Supplying services to the United States agency CMS
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services, previously known as the Health Care Financing Administration, is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state government…
Full Answer
What does NGS stand for in Medicare?
- JE processes FFS Medicare Part A and Part B claims for American Samoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands
- Total Number of Fee-for-Service Beneficiaries: 3,981,861 ( as of 9/30/2020)
- Total Number of Physicians: 123,904 (as of 9/30/2020)
- Total Number of Medicare Hospitals: 473 (as of 9/30/2020)
What is NGS Medicare?
- either recurrent, relapsed, refractory, metastatic, or advanced stages III or IV cancer; and,
- not been previously tested with the same test using NGS for the same cancer genetic content, and
- decided to seek further cancer treatment (e.g., therapeutic chemotherapy).
What is the Medicare official website?
Medicare.gov is the official website for the U.S. government’s Medicare program. Medicare.gov provides official benefit information regarding Medicare, including different coverage options, costs, preventative services, and tools for Medicare beneficiaries.
How to Find my Medicare provider number?
- Log into Internet-based PECOS
- Select "My Associates" on PECOS home page
- Select "View Enrollments" by applicable individual or organizational enrollment
- Click on "View Medicare ID Report"
- PTAN or PTANs are listed in Medicare ID column
What states does NGS Medicare cover?
Over 14,000 Part A providers of service in the states of Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont and Wisconsin.
What is NGS for Medicare?
NGSMedicare gives you access to the latest Medicare education and a wide variety of Medicare tools. NGSConnex, is your free, secure self-service portal to obtain beneficiary eligibility, claim status & more... saving you time and money!
Is national government services the same as Medicare?
National Government Services, Inc. provides health care information and support services. The Company offers medicare insurance claims processing services, including hospital, health, and medical insurance administration.
What is a Part B claim?
You are responsible for deductibles, copayments and non-covered services. Medicare pays Part B claims (doctors' services, outpatient hospital care, outpatient physical and speech therapy, certain home health care, ambulance services, medical supplies and equipment) either to your provider or you.
Where is National Government Services located?
Contact DetailsOrganization Type:A/B MAC -- A/B Medicare Administrative ContractorAddress:PO Box 6474 Indianapolis IN 46206-6474Information:Toll Free: 888 855 4356 Toll Free TDD: 866 786 7155 Web Site: https://www.ngsmedicare.com Hours: 8:00am - 4:00pm CST M-F4 more rows
Does Medicare cover whole genome sequencing?
Medicare Part B does not cover genetic tests used for predictive purposes. However, it does cover genetic tests used for diagnostic purposes under certain conditions.
What services are provided by national government?
The federal government collects taxes in order to pay for services it provides to citizens. Some services the federal government provides are helping the elderly and the poor get health care and housing, mail through the Postal Service, money and services to areas impacted by disasters, and the military.
What are the local government services?
Municipalities generally take responsibility for parks and recreation services, police and fire departments, housing services, emergency medical services, municipal courts, transportation services (including public transportation), and public works (streets, sewers, snow removal, signage, and so forth).
What are the government services?
Government Service means any buildings or lands from which government services are offered, including fire and police protection, municipal services, government offices, and correctional facilities, but excludes outside storage or the servicing of machinery and equipment.
Which of the following is not covered under Part B of a Medicare policy?
But there are still some services that Part B does not pay for. If you're enrolled in the original Medicare program, these gaps in coverage include: Routine services for vision, hearing and dental care — for example, checkups, eyeglasses, hearing aids, dental extractions and dentures.
What are Medicare Parts A and B?
Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. Part B (Medical Insurance): Helps cover: Services from doctors and other health care providers. Outpatient care.
What is the difference between Medicare Part A and Part B?
Part A is hospital coverage, while Part B is more for doctor's visits and other aspects of outpatient medical care. These plans aren't competitors, but instead are intended to complement each other to provide health coverage at a doctor's office and hospital.
What does NGS stand for?
Next-generation sequencing (NGS) is a massively parallel sequencing technology that offers ultra-high throughput, scalability, and speed. The technology is used to determine the order of nucleotides in entire genomes or targeted regions of DNA or RNA.
