Required Documentation

Required Documentation Table of Contents Required Documentation The medical record should contain patient specific information detailing Certification and Recertification Requirements Signature Requirement for Certifications and [...]

Skilled Services

Skilled Services Table of Contents Skilled Services Skilled Nursing Examples of skilled nursing Skilled Therapy Skilled Respiratory Nonskilled Service Examples Examples of personal care services General Skilled [...]

Coverage Requirements

Coverage Requirements Eligibility, preadmission, and 30-day transfer are components of coverage requirements for Skilled Nursing Facilities. There are several components to each of the coverage requirements; please utilize the links below to [...]

How to Prevent Common Skilled Nursing Facility Denials

How to Prevent Common Skilled Nursing Facility Denials This resource was developed to increase awareness and educate SNFs on the top errors found by our Medical Review team. The information includes suggestions to ensure documentation [...]

How to Find and Respond to Post Payment Review ADR

How to Find and Respond to Post Payment Review ADR Table of Contents How to Find and Respond to Post Payment Review ADR Responding to Post Payment Review ADR Steps to View and Print ADRs from FISS/DDE Provider Online System Related [...]

NGS Medical Review Process

NGS Medical Review Process Medicare contractors, like NGS, operate the medical review program to prevent improper payments and protect the Medicare Trust Fund. Medical reviews involve the collection and clinical review of medical records and [...]

Skilled Nursing Facility Educational Center

Skilled Nursing Facility Educational Center As part of the effort to lower the SNF improper payment rate, CMS has initiated a five claim Skilled Nursing Facility Probe & Educate allowing for outreach to all Medicare billing SNFs in the [...]

Medicare Review Contractors

During this webinar, we'll assist Medicare providers with knowing the difference between the Medicare review contractors and understanding their role in the Medicare review process. We'll discuss the Supplemental Medical Review [...]

Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated and Advance Payments for Part A Providers and Part B Suppliers

Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated and Advance Payments for Part A Providers and Part B Suppliers Please see the below for information related to the CHOPD Accelerated and Advance Payments for Part A Providers and [...]

MLN Connects® Newsletter: May 29, 2025

MLN Connects® Newsletter: May 29, 2025 News Inpatient Hospital Admissions: Transferring Medical Review Responsibilities for Short Stay Claims Medicare Shared Savings Program: Apply Now MLN Matters® Articles National Coverage [...]

Requesting an Exception to Timely Filing

Requesting an Exception to Timely Filing Table of Contents Requesting an Exception to Timely Filing No Appeal Rights for Claims Denied Based on Timely Filing Limit Provider Liability Exceptions that May Allow the Time Limit to be [...]

Tutorial

Medicare Claims: CMS-1500 or Electronic

PECOS: Manage Signatures and Additional Information Requests

During this webinar, we’ll give direction for the Provider Enrollment, Chain and Ownership System (PECOS) application on understanding how to manage signatures and respond to additional information request from submitted applications.

Modifier 22 Supporting Documentation for Part B claims

Modifier 22 Supporting Documentation for Part B claims The Centers for Medicare & Medicaid Services, Internet-Only-Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 40.2.10 Unusual Circumstances states: [...]

How to Prevent Common Skilled Nursing Facility Denials

How to Prevent Common Skilled Nursing Facility Denials This article was developed to increase awareness and educate SNFs on the top errors found by our Medical Review team. The information below includes suggestions to ensure documentation [...]

Best Practices for a Successful Targeted Probe and Educate Review

Best Practices for a Successful Targeted Probe and Educate Review Table of Contents Getting Started With TPE Notification Letter During the Review Process Post-Probe/Review Results Letter Prepare for Post-Probe Education [Return to [...]

Best Practices for a Successful Targeted Probe and Educate Review

Best Practices for a Successful Targeted Probe and Educate Review Table of Contents Getting Started With TPE Notification Letter During the Review Process Post-Probe/Review Results Letter Prepare for Post-Probe Education [Return to [...]