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  • Posting Date: 07/18/2025
    54NCD

    Avoiding/Correcting This Error Review coverage guidelines for the service being denied to ensure medical necessity of the services being provided to the beneficiary. Ensure all Medicare coverage and medical necessity requirements are met [...]

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  • Posting Date: 07/18/2025
    55S05

    Avoiding/Correcting this Error The SNF should ensure that SNF services that are not covered are identified. After discussion with the beneficiary and/or representative you should properly issue an ABN and bill for the noncovered services [...]

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  • Posting Date: 07/18/2025
    55S29

    Avoiding/Correcting This Error Respond promptly to a MAC, CERT, RAC, SMRC, or UPIC request for additional documentation.  Documentation is necessary to verify compliance with a benefit category requirement. Ensure that all records, [...]

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  • Posting Date: 07/18/2025
    59118

    Avoiding/Correcting This Error Review reason code 59118 in the Direct Data Entry system for applicable codes. Alternatively, review the latest Change Requests/MLN® Matters articles for relevant ICD-10 updates. The most current MLN Matters [...]

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  • Posting Date: 07/18/2025
    59118

    Avoiding/Correcting This Error Review reason code 59118 in the Direct Data Entry system for applicable codes. Alternatively, review the latest Change Requests/MLN® Matters articles for relevant ICD-10 updates. The most current MLN Matters [...]

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  • Posting Date: 07/18/2025
    59301

    Avoiding/Correcting This Error You have the right to submit an appeal when you believe the medical records support that the denied services were reasonable and medically necessary. To prevent similar denials, ensure that all coverage [...]

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  • Posting Date: 07/18/2025
    5ND07

    Avoiding/Correcting This Error To prevent this error, ensure all Medicare coverage and medical necessity requirements are met prior to billing. Providers can visit the CMS Coverage Database to review the NCDs and LCDs to determine the [...]

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  • Posting Date: 07/18/2025
    31836

    Avoiding/Correcting This Error Verify billing and, if appropriate, correct and resubmit the claim for payment. Related Content CMS PFS Look-up Tool Overview

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  • Posting Date: 07/18/2025
    32243

    Avoiding/Correcting This Error Review the claim and either update the charges or remove the line containing zero or blank charges. Return the claim for processing. 

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  • Posting Date: 07/18/2025
    34538

    Avoiding/Correcting This Error To avoid this error: When submitting your Medicare primary claim, report the reason Medicare is primary using claim coding in Prevent an MSP Rejection on a Medicare Primary Claim. To correct this [...]

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