Is NGS covered by insurance?
In 2018, Medicare issued a national coverage determination (NCD) providing reimbursement for next-generation sequencing (NGS) tests for beneficiaries with advanced or metastatic cancer and no previous NGS testing.
Is next-generation sequencing covered by insurance?
Today the Centers for Medicare & Medicaid Services (CMS) took action to cover FDA approved or cleared laboratory diagnostic tests using Next Generation Sequencing (NGS) for patients with germline (inherited) ovarian or breast cancer.
How do I get a refund from Medicare overpayment?
Submit a check with the Part A Voluntary Refund Form. When the claim(s) is adjusted, Medicare will apply the monies to the overpayment. Option 2: Submit the Part A Voluntary Refund Form without a check and when the claim(s) are adjusted, NGS will create an account receivable and generate a demand letter to you.
Decision Summary
A.
Decision Memo
A. The Centers for Medicare & Medicaid Services (CMS) has determined that Next Generation Sequencing (NGS) as a diagnostic laboratory test is reasonable and necessary and covered nationally, when performed in a CLIA-certified laboratory, when ordered by a treating physician and when all of the following requirements are met:
Bibliography
American Society of Breast Surgeons. Consensus Guidelines on Genetic Testing for Hereditary Breast Cancer (2019), available at https://www.breastsurgeons.org/docs/statements/Consensus-Guideline-on-Genetic-Testing-for-Hereditary-Breast-Cancer.pdf .
Current Maps and Lists
To find out who the current A/B and DME MACs are, use these maps and lists to help you determine which MAC is of most interest to you.
DME MACs
The DME MACs process Medicare Durable Medical Equipment, Orthotics, and Prosthetics (DMEPOS) claims for a defined geographic area or "jurisdiction," servicing suppliers of DMEPOS. Learn more about the DME MAC in each jurisdiction.
I. Decision
- A. The Centers for Medicare & Medicaid Services (CMS) has determined that Next Generation Sequencing (NGS) as a diagnostic laboratory test is reasonable and necessary and covered nationally, when performed in a CLIA-certified laboratory, when ordered by a treating physician and when all of the following requirements are met: 1. The patient has: 1.1. ovarian or breast ca…
II. Background
- Throughout this document we use numerous acronyms, some of which are not defined as they are presented in direct quotations. Please find below a list of these acronyms and corresponding full terminology: ACCE - Analytical validity, clinical validity, clinical utility, ethical, legal and social implications of genetic testing ACS - The American Cancer Society AD - Lung adenocarcinoma A…
III. History of Medicare Coverage
- CMS issued an NCD on March 16, 2018, establishing the first national coverage policy for NGS. In general, the NCD provides national coverage for diagnostic laboratory tests using NGS that have FDA approval or clearance as a companion in vitro diagnostic for patients with recurrent, relapsed,refractory, metastatic, or advanced cancers, an FDA approv...
v. Food and Drug Administration (FDA) Status
- In the United States, NGS tests to diagnose disease or other conditions, a subset of in vitro diagnostic devices (IVD), are considered medical devices by the U.S. Food and Drug Administration (FDA). Generally, IVDs may be subject to premarket and postmarket controls and categorization under the Clinical Laboratory Improvement Amendments (CLIA '88) of 1988. At th…
VI. General Methodological Principles
- In general, when making national coverage determinations under section 1862(a)(1)(A), CMS evaluates relevant clinical evidence to determine whetheror not the evidence is of sufficient quality to support a finding that an item or service falling within one or more benefit categories is reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the fun…
VII. Evidence
- This section provides a summary of the evidence we considered during our review. The evidence reviewed to date includes the published medicalliterature on pertinent clinical research of NGS testing for patients with germline cancers. Our review and analysis of the evidence on the clinical utility of NGS in patients with a germline mutation or inherited cancer is guided by the following …
VIII. CMS Analysis
- National coverage determinations are determinations by the Secretary with respect to whether or not a particular item or service is covered nationally by Medicare (§1869 (f)(1)(B) of the Act). In general, in order to be covered by Medicare, an item or service must fall within one or more benefit categories contained within Part A or Part B, and must not be otherwise excluded from coverage…