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Posting Date: 05/03/2022
National Government Services: Raising Awareness about Care Management
National Government Services: Raising Awareness about Care Management According to the CDC, six in ten adults in the U.S. have a chronic disease and four in ten adults have two or more. As your Medicare Contractor for Jurisdiction 6 and [...]
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Posting Date: 10/27/2022
Primary Care Exception Guidelines
Primary Care Exception Guidelines Services performed by attending physicians at teaching hospitals, in collaboration with house staff in an approved GME program, generally require evidence of direct care by the attending physician in order to [...]
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Posting Date: 10/19/2022
Answers to Common Fee-for-Time Compensation Arrangements Questions
Answers to Common Fee-for-Time Compensation Arrangements Questions Does a fee-for-time compensation arrangement physician need to enroll with Medicare prior to acting as a physician? Answer: Currently, a fee-for-time compensation [...]
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Posting Date: 10/19/2022
Nonphysician Practitioners Billing for Surgical Procedures
Nonphysician Practitioners Billing for Surgical Procedures Several providers have asked about the Medicare guidance for NPPs include billing for surgical procedures. For the purpose of this education, NPPs include NPs, PA, and CNSs. State law [...]
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Posting Date: 10/12/2022
Surgical Pathology Billing Tips
Surgical Pathology Billing Tips CPT Codes: 88300-88399 Surgical pathology is the study of tissues removed from living patients during surgery to help diagnose a disease and determine a treatment plan. Surgical pathology involves gross and [...]
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Posting Date: 10/13/2022
Pathology Interpretation Services
Pathology Interpretation Services National Government Services has noted that there is some confusion and questions regarding the billing of professional components on some laboratory services. There is a certain subset of CPT codes for which [...]
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Posting Date: 05/23/2019
Performance Standards
Performance Standards If providers are credentialing as an IDTF, then the performance standards shall be reviewed thoroughly before submitting a Medicare application. Refer to the IDTF Performance Standards and Attachment 2 beginning on page [...]
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Posting Date: 10/24/2024
Notification of the 2025 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review
Notification of the 2025 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review The amount that must remain in controversy for ALJ hearing requests filed on or [...]
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Posting Date: 11/01/2024
Instructions for Unfinished PECOS Enrollment Application(s)
Table of Contents Instructions for Unfinished PECOS Enrollment Application(s) Instructions for Unfinished PECOS Application(s) Instructions for Application Status “Pending E-Signature” Submitted Enrollment Application(s) on Behalf of an [...]
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Posting Date: 11/07/2024
November is Lung Cancer Awareness Month
November is Lung Cancer Awareness Month Lung cancer is the leading cause of cancer death in the United States and worldwide. Although education, research and treatment options for lung cancer have dramatically improved in recent years, lung [...]
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Posting Date: 01/29/2021
Psychiatry and Psychology Services
Psychiatry and Psychology Services CERT has determined that insufficient documentation caused improper payments for psychiatry and psychotherapy; insufficient documentation means that information was missing from the medical [...]
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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: 02/12/2016
Physician Orders to Admit to Inpatient Hospital or for Observation Services
Physician Orders to Admit to Inpatient Hospital or for Observation Services Lack of a formal order for inpatient admission or observation services results in an increase of the CERT error rate for National Government Services. CERT auditors [...]
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Posting Date: 01/29/2021
Pacemakers and Cardiac Defibrillators
Pacemakers and Cardiac Defibrillators National Government Services would like to alert providers that although coverage indications of pacemakers and implantable cardiac defibrillators was revised and expanded effective with dates of service [...]
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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: 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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