Modifier CS and COVID-19 Billing

Modifier CS and COVID-19 Billing How should the CS modifier, which removes application of beneficiary cost-sharing (deductible and co-payment), be applied to telehealth services and/or E/M visits? The CS modifier should be applied for certain [...]

MLN Connects® Newsletter: September 21, 2023

MLN Connects® Newsletter: September 21, 2023     News CMS Announces Resources and Flexibilities to Assist with the Public Health Emergency in the State of Georgia Organ Transplantation Affinity Group: Strengthening [...]

Telehealth Services

Answers to Common Fee-For-Time Compensation Arrangements Questions

Save the Dates! National Government Services Fall 2023 Virtual Conference for Medicare Part A Providers

Save the Dates! National Government Services Fall 2023 Virtual Conference for Medicare Part A Providers Ending 2023 on a Strong Medicare Note 11/1/2023-11/2/2023 The National Government Services POE Team will be holding our bi-annual virtual [...]

Join Us for the A/B DME Collaborative Surgical Dressings Webinar

Join Us for the A/B DME Collaborative Surgical Dressings Webinar Representatives from all four DME MAC jurisdictions and the A/B MACs will explain medical record requirements for surgical dressings. We hope you’ll join the MACs for this [...]

October 2023

In This Issue National Government Services Articles for Part A and Part B Providers Dental Services: Billing and Coding Article A59543 is Available EDI Spotlight: Strengthening Security Local Coverage Determination Open Meeting [...]

Don't Miss Out - Register Today! National Government Services: Medicare Part B Care Management Tuesdays

Don't Miss Out - Register Today! National Government Services: Medicare Part B Care Management Tuesdays 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 [...]

LCD and Billing and Coding Article Update for October 2023

LCD and Billing and Coding Article Update for October 2023 Billing and Coding: Autonomic Function Testing (A57024) Due to the annual ICD-10 Code updates, ICD-10 code G20 has been deleted and the following ICD-10 codes have been added: G20.A1, [...]

Decrease Burden and Combine Multiple PDFs into One Before Responding to Additional Documentation Requests Using NGSConnex

Decrease Burden and Combine Multiple PDFs into One Before Responding to Additional Documentation Requests Using NGSConnex Recently, National Government Services has seen an increase in providers submitting multiple PDF attachments for the same [...]

MLN Connects® Newsletter: September 28, 2023

MLN Connects® Newsletter: September 28, 2023     News CMS Statement on Current Status of Blood Tests for Organ Transplant Rejection CMS Roundup (Sept 22, 2023) Cardiovascular Disease: Talk with Your Patients about [...]

Medicare Part B CMS-1500 Crosswalk for 5010 Electronic Claims

Collaborative A/B/DME Therapeutic Shoes for Persons with Diabetes Webinar

Collaborative A/B/DME Therapeutic Shoes for Persons with Diabetes Webinar Providers – Do you need assistance in understanding what is needed when ordering diabetic shoes? This collaborative webinar on Therapeutic Shoes for Persons with [...]

Billing for Services Not Included in the FQHC Benefit

Billing for Services Not Included in the FQHC Benefit Table of Contents Billing for Services Not Included in the FQHC Benefit Ambulance Services Body Braces Durable Medical Equipment Laboratory Services Medicare-Excluded [...]

Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims

Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims Table of Contents Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims Repetitive Services Repetitive Services [...]

What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy

What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy Table of Contents What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy [...]

Hospitals Must Correctly Assign Severe Malnutrition Diagnosis Codes to Inpatient Claims

Hospitals Must Correctly Assign Severe Malnutrition Diagnosis Codes to Inpatient Claims Table of Contents Hospitals Must Correctly Assign Severe Malnutrition Diagnosis Codes to Inpatient Claims Hospital Action(s) Related Content [...]

COVID-19 Part A Frequently Asked Questions

COVID-19 Part A Frequently Asked Questions Table of Contents COVID-19 Part A Frequently Asked Questions Section B. Diagnostic Laboratory Services Section LL. Hospital Billing for Remote Services Section MM. Outpatient Therapy Services [...]

Fiscal Intermediary Standard System Direct Data Entry Screen Changes – October 2023

Fiscal Intermediary Standard System Direct Data Entry Screen Changes – October 2023 The October 2023 quarterly system release was implemented on 10/2/2023 and includes the FISS DDE screen changes identified below. CMS issued CR 13138 which [...]

Tip Sheet: Proper Use of Modifier 25

Tip Sheet: Proper Use of Modifier 25 A review of top claim reason codes indicate a steady reoccurrence of claims being returned to provider (RTP) for reason code W7021, when there was a medical visit on same day as a type 'T' or 'S' procedure [...]

MLN Connects® Newsletter: October 5, 2023

MLN Connects® Newsletter: October 5, 2023     News Administration Moves Forward with Medicare Drug Price Negotiations to Lower Prescription Drug Costs for People with Medicare CMS Requests Public Input on Coverage of [...]

