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 [...]

Repetitive Scheduled Non-Emergent Ambulance Transports Prior Authorization

Attention All Independent Ambulance Suppliers! If you are providing repetitive, scheduled, non-emergent ambulance transports (RSNAT), you'll want to attend this webinar. Join us to learn everything you need to know about the RSNAT program.

Medically Unlikely Edits

Medically Unlikely Edits An MUE is the maximum number of UOS allowable under most circumstances for a single HCPCS/CPT code billed by a provider for a particular date of service for a single beneficiary. All claims submitted by physicians [...]

CMS Medically Unlikely Edits

Medically Unlikely Edits and Related Billing Clarifications

Medically Unlikely Edits and Related Billing Clarifications An MUE is the maximum number of UOS allowable under most circumstances for a single HCPCS/CPT code billed by a provider for a particular date of service for a single beneficiary. [...]

Medical Review Targeted Probe and Educate ADRs

Medical Review Targeted Probe and Educate Additional Development Requests Origins Facts Identification CMS’ TPE program is provider specific education that will focus on improving issues without allowing other [...]

General Information

General Information National Government Services or other CMS contractors may need to request additional information for Medicare claims to assess compliance with Medicare rules. These requests are ADRs. An ADR is a notification/letter [...]

Related Resources

Related Resources MLN® Educational Tool: How to Use the Medicare National Correct Coding Initiative (NCCI) Tools Medicare National Correct Coding Initiative (NCCI) Edits Medicare NCCI Medically Unlikely Edits (MUEs) National Correct [...]

The National Correct Coding Initiative Lookup Tool

The National Correct Coding Initiative Lookup Tool The National Correct Coding Initiative Lookup Tool is designed to help providers identify when certain codes are subject to the automated code pair edits. Search for coding pairs by entering a [...]

Ways to Respond to ADRs

Ways to Respond to ADRs When you are ready to submit, refer to the ADR for the specific submission methods available. NGS offers multiple ways for providers to submit their documentation in response to an ADR. CMS audit contractors notate in [...]

Relocation of the Medically Unlikely Edit Webpage Information

Relocation of the Medically Unlikely Edit Webpage Information National Government Services would like to inform you of an important change regarding the placement of the MUE section on our website. The MUE information has been relocated and is [...]

National Correct Coding Initiative and Medically Unlikely Edits

Procedure to Procedure Edits

Procedure to Procedure Edits The NCCI contains one table of edits for physicians/practitioners and one table of edits for outpatient hospital services. Hospital PTP edits apply to types of bills subject to the outpatient code editor for the [...]

Quarterly Version Update Changes

Quarterly Version Update Changes CMS posts changes to each of its NCCI PTP published edit files on a quarterly basis. This includes additions, deletions and modifier indicator quarterly changes to PTP column one/column two correct coding edits [...]

Add-on Codes

Add-on Codes Add-on codes are specific types of HCPCS/CPT codes intended to describe services that can only be reported in conjunction with a primary procedure. They represent additional work performed during the primary procedure and [...]

Using NGSConnex to Prevent Eligibility Denials and Rejections

During this webinar, we'll examine common eligibility denials and rejections for National Government Services Part B claims and provide strategies from NGSConnex to prevent them in future submissions. There will be time following the [...]

Medical Necessity and the Advance Beneficiary Notice

Register for this webinar and learn how to properly administer the Advance Beneficiary Notice of Noncoverage (ABN) within the office setting. If you are a physician, nonphysician practitioner or office staff member and interested in learning [...]

Unprocessable Claim Rejections and Corrections

Unprocessable Claim Rejections and Corrections Unprocessable claims are medical claims that cannot be processed by Medicare Part B National Government Services, because they contain incomplete, missing or invalid information. Incomplete [...]

National Correct Coding Initiative

National Correct Coding Initiative CMS developed the NCCI to promote national correct coding methodologies and eliminate improper coding of Medicare Part B claims. Coding policies are based on coding conventions defined in the AMA’s CPT [...]

