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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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  • 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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  • 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: 06/14/2023
    Facet Joint Interventions for Pain Management Best Practices

    Facet Joint Interventions for Pain Management Best Practices Table of Contents Indications and/or Medical Necessity Coverage Documentation Requirements Diagnostic Facet Joint Injections (IA or MBB) Therapeutic Facet Joint Injection [...]

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  • Posting Date: 07/17/2025
    Prior Authorization Outpatient Department Claim Billing

    Prior Authorization Outpatient Department Claim Billing Providers may observe an increase in claim denials for PA services due to a mismatch of information provided on the PAR compared to the information supplied on the claim. Prior [...]

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  • Posting Date: 10/26/2022
    Prior Authorization OPD Alerts

    Prior Authorization OPD Alerts Month/Year Topic July 2025 Prior Authorization Outpatient Department Claim Billing July 2025 Prior Authorization Outpatient Department Exemption and ABN ADRs [...]

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  • Posting Date: 07/18/2025
    52MUE

    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. Providers should review the information on the CMS website [...]

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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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