enrollment System Applications

CMS Is Using Multi-Factor Authentication Process for Online Provider Enrollment System Applications CMS announced they utilize an MFA process for users of their Provider Enrollment Systems.  MFA is a second layer of security used to [...]

National Government Services Medicare Part B Redetermination Notice Initiative Is Here

National Government Services Medicare Part B Redetermination Notice Initiative Is Here As previously announced, National Government Services is pleased to announce we are discontinuing issuing paper MRNs for requests submitted electronically [...]

Credentialing, Enrollment and Revalidation

Credentialing, Enrollment and Revalidation Table of Contents Requirements Facilities that are not qualified Qualifications Application Forms You Will Need Required Application Fee Documentation State Survey, Tie-in Notice [...]

Coverage Criteria and Frequency Limits

Coverage Criteria and Frequency Limits Table of Contents Counseling to Prevent Tobacco Use Diagnosis Coding Cost Sharing Reimbursement Nonparticipating Providers Related Content [Return to Top] Counseling to Prevent Tobacco Use [...]

Counseling to Prevent Tobacco Use and Tobacco Related Diseases Job Aid

April 2025 EDI Front End Quarterly Release

April 2025 EDI Front End Quarterly Release Please be advised that while the Centers for Medicare & Medicaid Services mandated release for April 2025 was installed the weekend of 4/6/2025, the code set updates included with this release [...]

Social Security Income Ratios

Social Security Income Ratios The federal fiscal year 2023 SSI ratios for IPPS hospitals, IRF and LTCH were posted on the CMS website. IPPS IRF LTCH NGS will update the latest published 2023 SSI ratios in the Provider Specific File of [...]

Top J6 Part B Claim Errors are Available

Top J6 Part B Claim Errors are Available We conduct a comprehensive data analysis on a quarterly basis to update and disseminate the latest insights on the most common claim errors. This initiative provides: Claim Error Reason Code [...]

W7113

Avoiding/Correcting This Error Prevent future similar errors by checking the I/OCE and ICD-10 official guidelines prior to claim submission. Verify the diagnosis codes reported; correct and resubmit. Related Content The I/OCE Quarterly [...]

38031

Avoiding/Correcting This Error If appropriate, correct and resubmit a new claim. To prevent this error on future claims, ensure you have received all charges from all departments and that no claim has been submitted for the same DOS and [...]

32404

Verify HCPCS code using the FISS Inquiries HCPCS file (option 14). Allowable HCPCS codes will be displayed based on DOS. Avoiding/Correcting This Error Use the claims correction option to report the appropriate HCPCS/CPT code and resubmit the [...]

32266

Avoiding/Correcting This Error Report influenza virus, pneumococcal pneumonia virus, and COVID-19 vaccines (and administration) with your charges on the 77X claim for informational and data collection purposes only. Report revenue code 0771 [...]

N5052

Avoiding/Correcting This Error The beneficiary’s name listed on the claim has to be an exact match to what is posted on CWF. Be sure that any special characters (including apostrophes, dashes, commas) and suffixes (Jr., Sr., III) that are [...]

U5220

Avoiding/Correcting This Error Verify the MBI and date(s) of service. If services were provided prior to the date the beneficiary was entitled to Medicare, no further action is necessary. Otherwise, correct and resubmit.

U538Q

Avoiding/Correcting This Error Medicare does not pay for medical items/services furnished to an alien beneficiary who was not lawfully present in the United States on the date of service that the items/services were furnished. Related Content [...]

34293

Avoiding/Correcting This Error Review your beneficiary’s enrollment in a Medicare HMO/MAO prior to providing services. A beneficiary may drop MAO coverage; review the CWF, IVR, NGSConnex, or HETS to identify a termination date for the MAO [...]

3/13/2025 Part B POE Advisory Group Meeting

3/13/2025 Part B POE Advisory Group Meeting Meeting Minutes Meeting Time: 10:00 a.m.‒12:00 p.m. ET Member Attendees: Doris Barnes, Aurelia Barraco, Brenda Bedard, Sheila Bembeneck, Madelon Berger, Todd Bergstrom, Kimberly Bischel, Mollie [...]

