LCD Open Meeting Records

Open Meeting Records Jurisdiction 6 and Jurisdiction K Open Meeting Records Meeting Date Audio Transcript 6/25/2025 – J6/JK Open Meeting Recording Transcript  3/13/2025 – J6/JK Open Meeting [...]

Medicare Preventive Services Resource Guide

Medicare Preventive Services Resource Guide Medicare covers many preventive services to keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep Medicare beneficiaries [...]

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 [...]

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 [...]

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 [...]

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 [...]

U5233

Avoiding/Correcting This Error Verify the admission date, from, and through dates on the claim and compare the dates to the HMO entitlement dates. Outpatient facilities and inpatient noninpatient PPS and IRF hospitals, or LTCH billing [...]

Prior Authorization Request for Outpatient Services: Facet Joint Interventions

38200

Avoiding/Correcting This Error Always verify the status of a submitted claim before submitting another claim. Verify claim status using the IVR system, FISS/DDE or the NGSConnex online portal. Per CMS mandate, PCC representatives are not [...]

Prior Authorization Request for Outpatient Services: Botulinum Toxin

Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate

Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate Table of Contents Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate Background: Standard Payment vs. [...]

32415

Avoiding/Correcting This Error Append the “A6” condition code to the claim and F9 or resubmit.  Related Content CMS Internet-Only Manual Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section [...]

34963

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 New Fiscal Intermediary Shared System Consistency Edit to Validate [...]

34963

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 New Fiscal Intermediary Shared System Consistency Edit to Validate [...]

34977

Avoiding/Correcting This Error If you are billing for on-campus services only: Report the billing provider address only in the billing provider loop 2010AA Do not report any service facility location in loop 2310E (or in DDE MAP 171F [...]

34977

Avoiding/Correcting This Error If you are billing for on-campus services only: Report the billing provider address only in the billing provider loop 2010AA Do not report any service facility location in loop 2310E (or in DDE MAP 171F [...]

34985

Avoiding/Correcting This Error The PO modifier is used on all claim lines for all services, procedures and/or surgeries provided at an excepted off-campus provider-based outpatient department (PBD). The PO modifier applies to a [...]

34985

Avoiding/Correcting This Error The PO modifier is used on all claim lines for all services, procedures and/or surgeries provided at an excepted off-campus provider-based outpatient department (PBD). The PO modifier applies to a [...]

34986

Avoiding/Correcting This Error The PN modifier is used on all claim lines for all services, procedures and/or surgeries provided at an excepted off-campus outpatient, PBD of a hospital. The PN modifier applies to a grandfather/excepted PBD for [...]

34986

Avoiding/Correcting This Error The PN modifier is used on all claim lines for all services, procedures and/or surgeries provided at an excepted off-campus outpatient, PBD of a hospital. The PN modifier applies to a grandfather/excepted PBD for [...]