Search Results - NGSMEDICARE

Posting Date: 04/09/2025

32402

Avoiding/Correcting This Error Verify HCPCS code using the FISS Inquiries HCPCS file (option 14). Allowable revenue codes will be displayed based on DOS. Use the claims correction option to report the appropriate HCPCS/CPT code and resubmit [...]

Posting Date: 04/09/2025

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 [...]

Posting Date: 04/09/2025

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 [...]

Posting Date: 04/09/2025

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 [...]

Posting Date: 04/09/2025

38119

SNF inpatient claims have to be processed in sequence. That means that when the beneficiary is going to be in the SNF as an inpatient for several months in a row, claims for the months the beneficiary is in the SNF must be submitted one at a [...]

Posting Date: 04/09/2025

37098

Avoiding/Correcting This Error Verify billing and, if appropriate, correct and return the claim. Related Content Billing for FQHC MAO Plan Supplemental Payment (PPS Providers) CMS Internet-Only Manual 100-04, Medicare Claims Processing [...]

Posting Date: 04/09/2025

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 [...]

Posting Date: 04/09/2025

38038

Avoiding/Correcting This Error Check OPPS claims for potential overlapping dates of service prior to claim submission and bill accordingly An adjustment bill must be submitted For bill type 34X, only vaccines and their administration, [...]

Posting Date: 04/09/2025

38119

Avoiding/Correcting This Error Verify the admission date and from date on this claim Verify the patient’s MBI to make sure that it has been correctly reported If the MBI is incorrect, this edit will be assigned If admission and from dates [...]

Posting Date: 04/09/2025

U5065

Avoiding/Correcting This Error Check/verify the beneficiary's entitlement dates in the CWF. A Medicare beneficiary, or their authorized representative, may have requested a new MBI. Verify eligibility and MBI number, correct and return the claim.

Posting Date: 04/09/2025

U5065

Avoiding/Correcting This Error Check/verify the beneficiary's entitlement dates in the CWF. A Medicare beneficiary, or their authorized representative, may have requested a new MBI. Verify eligibility and MBI number, correct and return the claim.

Posting Date: 04/09/2025

U5065

Avoiding/Correcting This Error HH+H may only bill services provided to the patient after the effective date of their Medicare coverage. Verify the effective date(s) for the MBI of the beneficiary prior to billing. If a new MBI has been issued [...]

Posting Date: 04/09/2025

U5065

Avoiding/Correcting This Error Check/verify the beneficiary's entitlement dates in the CWF. A Medicare beneficiary, or their authorized representative, may have requested a new MBI. Verify eligibility and MBI number, correct and return the claim.

Posting Date: 04/09/2025

U5065

Avoiding/Correcting This Error HHH may only bill services provided to the patient after the effective date of their Medicare coverage. Verify the effective date(s) for the MBI of the beneficiary prior to billing. If a new MBI has been issued [...]

Posting Date: 04/09/2025

W7088

Avoiding/Correcting This Error Each FQHC PPS claim must be billed with a qualifying visit code, and associated line-item charges, along with all other FQHC services furnished during the encounter. A qualifying visit code is the code that [...]

Posting Date: 04/09/2025

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 [...]

Posting Date: 04/09/2025

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 [...]

Posting Date: 04/09/2025

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 [...]

Posting Date: 04/09/2025

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, [...]

Posting Date: 04/09/2025

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 [...]

Posting Date: 04/09/2025

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 [...]

Posting Date: 04/09/2025

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 [...]

Posting Date: 04/09/2025

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 [...]

Posting Date: 04/09/2025

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. [...]

Posting Date: 04/09/2025

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. [...]

Posting Date: 04/09/2025

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 [...]

Posting Date: 04/09/2025

56900

Avoiding/Correcting This Error This reason code can and should be prevented. When providers receive an ADR, respond according to the date listed in the ADR. Providers should start gathering the documentation being requested immediately. This [...]

Posting Date: 04/09/2025

56900

Avoiding/Correcting This Error This reason code can and should be prevented. When providers receive an ADR, respond according to the date listed in the ADR. Providers should start gathering the documentation being requested immediately. This [...]

Posting Date: 04/09/2025

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.

Posting Date: 04/09/2025

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

Posting Date: 04/09/2025

31836

Avoiding/Correcting This Error Verify billing and, if appropriate, correct and resubmit the claim for payment. Related Content MLN® Booklet: How to Use the PFS Look-up Tool

Posting Date: 04/09/2025

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 [...]

Posting Date: 03/18/2025

Proper Part B Claim Submissions

This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments or denials. We will guide you through the CMS-1500 claim form and the electronic equivalent loops [...]

Posting Date: 03/12/2025

NGSConnex: Part B Redetermination Notifications

National Government Services will discontinue mailing paper Medicare Redetermination Notices (MRNs) when Part B redetermination requests are submitted through NGSConnex beginning in March 2025. During this webinar, we’ll share information and [...]

Posting Date: 03/18/2025

Part B Medicare Administrative Contractor Overview and Coverage for Dental Services

Medicare covers a limited number of dental services. The purpose of this webinar is to familiarize dental providers with National Government Services (NGS) and Medicare Part B dental coverage. Discussion will include an overview of the NGS [...]

Posting Date: 03/12/2025

NGSConnex: Part B Redetermination Notifications

National Government Services will discontinue mailing paper Medicare Redetermination Notices (MRNs) when Part B redetermination requests are submitted through NGSConnex beginning in March 2025. During this webinar, we’ll share information and [...]

Posting Date: 03/18/2025

Targeted Probe and Educate: Where to Find the Information Needed for a Successful Review

Do you know where to look on our website for current Part A Targeted Probe and Educate (TPE) topics? Are you receiving claim denials for TPE reviews and need more resources? Join us for a session where we will dive into our website to show you [...]

Posting Date: 03/05/2025

The Initial Preventive Physical Examination: Promoting Good Health Through Disease Prevention and Detection

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 your patients from getting certain diseases. Register today for an [...]

Posting Date: 03/20/2025

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 [...]

Posting Date: 03/18/2025

Part B Medicare Administrative Contractor Overview and Coverage for Dental Services

Medicare covers a limited number of dental services. The purpose of this webinar is to familiarize dental providers with National Government Services (NGS) and Medicare Part B dental coverage. Discussion will include an overview of the NGS [...]