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  • Posting Date: 07/18/2025
    C7010

    Avoiding/Correcting This Error If services are unrelated to hospice stay, resubmit with condition code 07 (treatment of nonterminal illness for hospice patient). Verify hospice enrollment prior to claim submission by reviewing the CWF, HETS [...]

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  • Posting Date: 07/18/2025
    U5200

    Avoiding/Correcting This Error Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS/DDE Provider Online System, HETS or NGSConnex to verify [...]

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  • Posting Date: 07/18/2025
    U5233

    Avoiding/Correcting This Error Verify the admission date, from, and through dates on the claim and compare the dates to the MAO/HMO entitlement dates. Outpatient facilities and IPPS and IRF hospitals, or LTCH billing services within an [...]

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  • Posting Date: 07/18/2025
    W7113

    Avoiding/Correcting This Error Prevent future similar errors by checking the I/OCE and ICD-10-CM official guidelines prior to claim submission. Verify the diagnosis codes reported; if appropriate, correct and resubmit. Related Content CMS [...]

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  • Posting Date: 07/18/2025
    53NCD

    Avoiding/Correcting This Error Ensure all claim coding is accurate prior to submitting the claim. Verify billing and, if appropriate, submit an adjustment to correct the diagnosis code according to instructions in the NGS article Submit an [...]

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  • Posting Date: 07/18/2025
    34072

    Avoiding/Correcting This Error Resolve all conflicting claim information: If the claim has an OC 18 and date, verify the beneficiary’s retirement date. If the date is correct, add remarks to indicate the OC 18 date was verified and is [...]

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  • Posting Date: 07/18/2025
    Top Claim Errors Updated

    Top Claim Errors Updated National Government Services updates the Top Claim Errors on our website each quarter to ensure our Part A providers have the latest information on top claim errors including denials, return to provider, and rejection [...]

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  • Posting Date: 07/18/2025
    52NCD

    Avoiding/Correcting This Error Ensure all Medicare coverage and medical necessity requirements are met prior to billing. If the provider determines that Medicare will not cover the services, consider submitting the charges as noncovered. [...]

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  • Posting Date: 07/18/2025
    52NCD

    Avoiding/Correcting This Error Ensure all Medicare coverage and medical necessity requirements are met prior to billing. If the provider determines that Medicare will not cover the services, consider submitting the charges as noncovered. [...]

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  • Posting Date: 07/18/2025
    55B31

    Avoiding/Correcting This Error Review coverage guidelines and patient records to determine if all appropriate documentation was sent for review that may have supported medical necessity. When you receive an ADR from National Government [...]

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