Part A Summit Let’s Chat: Prior Authorization for Certain Hospital Outpatient Department Services

This Let’s Chat session focuses on Prior Authorization for certain hospital outpatient department (OPD) services and is an informal opportunity for you to chat with our staff about the selected topic. During the session, you may ask us [...]

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 [...]

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 [...]

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 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 [...]

Skilled Nursing Facility Consolidated Billing

Did you know that skilled nursing facilities (SNFs) are responsible for paying outside entities for most services provided to beneficiaries while they are in a covered Part A stay and for certain services for Part B beneficiaries? Streamline [...]

Outpatient Psychotherapy Services: A Focus on Coverage and Documentation Requirements

Outpatient psychotherapy services are being reviewed as part of our Part A Medical Review Targeted Probe and Educate program. This session will provide a high-level overview of outpatient psychotherapy services with a focus on coverage and [...]

PR-31

Avoiding/Correcting This Error Services were denied for one or more of the following reasons: The name or Medicare number was incorrect or missing. The date of death precedes the date of service. Expenses were incurred prior to coverage. [...]

PR-31

Avoiding/Correcting This Error Services were denied for one or more of the following reasons: The name or Medicare number was incorrect or missing. The date of death precedes the date of service. Expenses were incurred prior to coverage. [...]

NGSConnex- Account Management

Do you need assistance with login issues and account suspensions? Do you know who your Local Security Officer is and what they are responsible for? We will also review how to edit the user profile and updating access within the portal. After [...]

Provider Enrollment: Opioid Treatment Program

During this webinar, we’ll provide a brief overview of an Opioid Treatment Program (OTP) provider, an understanding of submitting the CMS-855A or CMS-855B paper application and how to complete the provider enrollment Internet-based Provider [...]

Telehealth for Hospice Face-to-Face Recertification Extended Through September 30, 2025

Telehealth for Hospice Face-to-Face Recertification Extended Through September 30, 2025 Hospice physicians and nurse practitioners may continue to conduct the face-to-face encounter required for recertification using telehealth (audio/video [...]

MLN Connects® Newsletter: May 8, 2025

MLN Connects® Newsletter: May 8, 2025 News Direct Graduate Medical Education: Get Annual Update Factors Compliance Walkers: Prevent Claim Denials Events HCPCS Public Meeting — June 2–3 Medicare Advisory Panel on Clinical [...]

CMS FQHC Booklet

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 [...]

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 [...]

Rural Health Clinic Billing Basics

This webinar will provide a detailed overview of the Medicare billing requirements for rural health clinics (RHC), including the definition of a qualifying visit, locations where billable RHC services can occur, claim coding guidelines and [...]

A/B and DME Collaborative YouTube Video

A/B and DME Collaborative YouTube Video The A/B DME MACs are offering a YouTube video on Urological Supplies. This DME video tutorial provides information about urological supply requirements. Posted 5/7/2025  

Provider Contact Center – Make the Most of Your Call

Provider Contact Center – Make the Most of Your Call As of 5/1/2025, the Provider Contact Center (PCC) will service one PTAN/NPI combination per call. Before calling the PCC, make the most of your call by ensuring you have all authentication [...]

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 [...]

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 [...]

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-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 [...]

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. [...]

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 [...]

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 [...]

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 [...]

Ambulance Services and Establishing Medical Necessity for Part B Providers

This webinar will help the ambulance community understand the importance of medical necessity as it pertains to Medicare’s coverage guidelines.

Understanding Medicare Fraud and Abuse

Learn about fraud and abuse affecting providers and your Medicare patients to increase your awareness of integrity issues and prevent potential fraudulent and abusive practices against the Medicare Program.

Reducing Unprocessable Claims

When claims are submitted with invalid, incomplete or incorrect information, our claims processing system will detect these errors and will reject claims as unprocessable. Our goal is to assist our providers in submitting claims correctly the [...]

Practitioners - Are You Ordering Surgical Dressings for Your Patients?

Practitioners - Are You Ordering Surgical Dressings for Your Patients? In order for a DME supplier to provide surgical dressings to your patients, there are actions you can take to make sure that all the required supporting medical record [...]

Clinicians: Are You Ordering Urological Supplies for Your Patients?

Clinicians: Are You Ordering Urological Supplies for Your Patients? Urological supplies are covered as part of the prosthetic device benefit as outlined in the Social Security Act, Section 1861(s)(8). Prosthetic devices (other than dental) [...]