Clinicians: Are You Ordering PAP Devices and Related Accessories for Your Patients?

Clinicians: Are You Ordering PAP Devices and Related Accessories for Your Patients? Medicare can make payment for PAP devices and related accessories when the patient’s medical record shows the patient has OSA and meets medical documentation, [...]

Practitioners: Are You Ordering Spinal Orthoses for Your Patient?

Practitioners: Are You Ordering Spinal Orthoses for Your Patients? The DME MACs are providing helpful guidance to assist the supplier in providing a spinal orthosis to your patient. Medicare must be able to verify there is supporting medical [...]

Clinicians: Are You Ordering Oxygen for Your Patient?

Clinicians: Are You Ordering Oxygen for Your Patient? Home use of oxygen and oxygen equipment is eligible for Medicare reimbursement only when a beneficiary meets all of the requirements set out in the CMS IOM, Publication 100-03, Medicare [...]

Clinicians: Are You Ordering Diabetic Shoes for Your Patients?

Clinicians: Are You Ordering Diabetic Shoes for Your Patients? The following section outlines roles of various practitioners that are involved in the decision-making and provision process for diabetic shoes: Certifying physician: The [...]

Physicians Ordering Oxygen and Oxygen Equipment - Quick Tips

Physicians Ordering Oxygen and Oxygen Equipment - Quick Tips The following is a quick reference guide for physicians and nonphysician practitioners concerning Medicare’s coverage of oxygen and oxygen equipment. For Medicare to consider [...]

Physicians: Are You Ordering DMEPOS for Your Patients?

Physicians: Are You Ordering DMEPOS for Your Patients? Physicians provide the foundation for correctly billing services and/or supplies to Medicare. DMEPOS suppliers rely on prescribing providers to substantiate the need for services and/or [...]

Physicians: Are You Ordering External Breast Prostheses for Your Patient?

Physicians: Are You Ordering External Breast Prostheses and Supplies for Your Patient? Following this guidance will help your patients and the Medicare Program by verifying there is medical documentation to support the provision of external [...]

Long-Term Care Hospital

Reminder: The Self-Service Pulse Has Ended

Reminder: The Self-Service Pulse Has Ended We sincerely thank you for being a loyal reader of our Self-Service Pulse each week. To continue receiving updates on our latest self-service tools and services, please subscribe to our general Email [...]

Health Equity Vaccination Efforts: Achieving the Highest Level of Health and Well-Being for Your Patients

Health Equity Vaccination Efforts: Achieving the Highest Level of Health and Well-Being for Your Patients Health equity is the concept that all people should have a fair and just chance to be as healthy as possible, regardless of their [...]

Who May File an Appeal?

Who May File an Appeal? Who May File an Appeal? Appointment of Representative Who May Be a Representative How to Make and Revoke an Appointment Attorney Representatives Required Elements When to Submit the Appointment Validity of an [...]

About Appeals

About Appeals Providers, suppliers and beneficiaries have the right to appeal claim determinations made by National Government Services. The purpose of the appeals process is to ensure the correct adjudication of claims. Appeals activities [...]

MSP Overpayments

MSP Overpayments If you are appealing or correcting a claim that you have received an overpayment on because Medicare paid as the primary insurer and another insurance carrier should be the primary payer, follow the instructions on the [...]

What Documents are Needed

What Documents are Needed? What Documents are Needed? Medical Records to Support an Appeal Anesthesia Biofeedback Blepharoplasty Cardiac Rehabilitation Services Chiropractic Services Concurrent Care Cosmetic [...]

Submit an Appeal Electronically with NGSConnex

Submit an Appeal Electronically with NGSConnex You can submit redetermination or reopening requests electronically through NGSConnex. To determine if your appeal qualifies as a reopening or redetermination, access the About Appeals page. All [...]

Submit an Appeal Electronically via esMD

Submit an Appeal Electronically via esMD CMS developed a mechanism for contractors to receive first level appeals electronically from providers via a secure gateway known as Electronic Submission of Medical Documentation, or esMD. Some [...]

Get Help Submitting a Appeal Hard Copy

Get Help Submitting a Appeal Hard Copy All levels of appeals may be submitted by mail. The only types of appeals submitted to National Government Services are reopening and redetermination requests. For information on other types of appeals, [...]

How to Avoid Costly Appeals

How to Avoid Costly Appeals This table includes helpful information to help avoid costly appeals. Use the initial submission tips and resources to help reduce claim denials and improve revenue cycle workflow issues within your office. [...]