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 [...]