New Version of PC-ACE: April 2025

New Version of PC-ACE: April 2025 PC-ACE Version 6.6 contains several CMS mandates and product enhancements including but not limited to the items listed below. 13891 – Implement Operating Rules – Phase III Electronic Remittance Advice [...]

Meeting Minutes

Meeting Minutes 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 Islands, Washington and Wisconsin [...]

[RESOLVED] NGS Phone Lines Currently Unavailable

[RESOLVED] NGS Phone Lines Experiencing Outages The outages we were experiencing with our Provider Contact Center telephone lines have now been resolved. This includes EDI, Provider Enrollment Customer Inquiry, Telephone Reopening Unit and [...]

CMS to Begin Using MFA Process for Online Provider Enrollment System Applications

CMS to Begin Using MFA Process for Online Provider Enrollment System Applications CMS recently announced they will begin utilizing a MFA process for users of their Provider Enrollment Systems. MFA is a second layer of security used to [...]

Credit Balance Report - CMS 838 (R3)

Chapter VII: Online Reports View Submenu (04) Credit Balance Report - CMS 838 (R3) Purpose Credit balance reporting is used to certify whether you have any outstanding monies owed to the Medicare Program. Part A providers submit credit [...]

DDE: How do I get my log on ID password reset?

Telehealth Services

Telehealth Services Table of Contents General Information Originating Site Distant Site List of Covered Medicare Telehealth Services Billing Facility Fee for Originating Site Payment for Professional Fee Place of [...]

Telehealth Extension 2025

Telehealth Extension 2025 A Congressional continuing resolution bill has extended telehealth coverage for services in all U.S. geographic locations through 9/30/2025. Based on this guidance, National Government Services will continue to pay [...]

Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities

Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities The hospital is the entity required to bill POA indicators on all inpatient claims billed to Medicare. However, accurate coding of all diagnosis [...]

NCCI Lookup Tool Top

National Correct Coding Initiative Lookup Tool The NCCI PTP lookup tool is designed to help providers identify when certain codes are subject to the automated code pair edits. When two codes of an edit pair are identified, the major code [...]

Exemption Process for the Prior Authorization Program for Certain Hospital Outpatient Department Services

The Centers for Medicare & Medicaid Services (CMS) implemented a prior authorization program for certain hospital outpatient department (OPD) services for date of service (DOS) on or after 7/1/2020 and subsequently added an exemption [...]

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 [...]

32402

Avoiding/Correcting This Error Verify HCPCS code using the FISS DDE Inquiries HCPCS file (option 14) to determine the allowable revenue codes based upon the date of service. Verify billing and, if appropriate, correct the claim using the [...]

Part B Medicare Administrative Contractor Overview and Coverage for Dental Services

Medicare covers a limited number of dental services. The purpose of this webinar is to familiarize dental providers with National Government Services (NGS) and Medicare Part B dental coverage. Discussion will include an overview of the NGS [...]

Medicare Physician Fee Schedule Database

Medicare offers several tools to help providers bill their services. Many questions you have can be answered by learning how to access and use the Medicare Physician Fee Schedule Database. We hope you'll join us for an overview of this database.

Medicare Part B Ambulance Coverage, Basics and Billing

During this webinar, we'll educate new staff or those needing a refresher on basic Medicare Part B ambulance billing guidelines.

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 [...]

MLN Connects® Newsletter: April 11, 2025

MLN Connects® Newsletter: April 11, 2025 News Dr. Mehmet Oz Shares Vision for CMS Skilled Nursing Facility Value-Based Purchasing Program: March 2025 Confidential Feedback Reports Skilled Nursing Facilities: Revalidation Deadline is May 1 [...]

The National Correct Coding Initiative and Medically Unlikely Edits for Part B Providers

This webinar will assist Part B providers with navigating tables for the National Correct Coding Initiative and the medically unlikely edits. We'll also review the proper modifiers to use to avoid denials. There will be time for your [...]

Update-CMS Delay of Skin Substitutes Effective Date

Update-CMS Delay of Skin Substitutes Effective Date As part of the transition to a new Administration, CMS is reviewing its coverage policies for skin substitute products. CMS believes it is important to maintain patient access to skin [...]

