APPEALS: Is there a reference sheet to determine what constitutes an appeal?

APPEALS: What is a Medicare appeal?

APPEALS: What is the solution to avoiding claim denials?

APPEALS: What is the appeal process?

APPEALS: What is the best way to get duplicate denials paid on appeal?

MLN Connects® Newsletter: March 25, 2025

MLN Connects® Newsletter: March 25, 2025 News ESRD: Payment for Phosphate Binders Effective January 1, 2025 Hospitals: Apply for Additional Residency Positions by March 31 Skilled Nursing Facilities: Revalidation Deadline is May 1 [...]

APPEALS: Is documentation required for an appeal?

APPEALS: Another denial we see is “This service has been provided at a frequency that is more than the medically appropriate indication by policy or regulation.” How can we avoid these denials?

APPEALS: We are a large group with many physicians and nonphysician practitioners. When we submit claims for nonphysician practitioners working in different sub-specialties, we get claim denials that state: “D463: New patient qualifications were not met or M13: Only one initial visit is covered per specialty per medical group.” How can we avoid these?

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction K Part A Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Debridement, subcutaneous tissue (includes epidermis and dermis, if performed) 11042, 11045 [...]

Hospital-Based Ambulance Basic Billing Guidelines

Hospital-Based Ambulance Basic Billing Guidelines For hospital-based ambulance billing under Medicare, services should be billed on the UB-04 form using the ambulance service-specific NPI, not the acute hospital NPI, and claims for inpatient [...]

About Appeals

About Appeals Table of Contents About Appeals Reopening vs. Redetermination Reopening Redetermination [Return to Top] About Appeals Providers and beneficiaries have the right to appeal claim determinations made by National [...]

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 [...]

About Us

National Government Services, Inc., a subsidiary of Elevance Health, Inc., has a long history of supporting federal health agencies, including CMS. Throughout the country, NGS has served as a Medicare contractor since the inception of the [...]

REMITTANCE: What do the two-letter codes on my remittance advice mean?

REMITTANCE: Can I post the electronic remittance advice information into my accounts receivable system?

REMITTANCE: Do I need special computer software to use the electronic remittance advice?

REMITTANCE: How long will I receive paper remittances once I sign up for the electronic remittance advice?

REMITTANCE: If I have a computer problem while trying to download my electronic remittance advice, can I have it reposted to download again?

PC-ACE: Where can I find out more about the PC-ACE free billing software?

PC-ACE: Why did my PC-ACE software expire?

PC-ACE: Why am I receiving security rights error/issue when installing PC-ACE?

PC-ACE: How often is the PC-ACE software upgraded?

PC-ACE: How do I determine the version of PC-ACE I am using?

LCD NCD: What are the differences between LCDs and NCDs?

PC-ACE: Where can I find out more about the PC-ACE free billing software?

PC-ACE: How do I correct a web browser error when downloading or making changes to the software?

PC-ACE: Is there a resource I can use to assist me with Medicare Secondary Payer (MSP) claims when using PC-ACE?

CAR-T: Will the Part A claim for CAR-T deny if it is submitted with the KX modifier?

CAR-T: Is the KX modifier required for Part A and Part B claims?

CAR-T: Is Risk Evaluation and Mitigation Strategy (REMS) verified by the facility’s site name or address?

CAR-T: What is the effective date for the requirement of the KX modifier for administration of CAR-T?

EDI: I heard that 5010 requires a physical address in box 33 and P.O. boxes are no longer accepted. Is this true?

EDI: How long are Electronic Remittance Advices (ERAs) available in my mailbox?

EDI: Is the 277CA returned for each test submission?

EDI: I am receiving the following CSC and EIC code on my 277CA. How do I make the correction?

EDI: How do I restore a remit file?

EDI: I am missing an Electronic Remittance Advice (ERA). How do I order a duplicate?

EDI: After I receive a 277CA will I receive anything else?

EDI: How can I tell if I am set up for electronic billing?