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

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

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

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

CLAIMS: Why would my postoperative claims deny?

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

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

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

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 denied “56900 Documentation not received”; however, I did send in documentation. What now?

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 find more details about the reasons my claims were denied?

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

MEDICAL REVIEW: What constitutes a valid signature?

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

Observation Services

Observation Services Please define guidelines for providers billing observation services. Answer: Observation services are ordered, performed and billed by the practitioner (or group), who is responsible for the patient’s care during the [...]

Preoperative Clearance

Preoperative Clearance What requirements must be met for a preoperative clearance visit to be considered medically necessary and billable? Answer: CMS does not set requirements for medical clearance; these are established by individual [...]

Prolonged Services

Prolonged Services Note: View the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.15.2 and Section 30.6.15.3 for CPT codes [...]

Provider Specialty

Provider Specialty Should each MD in the same practice bill with two different taxonomy codes based on whether functioning as a cardiologist or electrophysiologist? Answer: Yes, providers should be billing with their taxonomy codes. The [...]

Scribes

Scribes When a physician or NPP performs a service that is documented by a scribe, what are the documentation requirements? Answer: As per CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.4: “CMS [...]

Separately Identifiable Service

Separately Identifiable Service Please define the appropriate use of modifier 57 to identify a separately payable E/M with an initial decision for surgery. Answer: Modifier 57 is added to an E/M service that resulted in an initial [...]

Skilled Nursing Facility Services

Skilled Nursing Facility Services Please define rules for initial and subsequent SNF services, when the same provider has treated the patient at another site on the same date of service. Answer: This depends on the site of the prior [...]

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 JK Part B Claim Errors are Available

Top JK 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 [...]

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 [...]

CO-16

Avoiding/Correcting This Error The MBI is necessary for all claims submitted to MAC. Claims without a correct MBI are rejected, requiring providers to verify and resubmit them. To avoid this, use the Eligibility Lookup in NGSConnex before [...]

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 The billing provider's information on the claim is missing or invalid. To avoid this error, ensure the following details are accurate and included: the billing provider's NPI, name, address, ZIP code and phone [...]

CO-109

Avoiding/Correcting This Error This denial is received when your Medicare patient is enrolled in an MA plan, instead of “traditional fee-for-service” Medicare. MA plans are health plans offered by private companies approved by Medicare [...]

CO-16

Avoiding/Correcting This Error Certain services require the name and NPI of the ordering or referring physician, depending on the service type. Definitions: Referring Physician: Requests an item or service for a Medicare beneficiary. [...]

PR-31

Avoiding/Correcting This Error Services were denied for one or more of the following reasons: The name or Medicare number was incorrect or missing. The date of death precedes the date of service. Expenses were incurred prior to coverage. [...]

Care Coordination Services for FQHC/RHC Claims Improperly Paid

Care coordination services for FQHC and RHC providers are being reimbursed incorrectly. According to CR 13581, they should be paid at the national nonfacility fee rate, but FISS is using the facility fee rate.

Hospice Top Claim Errors

Do you see the same rejections and return to provider over and over? Do you know how to correct the most common errors and more importantly how to avoid them in the future? In this session we’ll review the most common reason codes assigned to [...]

Patient Status <6>

table, td, th table { border-collapse: collapse; width: 50%; } Patient Status <6> When Patient Status is selected, the IVR will request and collect the following information: NPI PTAN TIN Once the authentication elements [...]

Appeals <7>

table, td, th table { border-collapse: collapse; width: 50%; } Appeals <7> When the Appeals option is selected, the IVR will request and collect the following elements: Provider authentication elements: NPI PTAN TIN Note: [...]

Claim Status <2>

table, td, th table { border-collapse: collapse; width: 50%; } Claim Status <2> If you are part of a group, remember to use the group NPI, PTAN and TIN for authentication purposes. When Claim Status is selected, the IVR will [...]

Offsets <4>

table, td, th table { border-collapse: collapse; width: 50%; } Offsets <4> Upon selecting Offsets, the provider will need to authenticate the following information: NPI PTAN Last five digits of the TIN Next, a submenu will [...]

ASCA: When applying for an ASCA waiver, do I need to complete the Waiver Request form for each provider number?

ASCA: I was under Administrative Simplification Compliance Act review once and received an approved waiver request to send paper claims, why am I under review again?

ASCA: What kind of supporting documentation should I attach to my Administrative Simplification Compliance Act Waiver Request?

ASCA: How will the Administrative Simplification Compliance Act enforcement review affect me as a “small provider/supplier?” Will I be required to submit claims electronically?

ASCA: If my Administrative Simplification Compliance Act Waiver Request is denied, what will happen to my paper claims?

ASCA: How will I know the outcome of my Administrative Simplification Compliance Act waiver request form?

ASCA: Must an Administrative Simplification Compliance Act waiver be mailed or can it be faxed?

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 [...]