Update on proposed LCD for Transesophageal Echocardiography

Update on proposed LCD for Transesophageal Echocardiography The LCD for Transesophageal Echocardiography (TEE) was published for comment and presented at an Open Meeting in July 2023. NGS is continuing to assess the provisions in this LCD and [...]

MLN Connects® Newsletter: October 6, 2023

MLN Connects® Newsletter: October 6, 2023     News COVID-19: Updated Novavax COVID-19 Vaccine, Adjuvanted for Patients 12 & Older Posted 10/6/2023

Cognitive Assessment and Care Plan Services CPT Code 99483

Cognitive Assessment and Care Plan Services CPT Code 99483 Effective 1/1/2021, Medicare increased payment for these services to $282 (may be geographically adjusted) when provided in an office setting, added these services to the definition of [...]

Mental Health Crisis Help

Mental Health Crisis Help Anyone experiencing a mental health crisis, including substance use crisis or thoughts of suicide, can get confidential support 24/7 by calling 988 or visiting the 988 Suicide & Crisis Lifeline website. View the [...]

Notification of the 2024 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review

Notification of the 2024 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review The amount that must remain in controversy for ALJ hearing requests filed on or [...]

MLN Connects® Newsletter: October 12, 2023

MLN Connects® Newsletter: October 12, 2023     News CMS Roundup (Oct 6, 2023) Protect Your Patients: Give Them a Flu Shot Publications Direct Data Entry: 10-Digit Screen Expansion Medicare Preventive Services — [...]

Let’s Get Ready for The Great American Smokeout on 11/16/2023!

Let’s Get Ready for The Great American Smokeout on 11/16/2023! For more than 40 years, the American Cancer Society has hosted the Great American Smokeout on the third Thursday of November. This yearly event is a call for action, not just for [...]

Prior Authorization Exemption Process FAQ

Prior Authorization Exemption Process FAQ How many days notice will I receive before I switch from PAR submissions to an exemption cycle? Answer: MACs will provide a 60-day notice prior to any transition period, continuation, or withdrawal [...]

NGSConnex User Guide

Initiate a Claim Status Lookup

Initiate a Claim Status Lookup Click the Claim Status Lookup button from the NGSConnex homepage. In the Select a Provider panel, click the Select button next to the applicable provider account. To search for claims use the filter [...]

Check Status of Prior Authorization Requests

CMS Newsroom

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Tip Sheet #2

National Government Services Office of Congressional Affairs Inquiry: Tip Sheet #2 Tips for a Congressional Inquiry to Move Forward Without Delay Each congressional inquiry includes a ‘Consent for Release’ form of Medicare personal records [...]

Reopening Not Appropriate to Change Diagnosis on Paid Claims

Reopening Not Appropriate to Change Diagnosis on Paid Claims National Government Services periodically receives reopening requests to change the diagnosis on a paid claim.  Submitting a new, or corrected diagnosis on a claim that has [...]

MLN Connects® Newsletter for Thursday, December 2, 2021

MLN Connects® Newsletter for Thursday, December 2, 2021 National Influenza Vaccination Week News National Influenza Vaccination Week Clinical Laboratory Fee Schedule: CY 2022 Final Payment Determinations Skilled Nursing Care & [...]

MLN Connects® Special Edition for Friday, January 7, 2022

MLN Connects® Special Edition for Friday, January 7, 2022 COVID-19: New HCPCS Code for Remdesivir Antiviral Medication Following the recent statement from the National Institutes of Health (NIH) COVID-19 Treatment Guidelines Panel regarding [...]

MLN Connects® Newsletter for Thursday, February 3, 2022

MLN Connects® Newsletter for Thursday, February 3, 2022 Provider Compliance Virtual Focus Group — February 24 News COVID-19: Letter to Health Care Facility Administrators on Health Care Worker Vaccination Rule COVID-19 Vaccine & [...]

MLN Connects® Newsletter for Thursday, February 17, 2022

MLN Connects® Newsletter for Thursday, February 17, 2022 Expanded Coverage: Lung Cancer Screening with Low Dose Computed Tomography News CMS Expands Coverage of Lung Cancer Screening with Low Dose Computed Tomography There’s Still Time [...]

MLN Connects® Special Edition for Friday, February 18, 2022

MLN Connects® Special Edition for Thursday, February 18, 2022 COVID-19 Monoclonal Antibodies: FDA Authorized Bebtelovimab On February 11, the FDA authorized the emergency use of the monoclonal antibody bebtelovimab for the treatment of [...]

MLN Connects® Newsletter for Thursday, February 24, 2022

MLN Connects® Newsletter for Thursday, February 24, 2022 CMS Released Skilled Nursing Facility & ESRD Web Pricers News Podiatry Nail Debridement & Evaluation and Management Services: Comparative Billing Report Skilled Nursing [...]

MLN Connects® Newsletter for Thursday, March 17, 2022

MLN Connects® Newsletter for Thursday, March 17, 2022 Kidney Health: Help Address Disparities News Medicare Shared Savings Program: Application Deadlines for January 1, 2023, Start Date Kidney Health: Help Address Disparities Claims, [...]

