Understanding the Reopening and Appeal Process Open Forum

National Government Services is committed to reducing provider burden associated with Medicare claim denials, reopenings and appeals. Filing an inquiry on a Medicare claim can be frustrating and costly to your organization. This delay in [...]

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 [...]

Steps to Claim Corrections

This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

Steps to Claim Corrections

This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

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 [...]

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 [...]

55H2B

Avoiding/Correcting This Error Ensure the submitted documentation supports the beneficiary is confined to the home. An individual shall be considered “confined to the home” (homebound) if the following two criteria are met:   [...]

31287

Avoiding/Correcting This Error Hospice claims are required to be billed monthly. Verify the month beginning and ending date and the ‘From’ and ‘To’ dates on your claim. The claim must span the entire month for continuing care claims.

30993

Verify the MBI submitted on the claim matches the MBI in the Common Working File. If a new MBI has been assigned, follow the guidelines regarding the claim submission: For dates of service before the MBI change date use old or new MBI If [...]

37236

Avoiding/Correcting This Error Verify eligibility of the attending/ordering physicians in PECOS. Print that verification and make it part of the medical record. If applicable, submit a reopen request to the Appeals Department indicating error [...]

55HTP

Avoiding/Correcting This Error Verify that the initial certification is complete and includes all necessary elements, such as the patient’s homebound status, the need for skilled services, and a face-to-face encounter with a physician or [...]

55H1L

Avoiding/Correcting This Error Clinical progress notes should show evidence of a steady decline or downward trajectory in the beneficiary’s clinical status over time. Documentation should be objective, measurable and must support a life [...]

How to Avoid and Correct Duplicate Claim Denials

How to Avoid and Correct Duplicate Claim Denials A duplicate claim submission occurs when a physician or other qualified healthcare professional resubmits a claim either on paper or electronically for a single encounter and the service is [...]

Portable X-Ray Cost Analysis Survey

Clinical Trials

Clinical Trials Clinical trials are interventional studies that assess treatments or diagnostics compromising experimental and control groups. Medicare coverage in these trials is guided by strict CMS rules and is limited to FDA-approved [...]

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 & [...]

MLN Connects® Newsletter: April 24, 2025

MLN Connects® Newsletter: April 24, 2025 News Open Payments: Review Your Data by May 15 Medicare Shared Savings Program: Application Toolkit Materials MLN Matters® Articles Inpatient Psychiatric Facilities: Return to Provider Claims [...]

Skilled Nursing Facility and Swing Bed Quarterly Top Claim Errors

Do you struggle with your claim denials, rejections and return to provider (RTP) claims? Do you want to be proactive in preventing unnecessary errors? Join us in a review of top claim errors for your provider type based on recent data analysis. [...]

Hospital, CMHC, CORF/ORF and ESRD Facilities Quarterly Top Claim Errors

Do you struggle with your claim denials, rejections and return to provider (RTP) claims? Do you want to be proactive in preventing unnecessary errors? Join us in a review of top claim errors for your provider type based on recent data analysis. [...]

34538

Avoiding/Correcting This Error To avoid this error: When submitting your Medicare primary claim, report the reason Medicare is primary using claim coding in Prevent an MSP Rejection on a Medicare Primary Claim. To correct this [...]

(CORRECTION) Some Claims Editing for Reason Code U537I, HH Claim Falls Outside of an HH Admission Period for the Same Provider

The CWF can only hold the 36 most recent periods of care for any beneficiary. CWF also contains the indicator of when the HH admission (NOA) was processed. This indicator allows CWF to determine whether an HH admission period is on file with [...]

Acute Care Hospitals: Advance Beneficiary Notice of Noncoverage (CMS-R-131 Form) for Outpatient Services

Acute care hospitals: Do you understand when and how to issue an Advance Beneficiary Notice of Noncoverage (ABN) for outpatient services? Join this session to learn more about the voluntary and mandatory ABN, three payment liability conditions, [...]

New Version of PC-ACE: April 2025

New Version of PC-ACE: April 2025 PC-ACE Version 6.6 contains several CMS mandates and product enhancements including but not limited to the items listed below. 13891 – Implement Operating Rules – Phase III Electronic Remittance Advice [...]

Illinois, Minnesota, Wisconsin

Member Name Group Email Aldrich, Elizabeth IPW (Independent Physicians of Wisconsin), Allen Family Practice ealdrich@ipw-offices.org Anderson, Benita Aurora Health Care Benita.Anderson@aurora.org [...]

NGSConnex: Initiating and Checking Status of Reconsiderations

Did you know that you can save time and money by requesting a reconsideration via NGSConnex? When you submit reconsideration requests electronically using NGSConnex, you no longer need to complete a form, copy documentation and waste time with [...]

Exemption Process for the Prior Authorization Program for Certain Hospital Outpatient Department Services

The Centers for Medicare & Medicaid Services (CMS) implemented a prior authorization program for certain hospital outpatient department (OPD) services for date of service (DOS) on or after 7/1/2020 and subsequently added an exemption [...]

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 [...]

Prior Authorization for Certain Hospital Outpatient Department Services – General PA

Join us for this general webinar about Prior Authorization for certain Hospital Outpatient Department (OPD) services. This webinar will have a non-clinical focus with emphasis on general requirements as listed in the OPD Operational Guide.

Provider Enrollment: Initially Enrolling a Dentist in the Medicare Program

During this webinar, we’ll address the Medicare dental specialty codes and provide an overview of how to enroll using Provider Enrollment, Chain and Ownership System (PECOS) as well as using the CMS-855I paper application. This session is [...]

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 & [...]

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 [...]

Submitting Revalidation via PECOS

During this webinar, we’ll provide an understanding of how to utilize the Centers for Medicare & Medicaid Services (CMS) Internet-based Provider Enrollment Chain & Ownership System (PECOS) to be comfortable in navigating the system to [...]

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.

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.

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.

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.

Submitting Part B Medicare Secondary Payer Claims

During this Medicare Secondary Payer (MSP) learning session, we'll teach you how to submit your MSP claims with the appropriate loops and segments. We'll review the MSP billing requirements for paper and electronic claims 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 [...]

PECOS: Manage Signatures and Additional Information Requests

During this webinar, we’ll give direction for the Provider Enrollment, Chain and Ownership System (PECOS) application on understanding how to manage signatures and respond to additional information request from submitted applications.

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 [...]