Search Results - NGSMEDICARE

Posting Date: 07/21/2022

Late Notice of Admission - The Exception Process

Late Notice of Admission - The Exception Process Table of Contents Timeliness of the NOA and the Penalty Requirements for Submission of the NOA Exception Process Canceling a Timely NOA to Correct an Error Reasons Not to Cancel an NOA [...]

Posting Date: 05/09/2022

Home Health Transfers

Home Health Transfers Table of Contents Background What To Do As a Receiving HHA What To Do As the Initial HHA What To Do In Case of a Dispute Related Content [Return to Top] Background A home health transfer occurs when a [...]

Posting Date: 12/05/2017

Disposable Negative Pressure Wound Therapy Services Under Home Health

Disposable Negative Pressure Wound Therapy Services Under Home Health Effective for services furnished on or after 1/1/2017, Medicare will make separate payment to HHAs for dNPWT services for patients under the home health benefit. NPWT [...]

Posting Date: 05/09/2022

Home Health Agency Transfer and Dispute Protocol

Home Health Agency Transfer and Dispute Protocol Specific protocol and steps must be followed prior to opening an admission period for a new patient. Step One: Verify the patient’s eligibility You must ensure the patient is not [...]

Posting Date: 12/20/2016

Reporting Site of Service Codes for Home Health Care

Reporting Site of Service Codes for Home Health Care HH PPS claim payments are based on the site of the beneficiary’s care. In order for Medicare to accurately capture where home health services are provided, HHAs are required to report the [...]

Posting Date: 05/19/2022

Home Health Demand Billing

Home Health Demand Billing Table of Contents Background What is a Demand Bill? Requirements for Submission How to Submit a Demand Bil Claim Page 1: Claim Page 2: Covered and Noncovered Charges Claim Page 2: All Noncovered Charges [...]

Posting Date: 06/23/2025

Billing Telehealth Services for Part B Providers

During this webinar, we’ll provide you with insight into covered Medicare telehealth services and coverage requirements. We’ll discuss originating sites, distant sites and billing and payment guidelines.

Posting Date: 07/12/2024

Hospice Transfers

Hospice Transfers The purpose of a hospice transfer is to allow the beneficiary the opportunity to transfer to another agency without affecting the current benefit period and providing continuity of care. Instead of the beneficiary revoking [...]

Posting Date: 10/22/2015

Hospice Documentation Tips

Hospice Documentation Tips Medicare coverage of hospice depends on a physician’s certification that an individual’s prognosis is a life expectancy of six months or less if the terminal illness runs its normal course. It is important that the [...]

Posting Date: 10/05/2022

Tips for Responding to a Hospice ADR

Tips for Responding to a Hospice ADR National Government Services performs medical review audits of services billed to Medicare to validate that the documentation supports coverage and level of services billed. If one of your claims is [...]

Posting Date: 10/04/2021

Implementation of the Election Statement Addendum

Implementation of the Election Statement Addendum Hospice Election Statement Addendum Hospice care is a benefit under the hospital insurance program. To be eligible to elect hospice care under Medicare, the beneficiary must be entitled to [...]

Posting Date: 10/04/2021

Documentation Requirements for the Medicare Hospice Election Statement

Documentation Requirements for the Medicare Hospice Election Statement Election of Hospice Hospice care is a benefit under the hospital insurance program. To be eligible to elect hospice care under Medicare, the beneficiary must be entitled [...]

Posting Date: 09/23/2015

Completing the Advance Beneficiary Notice for Home Health Agency Demand Claims

Completing the Advance Beneficiary Notice of Noncoverage for Home Health Agency Demand Claims The purpose of the ABN is to appropriately notify a Medicare beneficiary of services that the HHA believes Medicare will not cover. In order for the [...]

Posting Date: 12/16/2020

The Medicare Home Infusion Therapy Benefit and Home Health Agencies

The Medicare Home Infusion Therapy Benefit and Home Health Agencies If you are a HHA that wants to provide and bill Medicare HIT professional services starting in CY 2021, you are required to enroll with the Part B Medicare Administrative [...]

