Understanding the 2026 Cost Analysis Survey for Medicare Allowances on Portable X-Ray Transportation Codes R0070 and R0075

Understanding the 2026 Cost Analysis Survey for Medicare Allowances on Portable X-Ray Transportation Codes R0070 and R0075 Introduction Medicare plays a critical role in ensuring beneficiaries receive medically necessary diagnostic services, [...]

Changes to the Written General Inquiries Process at National Government Services, Inc.

Changes to the Written General Inquiries Process at National Government Services, Inc. Effective 5/27/2025, NGS will no longer accept inquiries submitted through the postal service to any of our P.O. Boxes or faxed to any of our fax lines. The [...]

2024 Medicare Cost Report Due Dates

2024 Medicare Cost Report Due Dates FYE 12/31/2024 cost reports are due by 6/2/2025. We strongly encourage early filing of the cost report. Early-filed cost reports that are rejected will receive a grace period to resubmit prior to [...]

Ambulance Services and Establishing Medical Necessity for Part B Providers

This webinar will help the ambulance community understand the importance of medical necessity as it pertains to Medicare’s coverage guidelines.

Billing the Home Health Notice of Admission via DDE

Billing the Home Health Notice of Admission via DDE Table of Contents Billing the Home Health Notice of Admission via DDE NOA Claim Page 1 NOA Claim Page 4 Notes Related Content [Return to Top] Billing the Home Health [...]

Holding MSP Claims Receiving CWF Edit 6802

Certain MSP claims are incorrectly rejected against CWF edit 6802. On 4/24/2025, CMS directed MACs to hold all MSP claims editing with 6802 while CWF works to correct the issue.

Practitioners - Are You Ordering Surgical Dressings for Your Patients?

Practitioners - Are You Ordering Surgical Dressings for Your Patients? In order for a DME supplier to provide surgical dressings to your patients, there are actions you can take to make sure that all the required supporting medical record [...]

Understanding Medicare Fraud and Abuse

Learn about fraud and abuse affecting providers and your Medicare patients to increase your awareness of integrity issues and prevent potential fraudulent and abusive practices against the Medicare Program.

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 [...]

Clinicians: Are You Ordering Urological Supplies for Your Patients?

Clinicians: Are You Ordering Urological Supplies for Your Patients? Urological supplies are covered as part of the prosthetic device benefit as outlined in the Social Security Act, Section 1861(s)(8). Prosthetic devices (other than dental) [...]

Meeting Minutes

Meeting Minutes Jurisdiction 6 Illinois, Minnesota, Wisconsin Jurisdiction K Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont Jurisdiction 6 and Jurisdiction K Combined Meeting 4/3/2025 12/5/2024 [...]

PR-31

Avoiding/Correcting This Error Services were denied for one or more of the following reasons: The name or Medicare number was incorrect or missing. The date of death precedes the date of service. Expenses were incurred prior to coverage. [...]

PR-31

Avoiding/Correcting This Error Services were denied for one or more of the following reasons: The name or Medicare number was incorrect or missing. The date of death precedes the date of service. Expenses were incurred prior to coverage. [...]

NGSConnex- Account Management

Do you need assistance with login issues and account suspensions? Do you know who your Local Security Officer is and what they are responsible for? We will also review how to edit the user profile and updating access within the portal. After [...]

MLN Connects® Newsletter: May 8, 2025

MLN Connects® Newsletter: May 8, 2025 News Direct Graduate Medical Education: Get Annual Update Factors Compliance Walkers: Prevent Claim Denials Events HCPCS Public Meeting — June 2–3 Medicare Advisory Panel on Clinical [...]

CO-109

Avoiding/Correcting This Error This denial is received when your Medicare patient is enrolled in a MA plan, instead of “traditional fee-for-service” Medicare. MA plans are health plans offered by private companies approved by Medicare that [...]

CO-109

Avoiding/Correcting This Error Palmetto GBA is the Medicare Administrative Contractor for processing claims of railroad retirees, regardless of their location. Providers and suppliers must verify patients' Medicare entitlement before [...]

CO-16

Avoiding/Correcting This Error This denial message is specific to chiropractic claims with CPT/HCPCS codes that are not billable by Medicare enrolled chiropractors. Medicare Part B coverage for chiropractic care is limited to spinal [...]

CO-16

Avoiding/Correcting This Error The billing provider's information on the claim is missing or invalid. To avoid this error, ensure the following details are accurate and included: the billing provider's NPI, name, address, ZIP code, and phone [...]

CO-16

Avoiding/Correcting This Error Certain services require the name and NPI of the ordering or referring physician, depending on the service type. Definitions:  Referring physician: Requests an item or service for a Medicare beneficiary. [...]