MLN Connects® Newsletter for Thursday, February 10, 2022

MLN Connects® Newsletter for Thursday, February 10, 2022 COVID-19: New HCPCS Code for Convalescent Plasma in Outpatient Setting News COVID-19: New HCPCS Code for Convalescent Plasma in Outpatient Setting Long-term Care Hospital [...]

MLN Connects® Newsletter for Thursday, January 20, 2022

MLN Connects® Newsletter for Thursday, January 20, 2022 COVID-19: Long-term Care, RHCs, & FQHCs   News COVID-19: Vaccine Access in Long-term Care Settings There’s Still Time: Recommend the Flu Shot Chiropractic Treatment of [...]

Save the Dates: National Government Services 2022 Spring Virtual Conference!

Save the Dates! National Government Services 2022 Spring Virtual Conference! Medicare for You 5/11/2022 – 5/12/2022 “Seasons change, and so do we.” - Nikkiche We also see many changes occur in Medicare. We want our provider community to have [...]

MLN Connects® Newsletter for Thursday, March 3, 2022

MLN Connects® Newsletter for Thursday, March 3, 2022 2022 Payment, Quality & Policy Changes News Ambulance Prior Authorization Model Expands April 1 Nutrition-related Health Conditions: Recommend Medicare Preventive Services [...]

Place of Service 10 for Telehealth Services Not for Medicare Billing

Place of Service 10 for Telehealth Services Not for Medicare Billing National Government Services is receiving calls from providers to our call center in regard to the usage of the new Place of Service 10 code.  POS 10 was established [...]

2022 CMS Evaluation and Management Regulation Modifications

2022 CMS Evaluation and Management Regulation Modifications On 2/23 and 2/24/2022, National Government Services presented webinars titled “2022 CMS Evaluation and Management Regulation Modifications”. Subsequent to those sessions, we sought [...]

Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2022

Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2022 This announcement provides information that may be helpful to clinicians in determining whether to become a Medicare participating provider, or to continue [...]

April 2022 Release "Dark Days" for the Common Working File Hosts

April 2022 Release "Dark Days" for the Common Working File Hosts For the upcoming April 2022 Release: For Production, CWF will be observing the Gray Day on Thursday, 3/31/2022 and Dark Days starting Friday, 4/1/2022 through Sunday, 4/3/2022 [...]

Chronic Care Management with Transitional Care Management Clarification

Chronic Care Management with Transitional Care Management Clarification TCM policy indicates that it is billable in the same month that CCM services are performed. MLN® Booklet Transitional Care Management Services includes a listing of the [...]

Social Security Income Ratios

Social Security Income Ratios The federal fiscal year 2020 SSI ratios for IPPS hospitals, IRFs and LTCHs were posted on the CMS website. IPPS IRF LTCH We will update the latest published 2020 SSI ratios in the Provider Specific File of [...]

Medicare Advantage Plan Beneficiaries Receiving the COVID-19 Vaccine and Monoclonal Antibody

Medicare Advantage Plan Beneficiaries Receiving the COVID-19 Vaccine and Monoclonal Antibody Effective 1/1/2022, claims for COVID-19 vaccinations or monoclonal antibody treatment provided to patients enrolled in MA plans on or after 1/1/ 2022, [...]

February and March 2022 Billing and Coding Article Updates

February and March 2022 Billing and Coding Article Updates Billing and Coding: Peripheral Nerve Blocks (A57452) This article has been updated due to a provider request to add diagnosis code G58.0 to Group 1 in the "ICD-10 codes that support [...]

Provider Compliance Virtual Focus Group - February 24, 2022

Provider Compliance Virtual Focus Group - February 24, 2022 Thursday, 2/24/2022 from 1:00–4:00 p.m. ET Register by Friday, 2/18/2022 - Registration Closed How can CMS improve its processes and eliminate unnecessary requirements for [...]

Prior Authorization Requests Submitted by Exempt Providers Alert

Prior Authorization Requests Submitted by Exempt Providers Alert The National Government Services PA Department has observed an increase in submission of PAR for exempt providers. These submissions are from the HOPD and/or physician offices on [...]

2022 Gap-Fill Request for Information

2022 Gap-Fill Request for Information National Government Services, the MAC for JK and J6, is in receipt of the new laboratory test codes identified by the CMS to be gap-fill priced for 2022. The PAMA regulations instruct the MACs to establish [...]

January 2022 EDI Front End Quarterly Release

January 2022 EDI Front End Quarterly Release Please be advised that while the Centers for Medicare & Medicaid Services mandated release for January 2022 will be installed the weekend of 1/2/2022, the code set updates included with this [...]

Home Health Bill Type 32A Returning With Reason Code U537I

Home Health Bill Type 32A Returning With Reason Code U537I CMS implemented HH TOB 32A for the NOA effective for period of care claims on or after 1/1/2022. The NOA is required for all HH period of care claim billing, including demand billing [...]

Skilled Nursing Facility Consolidated Billing Services Reminder

Skilled Nursing Facility Consolidated Billing Services Reminder For Medicare beneficiaries in a covered Part A stay, these separately payable, or excluded, services include select items or services in the following categories: physician’s [...]