Incarcerated or Unlawfully present in the US claim rejections (U538H, U538Q)

Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q) This stringent claim editing process helps ensure that Medicare does not make payments for services rendered to beneficiaries who are not eligible due to being [...]

Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)

Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q) This stringent claim editing process helps ensure that Medicare does not make payments for services rendered to beneficiaries who are not eligible due to being [...]

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 [...]

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 [...]

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 [...]

EDI Front End Clinical Edits

EDI Front End Clinical Edits EDI is continuing to implement EDI clinical business edits into the NGS EDI front end. These edits assist in proactively alerting providers of potential claim issues and provide resources to assist with avoiding [...]

Collaborative Surgical Dressings Webinar Coming May 6, 2025

Collaborative Surgical Dressings Webinar Coming May 6, 2025 This is your opportunity to hear directly from the Medicare contractors regarding Medicare’s criteria necessary for the coverage of surgical dressings. Representatives from all four [...]

Acute Care Hospitals Preparing Inpatient Claims: The Basics Part 1

This is part 1 of a 2-part webinar event (part 2 will be on 04/24/2025). In part 1, Acute Care Hospitals (ACH) will learn how to properly complete inpatient claims for submission to Medicare. We will review general inpatient ACH information [...]

Quarterly Top Ten Institutional EDI Edits

Quarterly Top Ten Institutional EDI Edits National Government Services EDI has identified the following top ten CEM edits that were received during Q1 2025 on the 277CA (Claims Acknowledgement) report for 837I 5010A1 formatted [...]

Quarterly Top Ten Part B EDI Edits

Quarterly Top Ten Part B EDI Edits National Government Services EDI has identified the following Top Ten CEM edits that were received during the Q1 2025 on the 277CA (Claims Acknowledgement) report for 837P 5010A1 formatted claims. The [...]

Termination of the Hospice Benefit Component of the VBID Model on 12/31/2024

Termination of the Hospice Benefit Component of the VBID Model on 12/31/2024 After carefully considering recent feedback about the increasing operational challenges of the Hospice Benefit Component and limited and decreasing participation [...]

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 [...]

Provisional Period of Enhanced Oversight for New Hospices

Provisional Period of Enhanced Oversight for New Hospices In recent years, CMS has reported a significant increase in fraudulent hospice billing practices, which cost the Medicare Program millions of dollars annually. The CMS has initiated a [...]

Introduction to Medicare Part II

Join us for Introduction to Medicare Part II to enhance your understanding of Medicare Part B. Topics include Local Coverage Determinations, Claim Filing Guidelines, Preventive Services, Front Office Assistance, Medigap/Supplemental/Advantage [...]

MLN Connects® Newsletter: April 3, 2025

MLN Connects® Newsletter: April 3, 2025 News Home Infusion Therapy & Intravenous Immune Globulin Services: Get Monitoring Reports Medicare Providers & Suppliers: Report Managing Employees External User Services Help Desk: New [...]

MLN Connects® Newsletter: April 14, 2025

MLN Connects® Newsletter: April 14, 2025 FY 2026 Proposed Payment Rules CMS Seeks Public Input on Inpatient Hospital Whole-Person Care, Proposes Updates to Medicare Payments Inpatient Rehabilitation Facility Prospective Payment System [...]

Preventive Services: Initial Preventive Physical Examination and Annual Wellness Visit

Ensure that your patients obtain the wellness examinations they are eligible for by knowing the differences between the initial preventive physical examination and annual wellness visit. During this webinar, we'll review the coverage, [...]

Get Access to Keep Provider Enrollment Records Up To Date with Medicare

Get Access to Keep Provider Enrollment Records Up To Date with Medicare If you need to manage Medicare enrollment information for an individual provider or entity electronically through PECOS, you must have authorized access. This access will [...]

National A/B MAC Ambulance Provider/Supplier Coalition Meeting Invite

National A/B MAC Ambulance Provider/Supplier Coalition Meeting Invite Attention Ambulance Suppliers and Providers Join the first virtual National A/B MAC Ambulance Provider/Supplier Coalition meeting during EMS Week: Thursday, 5/22/2025 from [...]

Part B Spring 2025 Virtual Conference: Register Now

Register Now! Register now for the 2025 Spring Part B Virtual Conference: Understanding Medicare Compliance for Part B Providers happening on June 3–5,2025. This event will offer innovative ideas and broaden your expertise in Medicare [...]

Medicare Part B Secondary Payer Post-Pay Overpayments

During this webinar, providers and office staff members will learn about the Medicare Part B overpayments and the appropriate steps for reporting Medicare Secondary Payer (MSP) overpayments. NGS MSP subject-matter experts will be on hand to [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

MSP Right Hand

Helpful Resources Verification of Medicare Secondary Payer Data