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

National AB Medicare Administrative Contractor Ambulance Provider/Supplier Coalition

National AB Medicare Administrative Contractor Ambulance Provider/Supplier Coalition Attention Ambulance Providers In response to numerous and continued requests from the ambulance community, the AB MACs have put together a National AB MAC [...]

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 [...]

National A/B Medicare Administrative Contractor Ambulance Provider/Supplier Coalition

National A/B Medicare Administrative Contractor Ambulance Provider/Supplier Coalition Attention Ambulance Providers In response to numerous and continued requests from the ambulance community, the AB MACs have put together a National AB MAC [...]

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 and [...]

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 and receive [...]

Learn Over Lunch-NGSConnex Introduction

Are you considering utilizing NGSConnex and want to learn more about this portal? During this brief webinar, we will provide an overview of NGSConnex and all it has to offer.

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 [...]

Incarcerated or Unlawfully Present in the U.S. 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 [...]

34538

Avoiding/Correcting This Error To avoid this error: When submitting your Medicare primary claim, report the reason Medicare is primary using claim coding in Prevent an MSP Rejection on a Medicare Primary Claim. To correct this [...]

34538

Avoiding/Correcting This Error To avoid this error: When submitting your Medicare primary claim, report the reason Medicare is primary using claim coding in Prevent an MSP Rejection on a Medicare Primary Claim. To correct this [...]

34538

Avoiding/Correcting This Error To avoid this error: When submitting your Medicare primary claim, report the reason Medicare is primary using claim coding in Prevent an MSP Rejection on a Medicare Primary Claim. To correct this [...]

Depression Screening: Promoting Good Health Through Disease Prevention and Detection

Medicare covers many preventive services to keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep your patients from getting certain diseases. Register today for an [...]

Medicare Secondary Payer: The Fundamentals Part 1

This is part 1 of a 2-part webinar. In part 1, we introduce our Part A providers to the fundamentals (basics) of Medicare Secondary Payer (MSP) by providing a high-level overview of the Group Health Plan (GHP) and non-GHP MSP provisions. We [...]

Medicare Secondary Payer: The Fundamentals Part 2

This is part 2 of a 2-part webinar. In part 2, we continue to introduce our Part A providers to Medicare Secondary Payer (MSP) by providing a high-level overview of your MSP responsibilities per your Medicare provider agreement. You will learn [...]

EDI Front End Clinical Edits

EDI Front End Clinical Edits EDI is continuing to implement EDI clinical business edits into the NGS EDI front end. These edits assist in proactively alerting providers of potential claim issues and provide resources to assist with avoiding [...]

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 [...]

Acute Care Hospitals Preparing Inpatient Claims: The Basics Part 1

This is part 1 of a 2-part webinar event (part 2 will be on 04/24/2025). In part 1, Acute Care Hospitals (ACH) will learn how to properly complete inpatient claims for submission to Medicare. We will review general inpatient ACH information [...]

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 [...]

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 [...]

Termination of the Hospice Benefit Component of the VBID Model on 12/31/2024

Termination of the Hospice Benefit Component of the VBID Model on 12/31/2024 After carefully considering recent feedback about the increasing operational challenges of the Hospice Benefit Component and limited and decreasing participation [...]

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 [...]

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 [...]

Provisional Period of Enhanced Oversight for New Hospices

Provisional Period of Enhanced Oversight for New Hospices In recent years, CMS has reported a significant increase in fraudulent hospice billing practices, which cost the Medicare Program millions of dollars annually. The CMS has initiated a [...]

Introduction to Medicare Part II

Join us for Introduction to Medicare Part II to enhance your understanding of Medicare Part B. Topics include Local Coverage Determinations, Claim Filing Guidelines, Preventive Services, Front Office Assistance, Medigap/Supplemental/Advantage [...]

Description of NPI and a Link to NPPES Registry

Description of NPI and a Link to NPPES Registry As mandated by HIPAA, you should maintain (verify and update) your NPI data via NPPES on a regular basis. The NPI: is a ten-digit number and must be submitted on the enrollment form, will [...]

Description of NPI and a Link to NPPES Registry

Description of NPI and a Link to NPPES Registry   As mandated by HIPAA, you should maintain (verify and update) your NPI data via NPPES on a regular basis. The NPI: is a ten-digit number and must be submitted on the enrollment form, [...]

Description of NPI and a Link to NPPES Registry

Description of NPI and a Link to NPPES Registry   As mandated by HIPAA, you should maintain (verify and update) your NPI data via NPPES on a regular basis. The NPI: is a ten-digit number and must be submitted on the enrollment form, [...]

MLN Connects® Newsletter: April 3, 2025

MLN Connects® Newsletter: April 3, 2025 News Home Infusion Therapy & Intravenous Immune Globulin Services: Get Monitoring Reports Medicare Providers & Suppliers: Report Managing Employees External User Services Help Desk: New [...]

MLN Connects® Newsletter: April 14, 2025

MLN Connects® Newsletter: April 14, 2025 FY 2026 Proposed Payment Rules CMS Seeks Public Input on Inpatient Hospital Whole-Person Care, Proposes Updates to Medicare Payments Inpatient Rehabilitation Facility Prospective Payment System [...]

Preventive Services: Initial Preventive Physical Examination and Annual Wellness Visit

Ensure that your patients obtain the wellness examinations they are eligible for by knowing the differences between the initial preventive physical examination and annual wellness visit. During this webinar, we'll review the coverage, coding [...]

Get Access to Keep Provider Enrollment Records Up To Date with Medicare

Get Access to Keep Provider Enrollment Records Up To Date with Medicare If you need to manage Medicare enrollment information for an individual provider or entity electronically through PECOS, you must have authorized access. This access will [...]

