What Should Be Provided if Medical Records Are Requested for Review?

What Should Be Provided if Medical Records Are Requested for Review? The following should be considered if applicable to the service being reviewed. This is not intended to be an all-inclusive list. Progress/visit notes Physician orders [...]

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. [...]

Claims for Drugs Without a Product-Specific Code Assigned

Claims for Drugs Without a Product-Specific Code Assigned National Government Services has noticed that when a claim RTPs for additional information to be added to the Remarks field concerning certain drugs, some providers attempt to provide [...]

Denials for HCPCS G2211

NCCI editing for HCPCS G2211 code was updated on 12/05/2024 to require HCPCS G0463 as the primary code for G2211 add-on code. This has resulted in denials of claims for the add-code G2211 when billed with CPTs 99202-99205 and 99211-99215. [...]

Home Health and Hospice New Provider Orientation

This webinar is designed for new home health and hospice agencies in an effort to provide essential information on: Doing business with National Government Services as your Medicare Administrative Contractor, Self-service tools to help make [...]

Provider Enrollment: Eliminate Development Request for Additional Information

Provider Enrollment: Eliminate Development Request for Additional Information To eliminate requests for additional information and documentation on provider enrollment applications, ensure all necessary actions are complete before submission. [...]

PECOS: View and Manage Reassignments through Group Enrollment

During this webinar, we’ll provide an understanding of how to view and manage reassignments through the group enrollment in Provider Enrollment, Chain and Ownership System (PECOS), including to add or terminate reassignments. Individual [...]

Provider Enrollment Revalidation Overview

During this webinar, learn about important changes in the revalidation process, how to determine Medicare enrollment revalidation due date and information to avoid disruption in Medicare billing.

Getting Access to PECOS

During this webinar, we’ll discuss how to obtain access to the Internet-based Provider Enrollment Chain & Ownership System (PECOS) and gain connection to provider enrollment record as well as understand other Centers for Medicare & [...]

Complying with Medicare Signature Requirements

Complying with Medicare Signature Requirements Medicare Compliance: Verify signature requirements have been met before you submit your medical records to prevent CERT errors. Review the CERT Alert article Signature [...]

NGSConnex: Part B Redetermination Electronic Notification of Decision Letters

National Government Services will discontinue issuing paper Medicare Part B redetermination requests that are submitted electronically through our portal, NGSConnex. Instead, they will only be accessible to view and print electronically through [...]

Provider Enrollment: Eliminate Development Request for Additional Information

Provider Enrollment: Eliminate Development Request for Additional Information To eliminate requests for additional information and documentation on provider enrollment applications, ensure all necessary actions are complete before submission. [...]

Counseling to Prevent Tobacco Use

In an effort to raise awareness and increase utilization of tobacco use counseling, we’ll focus on the effects of nicotine dependence including affected health consequences during this webinar. Medicare coverage, coding, billing and [...]

Counseling to Prevent Tobacco Use

In an effort to raise awareness and increase utilization of tobacco use counseling, we’ll focus on the effects of nicotine dependence including affected health consequences during this webinar. Medicare coverage, coding, billing and [...]

Provider Enrollment: Completing the CMS-855B Paper Application

During this webinar, we'll provide an understanding of how to complete the CMS-855B provider enrollment paper application for a clinic, group or supplier.

Provider Transaction Access Number Request Form

Observance of Memorial Day 2025

Observance of Memorial Day 2025 In observance of Memorial Day 2025, our offices will be closed Friday, 5/23/2025 and Monday, 5/26/2025. Note: EDI claim files transmitted after 4:00 p.m. CT/5:00 p.m. ET on 5/22/2025 will have a claim receipt [...]

MLN Connects® Newsletter: May 13, 2025

MLN Connects® Newsletter: May 13, 2025 News CMS Seeks Public Input on Improving Technology to Empower Medicare Beneficiaries Posted 5/13/2025

MLN Connects® Newsletter: May 15, 2025

MLN Connects® Newsletter: May 15, 2025 News CMS Releases Draft Guidance for the Third Cycle of Medicare Drug Price Negotiation Program to Lower Drug Prices for American Patients Opioid Treatment Programs: CY 2025 Updates Laboratories: [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

Private Practice Physical/Occupational Therapy Billing

We invite you to join our informative webinar focused on billing guidelines for physical and occupational therapy in private practice. During this webinar, we'll review important topics such as the appropriate use of the KX modifier and the [...]

How to Avoid Duplicate Claims

Duplicate denials continue to be one of the top billing errors. Unnecessary duplicate filing of Medicare claims cost the provider's office valuable time and resources, as well as Medicare's time and money to process them. Please join us [...]

Provider Enrollment: Completing the CMS-855A Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855A provider enrollment paper application.

Medicare Compliance With the Incident To Provision

Do you have nonphysician practitioners that are, or could be, providing services incident to the physicians in the practice? Are you following the Centers for Medicare & Medicaid Services (CMS) regulations for this program? Staying [...]

Billing Telehealth Services for Part B Providers

During this webinar, we’ll provide you with insight into covered Medicare telehealth services and coverage requirements. We’ll discuss originating sites, distant sites and billing and payment guidelines.

Provider Enrollment: Completing the CMS-855I Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855I provider enrollment paper application for a group member, sole proprietor or sole owner and we’ll also focus on reassigning Medicare benefits.

Critical Access Hospitals: Preparing and Submitting Compliant Inpatient Claims to Medicare

In this webinar, critical access hospitals (CAHs) will learn how to properly prepare inpatient claims for submission to Medicare. We will review Medicare inpatient hospital benefit days, the Medicare benefit period, the applicable fields of [...]

CO-109

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

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 [...]

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 [...]

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 [...]

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. [...]

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 [...]

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 [...]

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 [...]