MODIFIERS: When do I need to append the 99 modifier?

MODIFIERS: When should the QW modifier be appended?

MODIFIERS: When is modifier 50 used?

MODIFIERS: When is it appropriate to append the AQ modifier?

MODIFIERS: When should modifier 51 be added to a claim?

What are the administration codes for the pneumococcal vaccine?

Is an order required to administer the pneumococcal vaccine?

Can a mass immunizer combine pneumococcal with other vaccines on one roster bill?

What are the allowance limits for the cost of the pneumococcal vaccine?

If I administer two different vaccinations during the same visit, e.g., influenza and pneumococcal, can I bill for two separate administrations?

Does Medicare pay for counseling and education of the pneumococcal vaccine?

Is the pneumococcal vaccine subject to coinsurance and deductible?

What is the frequency requirement for the pneumococcal vaccine?

Where are the appeal forms?

What is the timely filing for an appeal?

What is the receipt date of the claim?

What is the QIC timely filing limit?

What is the refund address?

What is the denial date?

What is timely filing for a claim?

What is timely filing to adjust a claim?

Where is the written Part B Reopening Form located?

What is my pay-to address?

What is my Payer ID?

Does Medicare cover a sign language interpreter?

What is the mailing address for submitting a claim?

What is the address to send the QIC appeal?

What is the ICN?

CLAIMS: During the patient check in process, may we have the patient check a box on a form at each visit stating they agree to allow us to bill Medicare and have that serve as the patient’s acceptance for our filing a claim?

CLAIMS: How do I know if a HCPCS/CPT code is subject to MUE (medically unlikely edit)?

CLAIMS: Where are comments entered on the 837P electronic claim form?

CLAIMS: When submitting an ambulance claim, do the base and mileage codes need to have the same ZIP code for the same trip?

CLAIMS: I file all my Medicare claims electronically except for Medicare Secondary Payer (MSP) claims because I thought I had to attach the primary Explanation of Benefits (EOB). Is this the correct process?

CLAIMS: Why would my postoperative claims deny?

CLAIMS: Medicare is the beneficiary's secondary payer and I am receiving denials when submitting using the CMS-1500 form. How can I resolve this?

CLAIMS: How do I prevent monthly End Stage Renal Disease claims from denying?

CLAIMS: On a screening Pap smear test claim, which pointer does my diagnosis code need to be in?

CLAIMS: How do I submit documentation for an additional development request (ADR)?

CLAIMS: I am receiving inconsistent payments on claims billed for the same drug. How can I prevent this?

CLAIMS: What is the correct way to submit a beneficiary name on a claim?

MEDICAL REVIEW: How do I sign up for the CMS and NGS Listserv messages?

MEDICAL REVIEW: I’m appealing my claim but received a letter to recoup funds from the TPE denial. What do I do about these letters?

MEDICAL REVIEW: My claim was reopened or adjusted by Medical Review. Does this impact the appeal window?

MEDICAL REVIEW: How do I respond to an ADR Not In List?

MEDICAL REVIEW: How do I appeal a claim that MR reviewed but went to a T status or R status because of a CWF issue after MR processed?

MEDICAL REVIEW: How do I change my address and which address exactly am I changing to ensure receipt of the MR letters and ADRs?

MEDICAL REVIEW: Where can I get answers to billing questions?

MEDICAL REVIEW: Where can I find more details about the reasons my claims were denied?

MEDICAL REVIEW: My claim was denied “56900 Documentation not received”; however, I did send in documentation. What now?

MEDICAL REVIEW: What constitutes a valid signature?

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

APPEALS: How can I get status of my redetermination or reopening request?

APPEALS: What is a Medicare appeal?

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

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 [...]

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 [...]

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 [...]

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 [...]

W7050

Avoiding/Correcting This Error Verify billing and, if appropriate correct and return the claim. Online providers should press PF9 to restore the claim. Related Content Centers for Medicare & Medicaid Services Internet-Only Manual [...]

Top J6 Part B Claim Errors are Available

Top J6 Part B Claim Errors are Available We conduct a comprehensive data analysis on a quarterly basis to update and disseminate the latest insights on the most common claim errors. This initiative provides: Claim Error Reason Code [...]