Search Results - NGSMEDICARE

Posting Date: 06/09/2021

About Hospital OPD PA Model

About Hospital OPD PA Model Table of Contents General Information Related Content [Return to Top] General Information Question Description WHO It is the responsibility of the hospital OPD to submit all [...]

Posting Date: 06/09/2021

OPD Facility/Physician Communication

OPD Facility/Physician Communication The implementation of the Outpatient Department (OPD) Prior Authorization (PA) program has specific implications for Part B physicians performing services within hospital OPDs. Each prior authorization [...]

Posting Date: 06/09/2021

Ways to Submit Requests

Ways to Submit Requests NGSConnex Part A: NGSConnex User Guide Part B: NGSConnex User Guide esMD Content type 8.5 Fax JK: 317-841-4530 J6: 317-841-4528 Mail National Government Services, Inc. [...]

Posting Date: 06/14/2022

Documentation Information

Documentation Information It is recommended that PARs are submitted at least seven calendar days prior to the expected date of service to allow National Government Services (NGS) the full standard timeframe to receive and review requests. [...]

Posting Date: 07/18/2023

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction K Part B Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Paring or Cutting of Benign Hyperkeratotic Lesion 11055, 11056, 11057 A07 – The [...]

Posting Date: 06/23/2025

Billing Telehealth Services for Part B Providers

During this webinar, we’ll provide you with insight into covered Medicare telehealth services and coverage requirements. We’ll discuss originating sites, distant sites and billing and payment guidelines.

Posting Date: 07/12/2024

Hospice Transfers

Hospice Transfers The purpose of a hospice transfer is to allow the beneficiary the opportunity to transfer to another agency without affecting the current benefit period and providing continuity of care. Instead of the beneficiary revoking [...]

Posting Date: 10/22/2015

Hospice Documentation Tips

Hospice Documentation Tips Medicare coverage of hospice depends on a physician’s certification that an individual’s prognosis is a life expectancy of six months or less if the terminal illness runs its normal course. It is important that the [...]

Posting Date: 10/04/2021

Documentation Requirements for the Medicare Hospice Election Statement

Documentation Requirements for the Medicare Hospice Election Statement Election of Hospice Hospice care is a benefit under the hospital insurance program. To be eligible to elect hospice care under Medicare, the beneficiary must be entitled [...]

Posting Date: 10/05/2022

Tips for Responding to a Hospice ADR

Tips for Responding to a Hospice ADR National Government Services performs medical review audits of services billed to Medicare to validate that the documentation supports coverage and level of services billed. If one of your claims is [...]

Posting Date: 10/04/2021

Implementation of the Election Statement Addendum

Implementation of the Election Statement Addendum Hospice Election Statement Addendum Hospice care is a benefit under the hospital insurance program. To be eligible to elect hospice care under Medicare, the beneficiary must be entitled to [...]

Posting Date: 07/14/2024

Correcting Reason Code 37253

Correcting Reason Code 37253 To ensure home health claim information aligns with OASIS data, the iQIES OASIS claim data match is essential. If no matching assessment is found in iQIES when a claim is submitted, it will be returned with reason [...]

Posting Date: 06/01/2018

Avoiding Reason Code 38200

Avoiding Reason Code 38200 Claims are rejected with reason code 38200 when the FISS finds a previously submitted billing transaction that is a duplicate of the recently submitted billing transaction where all of the following fields on the [...]

Posting Date: 11/21/2024

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 [...]

Posting Date: 07/14/2024

Expanded Home Health Value-Based Purchasing Model

Expanded Home Health Value-Based Purchasing Model Overview The HHVBP Model is an initiative by CMS aimed at improving the quality of care provided by home health agencies while also fostering greater efficiency. It builds on the original [...]

Posting Date: 05/19/2022

Billing the Home Health Period of Care Claim - PDGM

Billing the Home Health Period of Care Claim – PDGM Table of Contents Billing the Home Health Period of Care Claim – PDGM Claim Page 1: Claim Page 2: Claim Page 3 Claim Page 4 Claim Page 5 Related Resources [Return to Top] [...]

Posting Date: 01/13/2022

Billing the Home Health Notice of Admission via DDE

Billing the Home Health Notice of Admission via DDE Table of Contents Billing the Home Health Notice of Admission via DDE NOA Claim Page 1 NOA Claim Page 4 Notes Related Content [Return to Top] Billing the Home Health [...]

Posting Date: 05/09/2022

Home Health Transfers

Home Health Transfers Table of Contents Background What To Do As a Receiving HHA What To Do As the Initial HHA What To Do In Case of a Dispute Related Content [Return to Top] Background A home health transfer occurs when a [...]

Posting Date: 02/26/2016

Reporting Home Health Periods with No Skilled Visits

Reporting Home Health Periods with No Skilled Visits Eligibility for the Medicare HH benefit requires that the beneficiary have a need for intermittent skilled nursing care, PT, SLP, or a continuing need for OT. The need for skilled care makes [...]

Posting Date: 05/19/2022

Home Health Third Party Liability Demand Billing

Home Health Third Party Liability Demand Billing Table of Contents Background What is a Demand Bill? Requirements for Submission How to Submit a TPL Demand Bill Claim Page 1: Claim Page 2 – Covered and Noncovered Charges Claim [...]