Incident to Quick Reference Chart

Incident to Quick Reference Chart Location PT Status Scenario Who Bills Comments Office New patient NPP sees patient - MD not present in office suite NPP bills for the service under the NPP NPI NPP [...]

“Incident to” Services

“Incident to” Services This article has been specially designed for our providers who perform services “Incident to” the services of a physician/NPP. Table of Contents The “Incident to” Provision of Medicare Your Office Hospital or [...]

Supplemental Security Income Ratio Realignment for Cost Reporting Periods Starting Before 10/1/2013

Supplemental Security Income Ratio Realignment for Cost Reporting Periods Starting Before 10/1/2013 On 6/9/2023, in response to the Supreme Court’s ruling in Azar v. Allina Health Services, 139 S. Ct. 1804 (2019), the CMS issued a final rule [...]

Education Partnership Request Form

Education Partnership Request Form

Education Partnership Request Form

Education Partnership Request Form

MLN Connects® Newsletter: August 8, 2024

MLN Connects® Newsletter: August 8, 2024 Final Payment Rule Hospital Inpatient Prospective Payment System & Long-Term Care Hospital Prospective Payment System FY 2025 Final Rule News Transitional Coverage for Emerging Technologies [...]

Removal of Facet HCPCS Codes

Removal of Facet HCPCS Codes Prior Authorization Outpatient Department Update  Effective 8/16/2024, the CMS is removing two current procedural terminology codes from the OPD Facet Joint Injection list of codes: 64492 – Facet joint [...]

Medical Policy Contact Information

Medical Policy Contact Information Please Note: General inquiries related to Medicare coverage policies, including clinical issues, drugs, radiopharmaceuticals, local and national coverage determinations, billing and reimbursement must be [...]

Medical Policy Contact Information

Medical Policy Contact Information Please Note: General inquiries related to Medicare coverage policies, drugs, radiopharmaceuticals, local and national coverage determinations, billing and reimbursement must be directed to the Provider [...]

Medical Policy Contact Information

Medical Policy Contact Information Please Note: General inquiries related to Medicare coverage policies, including clinical issues, drugs, radiopharmaceuticals, local and national coverage determinations, billing and reimbursement must be [...]

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations) If you disagree with Medicare’s claim determination, you may Appeal. However, please follow these important tips before you submit a first level of appeal [...]

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations) If you disagree with Medicare’s claim determination, you may Appeal. However, please follow these important tips before you submit a first level of appeal [...]

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations) If you disagree with Medicare’s claim determination, you may Appeal. However, please follow these important tips before you submit a first level of appeal [...]

Monoclonal Antibodies in Treatment of Alzheimer’s Disease - Medicare Advantage Plan Responsibility

Monoclonal Antibodies in Treatment of Alzheimer’s Disease - Medicare Advantage Plan Responsibility NCD 200.3 was issued by CMS in April,2022 and outlines Medicare coverage policy for monoclonal antibodies that target amyloid (or plaque) for [...]

HETS EDI Enrollment Form User Guide

The HETS ​​​​​​EDI Enrollment Form allows providers to attest their relationship with a 3rd party entity to exchange the ANSI X12 270/271 Beneficiary Eligibility transaction on their behalf. Table of Contents Step 1 – Authorization [...]

HETS EDI Enrollment Form

Telehealth Place of Service 02 and 10 Clarification

Telehealth Place of Service 02 and 10 Clarification National Government Services has been receiving inquiries from providers in regard to POS 02 and POS 10 for telehealth service reporting. We’ve created this article to provide clarification. [...]

CLIA Number Processing Issue

CLIA Number Processing Issue National Government Services has been made aware of an issue with CLIA lab claims processing. CLIA numbers were not loaded through CWF, resulting in claim denials as CLIA did not match any file. We were informed [...]

Home Health Documentation Checklist

Home Health Documentation

State License and Registrations for Certified Providers and Suppliers

State License and Registrations for Certified Providers and Suppliers Prior to submitting a provider enrollment application to Medicare, ensure that all applicable state requirements are met for your provider type. Each state has unique [...]

