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

LCD NCD: How do I find LCDs?

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

LCD NCD: What are the differences between LCDs and NCDs?

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

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

PC-ACE: Why am I receiving security rights error/issue when installing PC-ACE?

PC-ACE: How often is the PC-ACE software upgraded?

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

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

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

PC-ACE: How do I correct a web browser error when downloading or making changes to the software?

EDI: How can I tell if I am set up for electronic billing?

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

EDI: Is the 277CA returned for each test submission?

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

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

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

EDI: How do I restore a remit file?

EDI: After I receive a 277CA will I receive anything else?

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

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

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

EDI: How long are Electronic Remittance Advices (ERAs) available in my mailbox?

EDI: When is a provider authorization form required?

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

EDI: What is an Approved Entity?

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

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

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

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

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

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

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

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

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

APPEALS: What is the solution to avoiding claim denials?

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

APPEALS: What is a Medicare 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: Is documentation required for an appeal?

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

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

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

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

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: Where can I find the regulations on Medicare appeals?

APPEALS: What are the top appeals submitted to NGS?

Admission and Discharge Services

Admission and Discharge Services Is it permissible for an NPP to perform an initial hospital admission or discharge service on behalf of the attending physician, or on a split/shared basis, when both are members of the same provider [...]

Advanced Care Planning

Advanced Care Planning Please define documentation requirements when billing advanced care planning (CPT 99497 and 99498). Answer: ACP codes may be used with or without a base E/M code on the same date of service, based on whether a [...]

Behavioral/Mental Health Services

Behavioral/Mental Health Services Please explain the parameters for mental health services delivered via telehealth to a beneficiary who is at home. Answer: As of 1/1/2025, CMS has permanently extended permission for behavioral and mental [...]

Chronic Care Management

Chronic Care Management The guidelines state moderate or high complex MDM. Do the E/M guidelines apply here? Answer: Yes, the E/M guidelines for MDM are applicable, since chronic care management (CPT 99490) is included within the E/M [...]

Consultations

Consultations Does CMS permit payment for consultative E/M services? Answer: CMS permits payment for medically necessary consultative E/M services. The specific E/M codes previously used to represent consultative services were [...]

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-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.

SNF 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 [...]

56900

Avoiding/Correcting This Error Regularly access claims in status locations SB6001, SB6098, or SB6099 to obtain a listing of claims for which records have not yet been received by the MAC (Medical Review Department). Look for information on the [...]