Posting Date: 07/24/2017

Home Health Therapy Billing

Home Health Therapy Billing Table of Contents Home Health Therapy Billing 32X TOB: Billing Therapy Under a Home Health Plan of Care Discipline Revenue Codes (UB-04 FLs 42-43) Discipline HCPCS Codes (UB-04 FL 44) Service Units [...]

Posting Date: 07/18/2023

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction K Part B Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Paring or Cutting of Benign Hyperkeratotic Lesion 11055, 11056, 11057 A07 – The [...]

Posting Date: 08/13/2020

How to Get Started - Five Easy Steps

How To Get Started – Five Easy Steps Contact your vendor, clearinghouse or billing service to ensure they support the electronic attachment program which includes the following: 6020 version of the 275 transaction; HL7 CDA R2 [...]

Posting Date: 08/10/2023

Duplicate Claim Editing Information

Duplicate Claim Editing Information National Government Services implemented a Part A duplicate claim edit in our EDI front-end processing system. Providers are notified that a claim is a duplicate upon receipt of the 277 Claims [...]

Posting Date: 02/17/2022

How to Get Started

How to Get Started Making the change is easy. If you use a clearinghouse to submit claims, contact your clearinghouse to ask how to enroll for the electronic remittance service. If you currently have a claim submission software program, [...]

Posting Date: 03/01/2022

Benefits of Electronic Remittance Advice

Benefits of Electronic Remittance Advice Table of Contents Benefits of Electronic Remittance Advice There Are Several Benefits to Choosing ERA Versus SPR Help Interpreting the ERA Is Available [Return to Top] Benefits of Electronic [...]

Posting Date: 07/09/2020

Participating Clearinghouses and Vendors

Participating Clearinghouses and Vendors The following entities support electronic attachments with NGS. Any of these entities can assist you with implementing electronic attachments and participating in the NGS Attachment Program. [...]

Posting Date: 03/08/2021

Participating Clearinghouses and Vendors

Participating Clearinghouses and Vendors The following entities support electronic attachments with NGS. Any of these entities can assist you with implementing electronic attachments and participating in the NGS Attachment Program. [...]

Posting Date: 09/28/2022

EDI Gateway Self-Service Password Portal Overview

EDI Gateway Self-Service Password Portal Overview Table of Contents EDI Gateway Self-Service Password Portal Overview Changing versus Resetting Your Password Changing Your Password Resetting Your Password EDI Gateway Self-Service [...]

Posting Date: 09/19/2022

Resetting Your EDI Password

Resetting Your EDI Password EDI passwords have to be regularly changed or reset to maintain data security. You should note that passwords expire every 60 days and can be changed or reset prior to expiration. Follow these steps to reset your [...]

Posting Date: 09/19/2022

Password Reset Requirements Checklist

Password Reset Requirements Checklist The following information will assist you in successfully resetting your password and eliminate any unnecessary disconnects. You should note that passwords expire every 60 days and can be reset prior to [...]

Posting Date: 09/19/2022

Setting Your Security Questions

Setting Your Security Questions Setting up Security Questions is part of the required process for establishing an EDI Gateway Self-Service Portal account. Follow these steps to set up your account Security Questions. Access the Trading [...]

Posting Date: 08/13/2020

How To Get Started - Five Easy Steps

How To Get Started – Five Easy Steps Contact your vendor, clearinghouse or billing service to ensure they support the electronic attachment program which includes the following: 6020 version of the 277RFI transaction; HL7 CDA R2 [...]

Posting Date: 01/29/2020

Benefits of the 277 RFI

Benefits of the 277 RFI The X12 277 RFI transaction replaces the paper Additional Development Request letters. The 277RFI transaction is available for JK/J6 Part A and Part B providers. The benefits of the 277RFI transaction include: [...]

Posting Date: 01/29/2020

Key Features

Key Features PC-ACE is a comprehensive claims management system. Some of the more prominent features include: Combined Medicare Part A, Institutional All-Payer and Professional claims system Electronic submission of claims in ANSI-837 [...]

Posting Date: 09/19/2022

Changing Your EDI Password

Changing Your EDI Password EDI passwords have to be regularly changed or reset to maintain data security. You should note that passwords expire every 60 days and can be changed or reset prior to expiration. Follow these steps to change your [...]

