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  • Posting Date: 07/16/2025
    W7050

    Avoiding/Correcting This Error Verify billing and, if appropriate correct and return the claim. Online providers should press PF9 to restore the claim. Related Content Centers for Medicare & Medicaid Services Internet-Only Manual [...]

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  • Posting Date: 07/16/2025
    Top JK Part B Claim Errors are Available

    Top JK Part B Claim Errors are Available We conduct a comprehensive data analysis on a quarterly basis to update and disseminate the latest insights on the most common claim errors. This initiative provides:  Claim Error Reason Code [...]

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  • Posting Date: 07/16/2025
    Top J6 Part B Claim Errors are Available

    Top J6 Part B Claim Errors are Available We conduct a comprehensive data analysis on a quarterly basis to update and disseminate the latest insights on the most common claim errors. This initiative provides: Claim Error Reason Code [...]

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  • Posting Date: 07/16/2025
    CO-16

    Avoiding/Correcting This Error The MBI is necessary for all claims submitted to MAC. Claims without a correct MBI are rejected, requiring providers to verify and resubmit them. To avoid this, use the Eligibility Lookup in NGSConnex before [...]

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  • Posting Date: 07/16/2025
    Hospital, CMHC, CORF/ORF and ESRD Facilities Quarterly Top Claim Errors

    Do you struggle with your claim denials, rejections and return to provider (RTP) claims? Do you want to be proactive in preventing unnecessary errors? Join us in a review of top claim errors for your provider type based on recent data analysis [...]

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  • Posting Date: 02/21/2020
    IPPE and AWV Services

    IPPE and AWV Providers are reminded that the IPPE and AWV are Medicare-covered services within their own benefit category. As such, they are not subject to standard “incident to” billing guidelines and must be billed by the performing [...]

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  • Posting Date: 04/29/2021
    Medical Decision Making

    Medical Decision Making In a split/shared service, when a medical record includes a plan of care developed by the physician, based on a history and/or examination performed by the NPP and a personal review of diagnostic findings, [...]

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  • Posting Date: 01/27/2022
    New vs. Established Patients

    New vs. Established Patients How does CMS define a patient as “new” versus “established”? Answer: In 2023, the definition of a “new” patient differs based on whether the patient is being treated in an office or an observation/ inpatient [...]

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  • Posting Date: 10/26/2022
    Nonphysician Practitioner Services

    Nonphysician Practitioner Services In addition to the frequently asked questions below, please view NGS’ Nonphysician Practitioners-Reducing Costly Appeals; Increase Provider Revenue article for related information. Is it permissible for [...]

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  • Posting Date: 01/27/2022
    Observation Services

    Observation Services Please define guidelines for providers billing observation services. Answer: Observation services are ordered, performed and billed by the practitioner (or group), who is responsible for the patient’s care during the [...]

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