The National Government Services Medicare Contracting Company is a Medicare contracting company. In 1966, the company began serving U.S. government agency CMS Medicare.
NGS Medicare administers Medicare Part A, which includes hospitalization in Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont, and Wisconsin.
Our company manages Medicare Part B contracts for Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont, and Wisconsin.
Fee Schedules
The Balanced Budget Act of 1997 mandated the implementation of a national fee schedule for ambulance services furnished under Medicare Part B. This fee schedule is in effect for claims filed after April 1, 2002. The law applies to all ambulance services, whether they are volunteer, municipal, private, independent, or institutional, including hospitals, critical access hospitals (unless there is no ambulance service within 35 miles), and skilled nursing facilities.
Clinical Laboratory Fee Schedule
- As a result of the “Protecting Medicare and American Farmers from Sequester Cuts Act” (S. 610) passed on December 10, 2021, reporting requirements took effect under Section 1834A a year later. Additionally, they waited for the gradual phase-in of the 15% cut.
- In compliance with Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA), PAMA Section 1834A mandates significant changes to the way Medicare pays for Clinical Diagnostic Laboratory Tests (CDLTs). The CMS-1621-F “Medicare Clinical Diagnostic Laboratory Tests Payment System final rule” (CLFS-1621-F) was published in the Federal Register on June 23, 2016. This CLFS enforces section 1834A of the Medicare Act. CMS requires reporting entities to provide certain private payer rate information (applicable information) for their component appropriate laboratories in the CLFS final rule. The period that this data collection occurred (the period when relevant information about a suitable laboratory is obtained from the final payment received by the laboratory) was January 1, 2019, through June 30, 2019.
Medical Equipment Fee Schedule
In December of 2020, President Obama signed into law the Consolidated Appropriations Act of 2021 (Public Law 116-260). Accordingly, section 121 of this Act eliminates the budget neutrality requirement outlined in section 1834(a)(9)(D)(ii) of the Act for the establishment of separate classes and national limited monthly payment rates for any item of oxygen and oxygen equipment using the authority in section 1834(a)(9)(D)(i) of the Act.
Billing & Payment
For the therapy and counseling portions of the weekly bundles and for the add-on code for additional counseling or therapy for beneficiaries with opioid use disorders (HCPCS code G2080), CMS now allows audio-only telephone calls, as long as all other requirements are met. Providers may conduct periodic patient assessments (HCPCS code G2077) via two-way interactive audio-video communication technology or by telephone in cases where beneficiaries do not have access to two-way interactive technology.
Physician Fee Schedule
In December 2018, CMS published the C.Y. 2022 Medicare Physician Fee Schedule (PFS) final rule, which updated payment policies, payment rates, and other provisions. An overview of key requirements for January 1, 2022, and beyond is below:
- In certain circumstances, the Consolidated Appropriations Act, 2021 revises telehealth services and permits the use of audio-only communications technology.
- Adds policies for splitting up (or sharing) visits, critical care visits, and teaching physician services to the Evaluation and Management (E/M) visit codes.
- Payment for therapy services provided in whole or in part by a Physical Therapist Assistant or an Occupational Therapy Assistant has been modified.
- The payment regulation for Medical Nutrition Therapy has been updated.
- Vaccine administration considerations have been finalized.