National A/B MAC Ambulance Provider/Supplier Coalition Meeting Invite

National A/B MAC Ambulance Provider/Supplier Coalition Meeting Invite Attention Ambulance Suppliers and Providers Join the first virtual National A/B MAC Ambulance Provider/Supplier Coalition meeting during EMS Week: Thursday, 5/22/2025 from [...]

Description of NPI and a Link to NPPES Registry

Description of NPI and a Link to NPPES Registry   As mandated by HIPAA, you should maintain (verify and update) your NPI data via NPPES on a regular basis. The NPI: is a ten-digit number and must be submitted on the enrollment form, [...]

Part B Spring 2025 Virtual Conference: Register Now

Register Now! Register now for the 2025 Spring Part B Virtual Conference: Understanding Medicare Compliance for Part B Providers happening on June 3–5,2025. This event will offer innovative ideas and broaden your expertise in Medicare [...]

Part A Summit- Skilled Nursing Facility: Coverage and Documentation

During this collaborative education session between Case Management and Medical Review, attendees will learn documentation requirements for skilled nursing facility (SNF) coverage, how to properly respond to Additional Documentation Requests [...]

Part A Summit 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 [...]

Part A Summit -Need Answers? The Options to Consider Before Calling or Writing into Medicare

During this session, we will review top trends on why providers are reaching out to Medicare and the best options to resolve those inquires. Plus, valuable tips and resources to help get the most out of Medicare.

Part A Summit- Medicare Secondary Payer: Preventing Rejections of Your Medicare Primary Claims

Increase your cash flow by preventing rejections of your Medicare primary claims! In this webinar, we review why claims reject for Medicare Secondary Payer and explain how to prevent these rejections by reporting information on your claims that [...]

Part A Summit- Navigating Billing and Documentation for Behavioral Health Services in Federally Qualified Health Centers

Unlock the secrets to effective billing and documentation for behavioral health services within Federally Qualified Health Centers. This collaborative webinar will include insights from Medical Review and is designed to help healthcare [...]

Part A Summit - Exploring the NGS TPE Process

Join us to explore essential strategies for a successful Targeted Probe and Educate review. We'll cover the purpose of TPE and best practices, roles and responsibilities of National Government Service and providers under review. Gain practical [...]

Part A Summit – How to Submit an Appeal Request

Join us for a comprehensive session focused on understanding the appeal submission process within National Government Service. This presentation is designed to guide participants through each step of submitting an appeal, ensuring clarity and [...]

Part A Summit - NGSConnex: User Pain Points Examples/Solutions

Are you experiencing issues while utilizing NGSConnex? Join this informative session to learn what user pain points are and how to resolve these issues from an NGSConnex Agile Product Owner. This session will encompass issues with [...]

Part A Summit - World of Medicare Contractors

Medicare Administrative Contractors are responsible for processing claims, managing policy and payment, and establishing regional policy guidelines. Centers for Medicare & Medicaid Services also uses several additional contractors to manage [...]

Part A Summit - Maintaining Your Provider Files

This virtual webinar will aid in maintaining accurate provider enrollment files for the internet-based Centers for Medicare & Medicaid Services systems: Identity & Access Management System, National Plan & Provider Enumeration System and the [...]

Part A Summit- Navigating NGS and CMS Websites

Join us for this informative session where we will review how to find helpful Medicare references and resources on the National Government Services website (www.NGSMedicare.com) and the Centers for Medicare & Medicaid Services website [...]

Part A Summit - Provider Outreach and Education Roundtable

Join us for an interactive and insightful roundtable discussion with the Provider Outreach and Education Manager and team. This session is designed to offer a comprehensive look into the future of POE and explore innovative strategies for [...]

Medicare Part B Secondary Payer Post-Pay Overpayments

During this webinar, providers and office staff members will learn about the Medicare Part B overpayments and the appropriate steps for reporting Medicare Secondary Payer (MSP) overpayments. NGS MSP subject-matter experts will be on hand to [...]

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.

How to Avoid Duplicate Claims

Duplicate denials continue to be one of the top billing errors. Unnecessary duplicate filing of Medicare claims cost the provider's office valuable time and resources, as well as Medicare's time and money to process them. Please join us for [...]

Medicare Overpayment Process

Ensure that you are compliant and avoid financial penalties by understanding the Medicare overpayment regulations. This session will focus on identifying overpayments, using the proper forms and procedures, the timelines for repayment and the [...]

Understanding the Reopening and Appeal Process Open Forum

National Government Services is committed to reducing provider burden associated with Medicare claim denials, reopenings and appeals. Filing an inquiry on a Medicare claim can be frustrating and costly to your organization. This delay in [...]

55H2B

Avoiding/Correcting This Error Ensure the submitted documentation supports the beneficiary is confined to the home. An individual shall be considered “confined to the home” (homebound) if the following two criteria are met:   [...]

31287

Avoiding/Correcting This Error Hospice claims are required to be billed monthly. Verify the month beginning and ending date and the ‘From’ and ‘To’ dates on your claim. The claim must span the entire month for continuing care claims.

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Verify the MBI submitted on the claim matches the MBI in the Common Working File. If a new MBI has been assigned, follow the guidelines regarding the claim submission: For dates of service before the MBI change date use old or new MBI If [...]

37236

Avoiding/Correcting This Error Verify eligibility of the attending/ordering physicians in PECOS. Print that verification and make it part of the medical record. If applicable, submit a reopen request to the Appeals Department indicating error [...]

55HTP

Avoiding/Correcting This Error Verify that the initial certification is complete and includes all necessary elements, such as the patient’s homebound status, the need for skilled services, and a face-to-face encounter with a physician or [...]