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  

DDE: Can a provider view additional development requests (ADRs) via the FISS/DDE?

CLAIMS: How do I indicate on a Medicare claim that the services are NOT related to a liability, no fault (including medical payment) or Workers’ Compensation accident, injury or illness MSP record in the CWF?

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.

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-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.

Critical Access Hospitals, FQHC and RHC 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 for a review of top claim errors for your provider type based on recent data [...]

Update-CMS Delay of Skin Substitutes Effective Date

Update-CMS Delay of Skin Substitutes Effective Date As part of the transition to a new Administration, CMS is reviewing its coverage policies for skin substitute products. CMS believes it is important to maintain patient access to skin [...]

PC-ACE: Is there a resource I can use to assist me with Medicare Secondary Payer (MSP) claims when using PC-ACE?

DDE: Is there some place on FISS/DDE that shows how many physical therapy (PT) or occupational therapy (OT) visits the beneficiary has had?

DDE: I tried to access my claim through the FISS/DDE system and it will not let me pull it up. What is the problem?

CLAIMS: I received a denial stating that the documentation submitted did not support the medical necessity of laboratory services. Can you tell me what I can submit to support these services?

DDE: I have a claim which was fully denied and I am attempting to use the automated denial adjustment process, but the FISS/DDE system is not allowing me to adjust my claim. Why am I not able to bring up my claim and submit the adjustment?

DDE: My name changed and I need to change the name associated to my log on ID. How do I do that?

Revised and Updated Educational Frequently Asked Questions

Revised and Updated Educational Frequently Asked Questions Our educational FAQs have been updated. Please visit the Help and FAQs page under the Education section of our website to explore topics such as: ASCA Appeals CAR T-cell Therapy [...]

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 [...]

The Annual Wellness Visit: Promoting Good Health Through Disease Prevention and Detection

Medicare covers many preventive services to keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep your patients from getting certain diseases. Register today for an [...]

Four Reasons Patients Fear Quitting Tobacco

Four Reasons Patients Fear Quitting Tobacco Stress: If you rely on cigarettes to loosen up during your day, you might worry about losing this release valve. It’s essential to remember that using nicotine to relax is only a temporary fix and [...]

IDTF Procedure Codes (65 KB)

Prior Authorization CPT/HCPCS Code Inquiry Tool

Prior Authorization CPT/HCPCS Code Inquiry Tool

Prior Authorization CPT/HCPCS Code Inquiry Tool This is a self-service tool to allow ambulance service providers, hospital, or physician office staff responsible for submitting prior authorization requests (PARs), to determine if the [...]

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 [...]

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. [...]

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 [...]

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

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 [...]

(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 [...]

REVALIDATION: How do I know I need to revalidate?

REVALIDATION: Where is the revalidation notification letter sent?

SIGNATURES: Who signs the CMS applications and forms for an entity? (ex. 855A, 855B, 20134, 460, 588)

SIGNATURES: Who signs the CMS applications and forms for an entity? (ex. 855A, 855B, 20134, 460, 588)

APPLICATION FEE: Who needs to pay an application fee?

APPROVAL RECOMMENDATION STATUS: The status of my application is approval recommendation, how can I verify if the state agency or CMS has completed their process?

APPLICATION STATUS: Where can I find the status of a submitted application?

DETERMINATION LETTER: How can I get a copy of the determination (approval/denial) letter for a submitted application?

DETERMINATION LETTER: Where are the determination (approval/denial) letters sent?

PECOS: I received an email to sign an application; how do I do this?

REVALIDATION: How do I know I need to revalidate?

SIGNATURES: Who signs the CMS applications and forms for an entity? (ex. 855A, 855B, 20134, 460, 588)

SIGNATURES: Who signs the CMS-855I application?

APPROVAL RECOMMENDATION STATUS: The status of my application is approval recommendation, how can I verify if the state agency or CMS has completed their process?

DETERMINATION LETTER: How can I get a copy of the determination (approval/denial) letter for a submitted application?

DETERMINATION LETTER: Where are the determination (approval/denial) letters sent?

PECOS: I received an email to sign an application; how do I do this?

PECOS: In PECOS, how do I know if the authorized/delegated official or individual provider signed the application?