Eligible Institutional Providers

Eligible Institutional Providers Certified Providers and Certified Suppliers that Enroll via the Form CMS-855A. Unique statutory and regulatory requirements for these types of providers/suppliers are addressed in the CMS IOM Publication [...]

MLN Connects® Newsletter: August 15, 2024

MLN Connects® Newsletter: August 15, 2024 News Negotiating for Lower Drug Prices Works, Saves Billions Resources & Flexibilities to Assist with the Public Health Emergency in Florida, Georgia, and South Carolina Hospitals: New EMTALA [...]

Additional Development Requests for Part A Claims for CPT J9299

Additional Development Requests for Part A Claims for CPT J9299 A system error on 7/25/2024 caused ADR letters to be issued in error on Part A claims for CPT J9299 with DOS on or after 3/1/2024. The issue has been resolved and all impacted [...]

End-Stage Renal Disease: Medicare Part A Quick Reference Manual

End-Stage Renal Disease: Medicare Part A Quick Reference Manual Table of Contents ESRD Provider PTAN Number Range: Third through sixth digit FL 04 Type of Bill FL 6 Statement Covers Period FL 18-28 Condition Codes FL 18-28 Condition [...]

Claim Submission Guidelines

Claim Submission Guidelines CMS developed and transmitted HCPCS and PFS payment and coding files to include revisions to add other CDT codes and indicated parameters for payment to implement the finalized Medicare Parts A and B payment for [...]

Disproportionate Share Hospital

The Medicare DSH adjustment provision under Section 1886(d) (5) (F) of the Act was enacted by section 9105 of the COBRA of 1985 and became effective for discharges occurring on or after 5/1/1986. According to section 1886(d) (5) (F) of the Act, [...]

Electronically Submitted Claims that Exceed $99,999.99 Reminder

Electronically Submitted Claims that Exceed $99,999.99 Reminder Electronically submitted claims containing a dollar amount in excess of 99,999.99 will be rejected as a front-end EDI edit. The Standard Companion Guide for Health Care Claim: [...]

MLN Connects® Newsletter: August 22, 2024

MLN Connects® Newsletter: August 22, 2024 News Commemorating the 2nd Anniversary of the Lower Cost Prescription Drug Law MolDx Local Coverage Determination Statement Hospital Price Transparency: Get Resources to Help You Comply New [...]

Facet Joint Interventions

Facet Joint Interventions National Government Services will begin accepting PARs for Facet Joint Intervention codes on 6/15/2023 for services provided beginning on or after 7/1/2023.   To meet coverage criteria, the patient’s medical [...]

Part B

Part B  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us EDI Enrollment EDI Solutions Forms [...]

FQHC

FQHC and RHC  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us Cost Reports EDI Enrollment EDI [...]

Part A

Part A  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us Cost Reports EDI Enrollment EDI [...]

Home Health and Hospice

Home Health and Hospice  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us Cost Reports EDI [...]

Direct Graduate Medical Education/Indirect Medical Education

Direct Graduate Medical Education Table of Contents Direct Graduate Medical Education Indirect Medical Education [Return to Top] Direct Graduate Medical Education Section 1886(h) of the Act as added by section 9202 of the COBRA of [...]

Original Medicare Coverage Costs

Original Medicare Coverage Costs Important Links Medicare News Fact Sheet Your Medicare Costs Your Medicare Benefits Your Medicare Coverage Your Medicare Coverage for Home Health Services Your Medicare Coverage for Hospice Care [...]

Physician Fee Schedule Look-Up

"What If" and Scenario Questions

"What If" and Scenario Questions Physician offices often contact us with different scenarios and "what if?" questions regarding coding and documentation for a particular service(s). Providers ask the contractors for a definitive response on [...]

Medically Unlikely Edits Billing and Processing

Medically Unlikely Edits Billing and Processing Table of Contents Medically Unlikely Edits Billing and Processing Notes on MUE Processing Instructions MUE Program Inquires Related Content [Return to Top] Medically Unlikely Edits [...]

