Search Results - NGSMEDICARE

Posting Date: 05/09/2025

Federally Qualified Health Center Basic Billing and Reimbursement

Are you a federally qualified health center (FQHC) provider eager to deepen your understanding of billing and reimbursement under FQHC prospective payment system (PPS)? Whether you're new to the role or just need a refresher, this webinar [...]

Posting Date: 05/09/2025

CO-22

Avoiding/Correcting This Error During patient registration it’s important for office staff to identify whether a beneficiary’s claims should be covered by other insurance before, or in addition to, Medicare. Providers shall use our [...]

Posting Date: 05/09/2025

CO-109

Avoiding/Correcting This Error Palmetto GBA is the Medicare Administrative Contractor for processing claims of railroad retirees, regardless of their location. Providers and suppliers must verify patients' Medicare entitlement before [...]

Posting Date: 05/09/2025

CO-16

Avoiding/Correcting This Error This denial message is specific to chiropractic claims with CPT/HCPCS codes that are not billable by Medicare enrolled chiropractors. Medicare Part B coverage for chiropractic care is limited to spinal [...]

Posting Date: 05/09/2025

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 [...]

Posting Date: 05/09/2025

CO-16

Avoiding/Correcting This Error This rejection is the result of submitting a CPT/HCPCS code without a required modifier. You are required to research the proper modifier to report with the CPT/HCPCS code then submit a new claim. Please use [...]

Posting Date: 05/09/2025

OA-18

Avoiding/Correcting This Error A duplicate claim submission occurs when a provider resubmits a claim either on paper or electronically for a single encounter and the service is provided by the same provider to the: same beneficiary; for the [...]

Posting Date: 05/09/2025

CO-16

Avoiding/Correcting This Error The billing provider's information on the claim is missing or invalid. To avoid this error, ensure the following details are accurate and included: the billing provider's NPI, name, address, ZIP code and phone [...]

Posting Date: 05/09/2025

CO-109

Avoiding/Correcting This Error This denial is received when your Medicare patient is enrolled in an MA plan, instead of “traditional fee-for-service” Medicare. MA plans are health plans offered by private companies approved by Medicare [...]

Posting Date: 05/09/2025

CO-16

Avoiding/Correcting This Error Certain services require the name and NPI of the ordering or referring physician, depending on the service type. Definitions: Referring Physician: Requests an item or service for a Medicare beneficiary. [...]

Posting Date: 05/09/2025

Podiatry Services - Routine Foot Care and Debridement of Nails

While the Medicare Program generally excludes routine foot care services from coverage, there are specific indications or exceptions under which there are program benefits. Medicare payment may be made for routine foot care when the patient has [...]

Posting Date: 05/09/2025

Home Health Billing Coffee Break

Provider Outreach and Education is hosting a 30-minute coffee break to help answer your troublesome billing questions. This is a great opportunity to discuss areas of billing more in depth and review helpful guides and resources. Keep in mind [...]

Posting Date: 05/09/2025

Critical Care and Medicare Billing Compliance

While critical care codes did not change with the 2021 or 2023 AMA CPT updates, there are a lot of guidelines for billing these services. During this webinar, we'll discuss critical care coding, what is and is not critical care, how to [...]

Posting Date: 05/08/2025

Telehealth & Remote Patient Monitoring Updates

Telehealth & Remote Patient Monitoring Updates The CMS MLN Booklet® Telehealth & Remote Patient Monitoring has been updated with important information effective 10/1/2025. Posted 5/8/2025

Posting Date: 08/15/2022

Eligible Method II Providers

Eligible Method II Providers If a CAH wants to become a Method II biller, email the request to A&R at ngsreimbursement@anthem.com. Suppliers who can enroll as a Method II Biller Reassignment. Doctor of Medicine (MD) Doctor of [...]

Posting Date: 05/15/2025

The Medicare Appeals Process: What You Need to Know

This informative session will help you navigate Medicare’s appeals process by providing information on what an appeal is, how to determine if a claim can be appealed, who may file an appeal, the appeal levels, timeframes and documentation [...]

Posting Date: 11/03/2022

Paperwork Segment – PWK

Paperwork Segment – PWK PWK is a segment in the 837 electronic claim transaction. It links an electronic claim with the supporting documentation submitted by the provider. PWK indicators on the electronic claim notify NGS that documentation [...]

Posting Date: 05/15/2025

Paperwork Segment – PWK

Paperwork Segment – PWK The paperwork segment of an electronic claim submission is commonly known as PWK. PWK can be used when an electronically submitted claim requires additional documentation for purposes of claim processing. View our [...]

Posting Date: 04/25/2024

Local Coverage Determination Open Meeting Announcement

Local Coverage Determination Open Meeting Announcement Table of Contents Jurisdiction 6/Jurisdiction K Part A/Part B MAC Requests to Present Registered Presenters (Slide Presentations Only) Observers Comments on Proposed LCDs [...]

Posting Date: 01/01/1970

Biomarker Testing for Neuroendocrine Tumors/Neoplasms

Biomarker Testing for Neuroendocrine Tumors/Neoplasms N/A L37851 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=37851 A57059 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57059 A56247 [...]