CO-16

Avoiding/Correcting This Error The MBI is necessary for all claims submitted to MAC. Claims without a correct MBI are rejected, requiring providers to verify and resubmit them. To avoid this, use the Eligibility Lookup in NGSConnex before [...]

CO-16

Avoiding/Correcting This Error This rejection is the result of submitting a CPT/HCPCS code without a required modifier. You are required to research the proper modifier to report with the CPT/HCPCS code then submit a new claim. Please use [...]

OA-18

Avoiding/Correcting This Error A duplicate claim submission occurs when a provider resubmits a claim either on paper or electronically for a single encounter and the service is provided by the same provider to the: same beneficiary; for the [...]

CO-22

Avoiding/Correcting This Error During patient registration it’s important for office staff to identify whether a beneficiary’s claims should be covered by other insurance before, or in addition to, Medicare. Providers shall use [...]

CMS FQHC Booklet

Colorectal Cancer Screening

Preventive Services Guide Colorectal Cancer Screening Screenings are performed to diagnose colorectal cancer or to determine a beneficiary’s risk for developing colorectal cancer. Colorectal cancer screening may consist of several different [...]

Rural Health Clinic Billing Basics

This webinar will provide a detailed overview of the Medicare billing requirements for rural health clinics (RHC), including the definition of a qualifying visit, locations where billable RHC services can occur, claim coding guidelines and [...]

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 Urological Supplies. This DME video tutorial provides information about urological supply requirements. Posted 5/7/2025  

Provider Contact Center – Make the Most of Your Call

Provider Contact Center – Make the Most of Your Call As of 5/1/2025, the Provider Contact Center (PCC) will service one PTAN/NPI combination per call. Before calling the PCC, make the most of your call by ensuring you have all authentication [...]

Outpatient Psychotherapy Services: A Focus on Coverage and Documentation Requirements

Outpatient psychotherapy services are being reviewed as part of our Part A Medical Review Targeted Probe and Educate program. This session will provide a high-level overview of outpatient psychotherapy services with a focus on coverage and [...]

Provider Enrollment: Opioid Treatment Program

During this webinar, we’ll provide a brief overview of an Opioid Treatment Program (OTP) provider, an understanding of submitting the CMS-855A or CMS-855B paper application and how to complete the provider enrollment Internet-based Provider [...]

Skilled Nursing Facility Consolidated Billing

Did you know that skilled nursing facilities (SNFs) are responsible for paying outside entities for most services provided to beneficiaries while they are in a covered Part A stay and for certain services for Part B beneficiaries? Streamline [...]

Telehealth for Hospice Face-to-Face Recertification Extended Through September 30, 2025

Telehealth for Hospice Face-to-Face Recertification Extended Through September 30, 2025 Hospice physicians and nurse practitioners may continue to conduct the face-to-face encounter required for recertification using telehealth (audio/video [...]

COVID-19

COVID-19 The 2019 Novel Coronavirus (COVID-19) was declared a PHE on 3/13/2020 and it was officially expired on 5/11/2023. Please visit CMS' Current emergencies web page for complete details on the PHE. Email Updates To keep you informed [...]

Reminder: New Medicare Part B Redetermination Notice Initiative

Reminder: New Medicare Part B Redetermination Notice Initiative As a reminder, beginning 3/3/2025, National Government Services will only issue electronic versions of the MRN when a Medicare Part B Redetermination request is electronically [...]

2025 Gapfill Request

2025 Gapfill Request 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 2025. The PAMA regulations instruct the MACs to establish local payment [...]

2025 Gapfill Request Reminder

2025 Gapfill Request Reminder National Government Services, the MAC for JK and J6, is in receipt of the new laboratory test codes identified by CMS to be gap-fill priced for 2025. Please access the complete information on our website: 2025 [...]

Medicare Advantage Information For Part A and Part B Not Offered on the IVR Beginning 3/14/2025

Medicare Advantage Information For Part A and Part B Not Offered on the IVR Beginning 3/14/2025 Effective the evening of 3/14/2025, the Medicare IVR system will no longer provide information regarding the Medicare Advantage:  plan [...]

Medicare Diabetes Prevention Program

Medicare Diabetes Prevention Program Table of Contents Background What is the Medicare Diabetes Prevention Program? Overview of MDPP What is Covered Through the Model? What Does this Mean for Beneficiaries? What Does this Mean [...]

Membership Rosters

Membership Rosters Jurisdiction 6 and Jurisdiction K Home Health POE Advisory Group Roster Member Provider/Institution State Abreau-Costa, Maria Mozaic Senior Life Connecticut Adam, Sherie [...]