FY 2027 Hospital Wage Index Development Timetable Final

FY 2027 PUF Release

FY 2027 PUF Release Availability and Revisions to Wage Index PUF On Friday, 5/23/2025, CMS released the preliminary FY 2027 Worksheet S-3, Parts II and III wage index PUF. The FY 2027 IPPS wage index will be calculated based on Federal [...]

Skilled Nursing Facility Town Hall Question and Answers

Skilled Nursing Facility Town Hall Questions and Answers Are daily notes required for skilled rehabilitation? Answer: Daily notes for rehabilitation are not required, however, they do support that therapy performed was skilled and [...]

Required Documentation

Required Documentation Table of Contents Required Documentation The medical record should contain patient specific information detailing Certification and Recertification Requirements Signature Requirement for Certifications and [...]

NGS Medical Review Process

NGS Medical Review Process Medicare contractors, like National Government Services, operate the medical review program to prevent improper payments and protect the Medicare Trust Fund. Medical reviews involve the collection and clinical review [...]

Patient Driven Payment Model

Patient Driven Payment Model Table of Contents Assessment Schedule Administrative Presumption Lookback Period (Observation Period) Examples General PDPM Resources [Return to Top] Assessment Schedule Learn more about the [...]

Skilled Services

Skilled Services Table of Contents Skilled Services Skilled Nursing Examples of skilled nursing Skilled Therapy Skilled Respiratory Nonskilled Service Examples Examples of personal care services General Skilled [...]

Coverage Requirements

Coverage Requirements Eligibility, preadmission, and 30-day transfer are components of coverage requirements for Skilled Nursing Facilities. There are several components to each of the coverage requirements; please utilize the links below to [...]

Skilled Nursing Facility Educational Center

Skilled Nursing Facility Educational Center As part of the effort to lower the SNF improper payment rate, CMS has initiated a five claim Skilled Nursing Facility Probe & Educate allowing for outreach to all Medicare billing SNFs in the [...]

How to Find and Respond to Post Payment Review ADR

How to Find and Respond to Post Payment Review ADR Table of Contents How to Find and Respond to Post Payment Review ADR Responding to Post Payment Review ADR Steps to View and Print ADRs from FISS/DDE Provider Online System Related [...]

How to Prevent Common Skilled Nursing Facility Denials

How to Prevent Common Skilled Nursing Facility Denials This resource was developed to increase awareness and educate SNFs on the top errors found by our Medical Review team. The information includes suggestions to ensure documentation [...]

NGS Medical Review Process

NGS Medical Review Process Medicare contractors, like NGS, operate the medical review program to prevent improper payments and protect the Medicare Trust Fund. Medical reviews involve the collection and clinical review of medical records and [...]

MLN Connects® Newsletter: May 29, 2025

MLN Connects® Newsletter: May 29, 2025 News Inpatient Hospital Admissions: Transferring Medical Review Responsibilities for Short Stay Claims Medicare Shared Savings Program: Apply Now MLN Matters® Articles National Coverage [...]

Medicare Review Contractors

During this webinar, we'll assist Medicare providers with knowing the difference between the Medicare review contractors and understanding their role in the Medicare review process. We'll discuss the Supplemental Medical Review [...]

Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated and Advance Payments for Part A Providers and Part B Suppliers

Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated and Advance Payments for Part A Providers and Part B Suppliers Please see the below for information related to the CHOPD Accelerated and Advance Payments for Part A Providers and [...]

New Version of PC-ACE: January 2025

New Version of PC-ACE: January 2025 PC-ACE Version 6.5 contains several CMS mandates and product enhancements including but not limited to the items listed below. Change Request (CR) 13794 - Combined Common Edits/Enhancements Modules [...]

Electronic Health Records

Electronic Health Records Eligible professionals under the Medicare EHR Incentive Program include: Doctor of medicine or osteopathy Doctor of dental surgery or dental medicine Doctor of podiatry Doctor of optometry Chiropractor If [...]

HETS EDI Recertification

Tutorial

Medicare Claims: CMS-1500 or Electronic