Posting Date: 06/22/2022

PC-ACE Software Instructions, Resources and Guides

PC-ACE Software Instructions, Resources and Guides Creating a 276 Claim Status Request in PC-ACE and Importing and Reading the 277 Claim Status Report PC-ACE - For Institutional Users: Importing and Reading the 999 and 277CA Files PC-ACE [...]

Posting Date: 01/29/2020

Minimum System Requirements and Support

Minimum System Requirements and Support Minimum System Requirements SVGA monitor resolution (800 x 600) Windows 10, Windows 8.1, Windows 7 or Vista operating system Adobe Acrobat Reader Version 4.0 or later (for overlaid claim printing) [...]

Posting Date: 11/17/2020

Download PC-ACE

Download PC-ACE Download PC-ACE If you intend to administer the COVID-19 vaccines when they become available, or the new monoclonal antibody bamlanivimab, especially if you intend to roster bill these codes, please download and install the [...]

Posting Date: 10/01/2024

New Version of PC-ACE: January 2025

New Version of PC-ACE: January 2025 PC-ACE Version 6.5 contains several CMS mandates and product enhancements including but not limited to the items listed below. Change Request (CR) 13794 - Combined Common Edits/Enhancements Modules [...]

Posting Date: 01/29/2020

EDI and How it Works

EDI and How it Works EDI is an electronic communication method that enables fast, accurate and reliable exchange of data between the computer systems of organizations that do business together by using the same standardized message formatting, [...]

Posting Date: 03/16/2021

EDI Solutions JK

Helpful Resources EDI Front End Rejection Code Lookup Tool Reset My EDI Password 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. CT * Closed for training on the [...]

Posting Date: 01/29/2020

About PC Print

About PC Print The PC Print software is available for providers to view and print HIPAA-compliant ERAs from their own computer. The PC Print software is available to you at no cost. This software is easy to use and will save you both time and [...]

Posting Date: 01/29/2020

Key Features

Key Features PC Print offers several different report displays and the ability to print the reports as needed. The Single Claim Report includes the activity at the claim and detail line items for a single claim. The All Claims Report [...]

Posting Date: 11/16/2021

Technical Guides and Information

Technical Guides and Information 5010 Process Flow Chart X12 Website: Technical Reports/Implementation Guides, Newsletters and X12 Transaction Sets Reviewed 6/23/2025

Posting Date: 07/23/2024

Calculating the Batch Receipt Date

Calculating the Batch Receipt Date When a file is received in the EDI Gateway, the date and time received are applied as the receipt date of the claim(s). A business day is considered 12:00 a.m. to 4:59:59 p.m. ET Monday through Friday. [...]

Posting Date: 01/29/2020

Minimum System Requirements and Support

Minimum System Requirements and Support PC Print is only compatible with officially supported Microsoft Windows Operating Systems. Please note that PC Print v4.2.6 is the only version compatible with Windows XP. PC Print software allows [...]

Posting Date: 01/18/2022

Quarterly Top Ten Institutional EDI Edits

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

Posting Date: 06/23/2025

Benefits of EDI

There are a number of advantages to enrolling and submitting claims online. Claims and other transactions submitted electronically process considerably faster than paper submission. For example, HIPAA-compliant electronic claims are held in the [...]

Posting Date: 01/29/2020

Benefits of Electronic Attachments

Benefits of Electronic Attachments The X12 275 Attachment transaction supports sending additional documentation electronically. Clinical documentation includes but not limited to; operative notes, consult notes, procedure notes, care plan, and [...]

Posting Date: 03/16/2021

EDI Solutions J6

Helpful Resources EDI Front End Rejection Code Lookup Tool Reset My EDI Password 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. CT * Closed for training on the [...]

Posting Date: 06/18/2025

MLN Connects® Newsletter: June 18, 2025

MLN Connects® Newsletter: June 18, 2025 News 2023 Doctors & Clinicians Preview Period Open Until June 25 Hospital Price Transparency: Respond to Accuracy & Completeness RFI by July 21 Medicare Part B Discarded Drug Program: Get [...]