Avoid Processing Delays by Following Proper Submission Guidelines

Avoid Processing Delays by Following Proper Submission Guidelines Table of Contents Avoid Processing Delays by Following Proper Submission Guidelines Claims Appeals Responding to an ADR Consider Submission via NGSConnex or Electronic [...]

Acceptable Electronic Signatures Reminder

Acceptable Electronic Signatures Reminder Table of Contents Acceptable Electronic Signatures Reminder Examples of Acceptable Electronic Signature Examples [Return to Top] Acceptable Electronic Signatures Reminder CMS issued [...]

Primary Care Exception Guidelines

Primary Care Exception Guidelines Services performed by attending physicians at teaching hospitals, in collaboration with house staff in an approved GME program, generally require evidence of direct care by the attending physician in order to [...]

Cloned Documentation Could Result in Medicare Denials for Payment

Cloned Documentation Could Result in Medicare Denials for Payment Medicare providers today are faced with the challenges of providing quality healthcare while meeting ever increasing regulatory and compliance regulations. Many providers are [...]

Documentation Required for Home Visits

Documentation Required for Home Visits  CPT Codes 99341‒99350 As of 1/1/2019, CMS no longer requires providers to differentiate medical necessity for a home visit versus an office or outpatient visit. Providers no longer need to document [...]

Referring, Monitoring and Certifying Home Health Services

Referring, Monitoring and Certifying Home Health Services Table of Contents Referring, Monitoring and Certifying Home Health Services Homebound Status Need for Skilled Services Under the Care of a Physician or Allowed Practitioner Plan [...]

Scribing Medical Record Documentation

Scribing Medical Record Documentation National Government Services recognizes an increasing trend in providers’ use of scribes as assistants in medical record documentation. In these situations, a provider utilizes the services of staff to [...]

Submit Medical Record Documentation Electronically

Submit Medical Record Documentation Electronically Table of Contents Submit Medical Record Documentation Electronically What do you need to get started? What are the Attachment Transactions? Who can use the Attachment Transactions? [...]

Anesthesia for Pain Management Procedures

Anesthesia for Pain Management Procedures The use of moderate or deep sedation, general anesthesia, and MAC is rarely indicated for pain management procedures and is not considered reasonable and necessary. The ASA provides guidelines for [...]

Remittance Advice

Remittance Advice Table of Contents General Information Electronic Remittance Advice Remittance Message Codes Standard Paper Remittance General Information Once Medicare has processed a claim, the provider will receive a notice [...]

Outpatient Services for Registered Inpatients

Outpatient Services for Registered Inpatients There are occasional circumstances in which a registered inpatient may require a service that is not available at the inpatient facility. These inpatient facilities include acute-care hospitals [...]

Allergen Immunotherapy Preparation (95144-95165)

Allergen Immunotherapy Preparation (95144‑95165) National Government Services will allow the preparation and provision of antigen for allergen immunotherapy, codes 95144 through 95165 when performed incident to by auxiliary personnel. However, [...]

CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy

CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy CMS created the Medicare Physician Fee Schedule Look-up Tool for MACs to follow when processing claims. CMS listed CPT code 15830 as a [...]

Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid

Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid Table of Contents Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid Fee-For-Time Compensation Arrangements Reciprocal Billing Arrangements Related [...]

Answers to Common Fee-for-Time Compensation Arrangements Questions

Answers to Common Fee-for-Time Compensation Arrangements Questions Does a fee-for-time compensation arrangement physician need to enroll with Medicare prior to acting as a physician? Answer: Currently, a fee-for-time compensation [...]

Nonphysician Practitioners Billing for Surgical Procedures

Nonphysician Practitioners Billing for Surgical Procedures Several providers have asked about the Medicare guidance for NPPs include billing for surgical procedures. For the purpose of this education, NPPs include NPs, PA, and CNSs. State law [...]

Professional Services During a Patient Hospice Election

Professional Services During a Patient Hospice Election Table of Contents Article Overview Hospice Election Medicare Payment During Hospice Election Determining the Correct Entity to Bill Separately Payable Part B Services Hospice and [...]