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Posting Date: 05/28/2020
Hospital Discharge Summary: Insufficient Documentation Causes Most Improper Payments
Hospital Discharge Summary: Insufficient Documentation Causes Most Improper Payments Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there [...]
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Posting Date: 01/29/2021
Bill Inpatient or Outpatient Services
Bill Inpatient or Outpatient Services To help avoid denials, National Government Services has compiled information regarding references that will aid in determining whether to bill inpatient or outpatient services. CMS Medicare Learning [...]
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Posting Date: 01/29/2021
Process for Requesting Medical Records
Process for Requesting Medical Records Additional Documentation Requests INITIAL ADR letters for CERT are sent to the address on file with the NSC for DMEPOS suppliers, or the MAC for the provider/supplier that billed/submitted the [...]
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Posting Date: 01/29/2021
Inpatient Psychiatric Certification/Recertification/Delayed Certification
Inpatient Psychiatric Certification/Recertification/Delayed Certification Physicians are required to certify the medical necessity of inpatient services. This is required on admission and if the service is needed for an extended period of [...]
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Posting Date: 01/29/2021
SNF Inpatient Stays
SNF Inpatient Stays The CERT contractor has seen increased denials of SNF inpatient stays due to missing or incomplete physician certification statement of medical necessity. Certification of medical necessity of inpatient skilled nursing [...]
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Posting Date: 06/23/2021
When to Use the Provider Contact Center Versus Self-Service Tools
When to Use the Provider Contact Center Versus Self-Service Tools The CMS requires contractors to provide self-service and electronic communication technologies as efficient, cost effective means of disseminating Medicare provider information, [...]
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Posting Date: 09/20/2019
Prolonged Services
Prolonged Services Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was [...]
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Posting Date: 06/27/2019
Annual Wellness Visit
Annual Wellness Visit Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient documentation that caused improper payments for an [...]
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Posting Date: 01/29/2021
Hyperbaric Oxygen Therapy Treatment
Hyperbaric Oxygen Therapy Treatment Insufficient documentation is documentation that was incomplete, inaccurate or was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient [...]
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Posting Date: 01/29/2021
Surgery Services
Surgery Services Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient documentation that caused improper payments for [...]
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Posting Date: 01/29/2021
Medication Administration
Medication Administration Insufficient documentation means something was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient documentation that caused improper payments for [...]
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Posting Date: 01/29/2021
Stereotactic Body Radiation Therapy
Stereotactic Body Radiation Therapy Insufficient documentation means that something was missing from the medical records. Below are the most common reasons CERT determined there was insufficient documentation that caused improper payments for [...]
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Posting Date: 01/29/2021
Diagnostic Testing Services
Diagnostic Testing Services Insufficient documentation means something was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient documentation that caused improper payments for [...]
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Posting Date: 11/19/2020
2020 Changes Driven by You – National Government Services Self-Service Tools
2020 Changes Driven by You – National Government Services Self-Service Tools We are committed to improving your experience while using our secure self-service tools which includes our NGSConnex portal, our NGSMedicare.com website and our IVR [...]
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Posting Date: 10/16/2023
Tips for Documenting Homebound Status
Tips for Documenting Homebound Status Comprehensive and accurate documentation is crucial to providing safe and effective care to Medicare beneficiaries. National Government Services' medical review team reviews this documentation while making [...]
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Posting Date: 03/22/2023
Hierarchy of Medicare Regulations
Hierarchy of Medicare Regulations Have you wondered how Medicare determines what is covered? Below you will find the hierarchy of how Medicare regulations are created. Social Security Act Title XVIII of the Social Security Act is [...]
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Posting Date: 10/19/2023
MLN Connects® Newsletter: October 19, 2023
MLN Connects® Newsletter: October 19, 2023 News 2024 Medicare Parts A & B Premiums and Deductibles Help CMS Improve Provider Resources — Respond by November 9 CMS Health Information Handler Helps You Submit [...]
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Posting Date: 10/26/2023
Part B Top Claim Errors Are Updated
Part B Top Claim Errors Are Updated Our top claim errors are updated on a quarterly basis to reflect current information. Visit Top Claim Errors to learn what you can do to avoid claim processing delays. We’ve listed the error reason code, a [...]
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Posting Date: 07/21/2023
Prior Authorization Outpatient Department Exemption Additional Documentation Requests
Prior Authorization Outpatient Department Exemption Additional Documentation Requests National Government Services Prior Authorization initiated the process of issuing ADRs to exempt providers. Please monitor your facility’s ADR location [...]
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Posting Date: 10/26/2023
Coming Soon ‒ The CY 2024 Medicare Physician Fee Schedule
Coming Soon - The CY 2024 Medicare Physician Fee Schedule The CY 2024 MPFS will soon be available on the Fee Schedule Lookup tool located on NGSMedicare.com, after the CY 2024 physician fee schedule regulation is put on display. Once the Fee [...]
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