Diabetes Self-Management Training

Preventive Services Guide Diabetes Self-Management Training According to the Centers for Disease Control and Prevention, approximately 38.4 million Americans have diabetes and 27.2 million people aged 65 years or older (48.8%) have been [...]

Common Questions for Diabetes Self-Management Training and Medical Nutrition Therapy

Common Questions for Diabetes Self-Management Training and Medical Nutrition Therapy Table of Contents Diabetes Programs Billing for Services DSMT and MNT Telehealth Services Related Content [Return to Top] Diabetes Programs [...]

Meeting Schedules

Meeting Schedule Part A POE AG Meetings for Jurisdiction 6 and Jurisdiction K J6: Illinois, Minnesota, Wisconsin and Federally-Qualified Health Centers in all states JK: Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island [...]

The National Correct Coding Initiative

The National Correct Coding Initiative The purpose of the NCCI PTP edits is to prevent improper payment when incorrect code combinations are reported. The NCCI contains one table of edits for physicians/practitioners and one table of edits for [...]

Expanded Home Health Value-Based Purchasing Model

Expanded Home Health Value-Based Purchasing Model Overview The HHVBP Model is an initiative by CMS aimed at improving the quality of care provided by home health agencies while also fostering greater efficiency. It builds on the original [...]

Tobacco Cessation Counseling Doesn’t Have To Be Lengthy or Intimidating

Tobacco Cessation Counseling Doesn’t Have To Be Lengthy or Intimidating Did you know that tobacco cessation counseling is a covered Medicare service? Brief tobacco counseling provides substantial health benefits while producing cost savings. [...]

HCPCS 90658 Claim Hold

Claim hold for CPT 90658 (influenza vaccine)

FQHC Claim Hold Effective DOS 1/1/2025

CMS has issued claim hold instructions to all MACs, due to release and testing of a new FQHC pricer.

[RESOLVED] Medicare Claim Process System Experiencing Outages

[RESOLVED] Medicare Claim Process System Experiencing Outages We were experiencing outages with our IVR and NGSConnex claim status functionality. Technical support was engaged and the issue is now resolved. The IVR and NGSConnex claim status [...]

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 [...]

MLN Connects® Newsletter: February 14, 2025

MLN Connects® Newsletter: February 14, 2025 News Complex Non-Chemotherapeutic Drug Administration: Determining Payment for Services Claims, Pricers, & Codes Ambulance Fee Schedule: CY 2025 Inflation Factor Integrated Outpatient [...]

PA Exemption Tool Top

Prior Authorization Exemption Status Inquiry Tool This is a self-service tool to allow both hospital or physician office staff responsible for submitting PARs, to check the exempt status of the HOPD. This tool will only recognize the [...]

Reminder: New Medicare Part B Redetermination Notice Initiative

Reminder: New Medicare Part B Redetermination Notice Initiative As we’ve communicated, National Government Services is transitioning to electronic notifications for Part B Medicare Redetermination decisions when a Medicare Part B [...]

Collaborative Urological Supplies Webinar Coming 3/27/2025

Collaborative Urological Supplies Webinar Coming 3/27/2025 This is your opportunity to hear directly from the Medicare contractors regarding Medicare’s criteria necessary for the coverage of urological supplies. Representatives from all four [...]

Requirements of Medicare Opt-Out Affidavit Agreement

Requirements of Medicare Opt-Out Affidavit 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 if specific [...]

Prepare and Submit an MSP Conditional Claim

Table of Contents Background Step 1: Determine if You Can Submit a Conditional Claim Step 2: Prepare a Conditional Claim Conditional Billing Code Table Step 3: Check for a Matching MSP Record for the Beneficiary in the Common [...]

Local Coverage Determination Open Meeting

Local Coverage Determination Open Meeting National Government Services is hosting a Local Coverage Determination Open Meeting on 3/13/2025. Details are available by accessing the Local Coverage Determination Open Meeting Announcement. [...]

NCCI Lookup Tool

Reminder: New Medicare Part B Redetermination Notice Initiative

Reminder: New Medicare Part B Redetermination Notice Initiative Beginning 3/3/2025, NGS will only issue electronic versions of the MRN when a Medicare Part B Redetermination request is electronically submitted through our portal, NGSConnex. [...]

Pre-Exposure Prophylaxis Using Antiretroviral Therapy to Prevent HIV Infection

Preventive Services Guide Pre-Exposure Prophylaxis Using Antiretroviral Therapy to Prevent HIV Infection PrEP involves the use of antiretroviral drugs to decrease the risk of acquiring HIV. Under Section 1861(ddd)(1) of the Social Security [...]