Posting Date: 10/15/2021

Home Health Referrals

Home Health Referrals Table of Contents Home Health Referrals Order for Home Health Services Documentation to Support Homebound Status Documentation to Support the Need for Skilled Services Documentation Regarding the Face-to-Face [...]

Posting Date: 01/27/2015

Home Health Forms – Which is Required?

Home Health Forms – Which is Required? The Advance Beneficiary Notice/Home Health Change of Care Notice/Notice of Medicare Noncoverage Scenario ABN HHHCN NOMNC Patient met goals under the POC and is being [...]

Posting Date: 06/07/2021

Eligibility Criteria for Face-to-Face Encounters

Eligibility Criteria for Face-to-Face Encounters National Government Services is reminding home health providers that a face-to-face encounter form is not adequate documentation to support that a face-to-face encounter occurred. [...]

Posting Date: 02/08/2021

Wound Care Under the Medicare Home Health Benefit

Wound Care Under the Medicare Home Health Benefit Wound care treatment typically involves three skilled nursing interventions, which may be performed at the same time or separately from each other. The three services are: Performing the [...]

Posting Date: 05/11/2020

Home Health Plans of Care: NPs, CNSs and PAs Allowed to Certify

Home Health Plans of Care: Nurse Practitioners, Clinical Nurse Specialists and Physician Assistants Allowed to Certify Section 3708 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. No. 116-136) amended sections [...]

Posting Date: 11/30/2020

Homebound Status

Homebound Status A Medicare beneficiary must be confined to the home in order to use their Medicare home health benefit. CMS defines homebound status in the CMS IOM Publication 100-02, Medicare Benefit Policy [...]

Posting Date: 04/12/2022

Home Health: The Definition of an Allowed Practitioner

Home Health: The Definition of an Allowed Practitioner As per MM12615 the “Definition of an Allowed Practitioner” has been revised to read as follows (CR 12615): Medicare Benefit Policy Manual Chapter 7 Section 30.2.1 – Definition of an [...]

Posting Date: 05/02/2018

Filing an Electronic Notice of Cancelation (Type of Bill 8XD)

Filing an Electronic Notice of Cancelation (Type of Bill 8XD) Table of Contents Filing an Electronic Notice of Cancelation (Type of Bill 8XD) Steps to Cancel a NOE Steps to Cancel a Benefit Period Submitting the 8XD Related Content [...]

Posting Date: 09/30/2021

Filing an Electronic Notice of Transfer (Type of Bill 8XC)

Filing an Electronic Notice of Transfer (Type of Bill 8XC) Table of Contents Filing an Electronic Notice of Transfer (Type of Bill 8XC) Correcting the Transfer Date on a Previous Submitted Notice of Transfer Related Content [Return to [...]

Posting Date: 12/19/2016

Hospice Site of Service Codes

Hospice Site of Service Codes Table of Contents Hospice Site of Service Codes HCPCS Codes Site of Service Location Notes Edits Related Content [Return to Top] Hospice Site of Service Codes Hospice agencies must report an HCPCS [...]

Posting Date: 07/10/2017

The Medicare Hospice Benefit: Effects on Other Provider Types

The Medicare Hospice Benefit: Effects on Other Provider Types Table of Contents The Medicare Hospice Benefit: Effects on Other Provider Types What is Hospice Care Providing Services Related to the Terminal Condition Providing Services [...]

Posting Date: 03/22/2017

Reporting Hospice Discharges, Revocations and Transfers

Reporting Hospice Discharges, Revocations and Transfers Medicare regulations at 42 CFR 418.26 outline three reasons for discharge from hospice care: The beneficiary moves out of the hospice’s service area or transfers to another [...]

Posting Date: 11/09/2015

Avoiding Reason Code 7C625: Appropriate Use of Remarks on Final Hospice Claims

Avoiding Reason Code 7C625: Appropriate Use of Remarks on Final Hospice Claims Once a hospice chooses to admit a Medicare beneficiary, it may not automatically or routinely discharge the beneficiary at its discretion, even if the care promises [...]