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 [...]

Ambulance Billing Guidance

Ambulance Billing Guidance Table of Contents Ambulance Billing Ambulance Billing HCPCS Codes How to Bill Units with Transpiration HCPCS Codes Using Ambulance Modifiers When Billing Transportation Indicators Related Content [Return [...]

Level 1: Redetermination Request Form

Ensure Accurate Provider Enrollment Information on File

Ensure Accurate Provider Enrollment Information on File ATTENTION: Claims and Provider Enrollment Verify that accurate provider enrollment information is on file with Medicare. Are you familiar with the details identified in the PECOS system [...]

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction K HHH Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Home Health Medical Necessity N/A 55H3V– The documentation did not support the medical [...]

Understanding the Approval Recommendation Process for Certified Providers

Understanding the Approval Recommendation Process for Certified Providers The certified provider completes and submits a CMS-855 enrollment application and all supporting documentation to its MAC, including any state require documentation [...]

Ambulance Services and the Advance Beneficiary Notice of Noncoverage

Ambulance Services and the Advance Beneficiary Notice of Noncoverage To follow are Medicare’s guidelines regarding the use of an ABN for ambulance services. Per the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) [...]

MLN Connects® Newsletter: March 27, 2025

MLN Connects® Newsletter: March 27, 2025 News Extension of Medicare Provisions Final National Coverage Determination: Transcatheter Tricuspid Valve Replacement Nutrition-Related Health Conditions: Recommend Medicare Preventive Services [...]

Fundamentals of Medicare

LCD Open Meeting Records

Open Meeting Records Jurisdiction 6 and Jurisdiction K Open Meeting Records Meeting Date Audio Transcript 3/13/2025 – J6/JK Open Meeting Recording Transcript  10/24/2024 – J6/JK Open Meeting [...]

Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities

Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities The hospital is the entity required to bill POA indicators on all inpatient claims billed to Medicare. However, accurate coding of all diagnosis [...]

NCCI Lookup Tool Top

National Correct Coding Initiative Lookup Tool The NCCI PTP lookup tool is designed to help providers identify when certain codes are subject to the automated code pair edits. When two codes of an edit pair are identified, the major code [...]

Provider Outreach and Education Reminders

MODIFIERS: When should the QW modifier be appended?

MODIFIERS: When should modifier 51 be added to a claim?

MODIFIERS: When is modifier 50 used?

MODIFIERS: When is it appropriate to append the AQ modifier?

MODIFIERS: When do I need to append the 99 modifier?

Where is the written Part B Reopening Form located?

What is timely filing to adjust a claim?

Where are the appeal forms?

What is timely filing for a claim?

Additional Events Links

Resources Education Partnership Request Form Five Steps to Webinar Success Provider Outreach and Education Reminders

Additional Events Links

Resources Education Partnership Request Form Five Steps to Webinar Success Provider Outreach and Education Reminders

What is the receipt date of the claim?

What is the refund address?

What is the denial date?

What is the mailing address for submitting a claim?

What is the timely filing for an appeal?

What is the address to send the QIC appeal?

What is the QIC timely filing limit?

What is the ICN?

What is my pay-to address?

What is my Payer ID?

Does Medicare cover a sign language interpreter?

Telehealth Services

Telehealth Services Table of Contents General Information Originating Site Distant Site List of Covered Medicare Telehealth Services Billing Facility Fee for Originating Site Payment for Professional Fee Place of [...]

Telehealth Extension 2025

Telehealth Extension 2025 A Congressional continuing resolution bill has extended telehealth coverage for services in all U.S. geographic locations through 9/30/2025. Based on this guidance, National Government Services will continue to pay [...]