Ambulance Transports Included in SNF Consolidated Billing

Ambulance Transports Included in SNF Consolidated Billing Transport Description Medical Necessity Met Ambulance Billing Modifiers and Other Considerations Who is Responsible for Payment? Reference(s) SNF to [...]

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 [...]

Ambulance Billing Guidance

Ambulance Billing Guidance Table of Contents Ambulance Billing Ambulance Billing HCPCS Codes How to Bill Units with Transpiration HCPCS Codes Using Ambulance Modifiers When Billing Transportation Indicators Related Content [Return [...]

MLN Connects® Newsletter: March 27, 2025

MLN Connects® Newsletter: March 27, 2025 News Extension of Medicare Provisions Final National Coverage Determination: Transcatheter Tricuspid Valve Replacement Nutrition-Related Health Conditions: Recommend Medicare Preventive Services [...]

Fundamentals of Medicare

Reopening versus Redetermination

Reopening versus Redetermination Table of contents Reopening versus Redetermination Reopening Telephone Reopening Unit Redeterminations [Return to Top] Reopening versus Redetermination Understanding your next steps are very [...]

PC-ACE Software Instructions, Resources and Guides

PC-ACE Software Instructions, Resources and Guides Creating a 276 Claim Status Request in PC-ACE and Importing and Reading the 277 Claim Status Report PC-ACE Software – For Professional Users: Importing and Reading the 999 & 277CA Files [...]

Screening Mammography

Preventive Services Guide Screening Mammography A mammogram is an X-ray of the breast. Screening mammograms are routinely administered to detect breast cancer in women who have no apparent symptoms. Coverage Guidelines and Frequency Limits [...]

APPEALS: How would one submit a paper appeal?

APPEALS: Where can I find the regulations on Medicare appeals?

APPEALS: What are the top appeals submitted to NGS?

MLN Connects® Newsletter: March 25, 2025

MLN Connects® Newsletter: March 25, 2025 News ESRD: Payment for Phosphate Binders Effective January 1, 2025 Hospitals: Apply for Additional Residency Positions by March 31 Skilled Nursing Facilities: Revalidation Deadline is May 1 [...]

APPEALS: I received a remittance advice with the message “this care may be covered by another payer per coordination of benefits.” Is this an appealable claim?

APPEALS: Can one appeal a claim that rejected with MA130?

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

APPEALS: Is documentation required for an appeal?

APPEALS: Another denial we see is “This service has been provided at a frequency that is more than the medically appropriate indication by policy or regulation.” How can we avoid these denials?

APPEALS: We are a large group with many physician and nonphysician practitioners. When we submit claims for nonphysician practitioners working in different sub-specialties, we receive denials that state: D984: Coverage/program guidelines not met, N20: Service not payable with other service rendered on the same day.

APPEALS: Is there a time limit for filing an appeal?

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

APPEALS: We are a large group with many physicians and nonphysician practitioners. When we submit claims for nonphysician practitioners working in different sub-specialties, we get claim denials that state: “D463: New patient qualifications were not met or M13: Only one initial visit is covered per specialty per medical group.” How can we avoid these?

APPEALS: What is a Medicare appeal?

APPEALS: What is the appeal process?

APPEALS: What is the solution to avoiding claim denials?

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

Understanding the Approval Recommendation Process for Certified Providers

Understanding the Approval Recommendation Process for Certified Providers The certified provider completes and submits a CMS-855 enrollment application and all supporting documentation to its MAC, including any state require documentation [...]

EDI: I received a payer acknowledgement/acceptance report from my clearinghouse. Does this mean you accepted my claims?

EDI: I heard that 5010 requires a physical address in box 33 and P.O. boxes are no longer accepted. Is this true?

EDI: I am receiving the following Claim Status Code and EIC code on my 277CA. What do these codes mean?

EDI: I received my application back with errors on my Provider Authorization Form. Can I correct it or will I have to complete an entirely new application and authorization form?

EDI: What is a Network Service Vendor (NSV)?

EDI: I am missing an Electronic Remittance Advice (ERA). How do I order a duplicate?

EDI: I am receiving the following CSC and EIC code on my 277CA. How do I make the correction?

EDI: What PTAN should I enter on the EDI enrollment forms if the provider is a member of a group?

EDI: What Entity Name should I enter on the EDI Enrollment Agreement form?

EDI: What information do I need to have available when calling for Electronic Data Interchange (EDI) assistance?

EDI: Will you reject claims where the group number and policy number are the same values?

EDI: Where in the 277 CA file can we find the rejection message that provides the detailed rejection reason description?

EDI: What is an Approved Entity?

EDI: What provider address should I include on the EDI enrollment forms?

EDI: When is a provider authorization form required?

LCD NCD: How do I search for an LCD if I do not know the LCD number?

EDI: Will you reject claims with a P.O. Box in the billing provider address?

LCD NCD: How do I find LCDs?

LCD NCD: Does NGS offer any other LCD resources?

LCD NCD: How do I find out if an LCD or medical coverage policy has changed in my jurisdiction?

LCD NCD: How can I view and comment on proposed LCDs?

LCD NCD: What are Medical Policy Articles?

LCD NCD: Can I request a change be made to a current LCD?

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction K Part A Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Debridement, subcutaneous tissue (includes epidermis and dermis, if performed) 11042, 11045 [...]

Hospital-Based Ambulance Basic Billing Guidelines

Hospital-Based Ambulance Basic Billing Guidelines For hospital-based ambulance billing under Medicare, services should be billed on the UB-04 form using the ambulance service-specific NPI, not the acute hospital NPI, and claims for inpatient [...]

About Appeals

About Appeals Table of Contents About Appeals Reopening vs. Redetermination Reopening Redetermination [Return to Top] About Appeals Providers and beneficiaries have the right to appeal claim determinations made by National [...]

REMITTANCE: What do the two-letter codes on my remittance advice mean?

REMITTANCE: Can I post the electronic remittance advice information into my accounts receivable system?

REMITTANCE: If I have a computer problem while trying to download my electronic remittance advice, can I have it reposted to download again?

REMITTANCE: Do I need special computer software to use the electronic remittance advice?

PC-ACE: Where can I find out more about the PC-ACE free billing software?

REMITTANCE: How long will I receive paper remittances once I sign up for the electronic remittance advice?

PC-ACE: Why did my PC-ACE software expire?

PC-ACE: How do I determine the version of PC-ACE I am using?