PC-ACE: Is there a resource I can use to assist me with Medicare Secondary Payer (MSP) claims when using PC-ACE?

DDE: I tried to access my claim through the FISS/DDE system and it will not let me pull it up. What is the problem?

DDE: Is there some place on FISS/DDE that shows how many physical therapy (PT) or occupational therapy (OT) visits the beneficiary has had?

CLAIMS: I received a denial stating that the documentation submitted did not support the medical necessity of laboratory services. Can you tell me what I can submit to support these services?

DDE: I have a claim which was fully denied and I am attempting to use the automated denial adjustment process, but the FISS/DDE system is not allowing me to adjust my claim. Why am I not able to bring up my claim and submit the adjustment?

DDE: My name changed and I need to change the name associated to my log on ID. How do I do that?

Revised and Updated Educational Frequently Asked Questions

Revised and Updated Educational Frequently Asked Questions Our educational FAQs have been updated. Please visit the Help and FAQs page under the Education section of our website to explore topics such as: ASCA Appeals CAR T-cell Therapy [...]

Acute Care Hospitals Preparing Inpatient Claims: Taking a Deeper Dive Part 2

This is part 2 of a 2-part webinar event (part 1 will be held on 4/17/2025). In part 2, Acute Care Hospitals (ACH) will learn how to complete inpatient claims for submission to Medicare in a variety of situations. Topics include bill types, [...]

[URGENT] NGSConnex Experiencing Intermittent Issues

NGSConnex Experiencing Intermittent Issues We are experiencing intermittent outages with NGSConnex. This is impacting Part A providers only. In some cases when a provider account is selected to perform a transaction such as ‘Eligibility [...]

FQHC Example of a Per Visit Rate Calculation for MAO Supplemental Payments

MLN Connects® Newsletter: April 17, 2025

MLN Connects® Newsletter: April 17, 2025 News Clotting Factors: Medicare Part B Pays for Alhemo & Qfitlia Skilled Nursing Facilities: Revalidation Deadline Extended to August 1 Raise Awareness & Understanding of Alcohol Use and [...]

Reducing Unprocessable Claims

When claims are submitted with invalid, incomplete or incorrect information, our claims processing system will detect these errors and will reject claims as unprocessable. Our goal is to assist our providers in submitting claims correctly the [...]

Using the Medicare Coverage Database: How to Find Important Medicare Coverage Information

Are you responsible for looking up whether a service is covered in the Medicare Program at your facility but you're not sure where to look for the most relevant information? As a healthcare provider, you are responsible for understanding [...]

Medicare Secondary Payer: Let’s Chat About Preparing MSP and Conditional Claims

Were you unable to attend our Medicare Secondary Payer (MSP) and/or Conditional Billing webinars in January and February? Do you have questions about these topics? If so, join us for this "Let's Chat" session! You may ask questions [...]

MSP Right Hand

Helpful Resources BCRC Contact Information Note: Providers should not contact the BCRC to set up new MSP records. Instead, report MSP coding on your MSP and conditional claims. Providers should not contact the BCRC to correct MSP records to [...]

New P.O. Boxes for Part B Claim Submitters in Connecticut and New York (Upstate Counties and Queens)

New P.O. Boxes for Part B Claim Submitters in Connecticut and New York (Upstate Counties and Queens) Effective 5/19/2025, National Government Services (NGS) is closing the following Paper Claim Submission P.O. Boxes:  P.O. Box 6185 [...]

Incarcerated or Unlawfully present in the US claim rejections (U538H, U538Q)

Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q) This stringent claim editing process helps ensure that Medicare does not make payments for services rendered to beneficiaries who are not eligible due to being [...]

Collaborative Surgical Dressings Webinar Coming May 6, 2025

Collaborative Surgical Dressings Webinar Coming May 6, 2025 This is your opportunity to hear directly from the Medicare contractors regarding Medicare’s criteria necessary for the coverage of surgical dressings. Representatives from all four [...]

Quarterly Top Ten Part B EDI Edits

Quarterly Top Ten Part B EDI Edits National Government Services EDI has identified the following Top Ten CEM edits that were received during the Q1 2025 on the 277CA (Claims Acknowledgement) report for 837P 5010A1 formatted claims. The [...]

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 [...]