Search Results - NGSMEDICARE

Posting Date: 07/18/2025

34985

Avoiding/Correcting This Error The PO modifier is used on all claim lines for all services, procedures and/or surgeries provided at an excepted off-campus provider-based outpatient department (PBD). The PO modifier applies to a [...]

Posting Date: 07/18/2025

34985

Avoiding/Correcting This Error The PO modifier is used on all claim lines for all services, procedures and/or surgeries provided at an excepted off-campus provider-based outpatient department (PBD). The PO modifier applies to a [...]

Posting Date: 07/18/2025

34986

Avoiding/Correcting This Error The PN modifier is used on all claim lines for all services, procedures and/or surgeries provided at an excepted off-campus outpatient, PBD of a hospital. The PN modifier applies to a grandfather/excepted PBD for [...]

Posting Date: 07/18/2025

34986

Avoiding/Correcting This Error The PN modifier is used on all claim lines for all services, procedures and/or surgeries provided at an excepted off-campus outpatient, PBD of a hospital. The PN modifier applies to a grandfather/excepted PBD for [...]

Posting Date: 07/18/2025

37098

Avoiding/Correcting This Error Verify billing and, if appropriate, correct and return the claim. Related Content Billing for FQHC MAO Plan Supplemental Payment (PPS Providers) CMS Internet-Only Manual 100-04, Medicare Claims Processing [...]

Posting Date: 07/18/2025

38038

Avoiding/Correcting This Error Check OPPS claims for potential overlapping dates of service prior to claim submission and bill accordingly An adjustment bill must be submitted For bill type 34X, only vaccines and their administration, [...]

Posting Date: 07/18/2025

38119

Avoiding/Correcting This Error Verify the admission date and from date on this claim Verify the patient’s MBI to make sure that it has been correctly reported If the MBI is incorrect, this edit will be assigned If admission and from dates [...]

Posting Date: 07/18/2025

38119

SNF inpatient claims have to be processed in sequence. That means that when the beneficiary is going to be in the SNF as an inpatient for several months in a row, claims for the months the beneficiary is in the SNF must be submitted one at a [...]

Posting Date: 07/18/2025

U5065

Avoiding/Correcting This Error Check/verify the beneficiary's entitlement dates in the CWF. A Medicare beneficiary, or their authorized representative, may have requested a new MBI. Verify eligibility and MBI number, correct and return the claim.

Posting Date: 07/18/2025

U5065

Avoiding/Correcting This Error Check/verify the beneficiary's entitlement dates in the CWF. A Medicare beneficiary, or their authorized representative, may have requested a new MBI. Verify eligibility and MBI number, correct and return the claim.

Posting Date: 07/18/2025

W7088

Avoiding/Correcting This Error Each FQHC PPS claim must be billed with a qualifying visit code, and associated line-item charges, along with all other FQHC services furnished during the encounter. A qualifying visit code is the code that [...]

Posting Date: 07/18/2025

38105

Avoiding/Correcting This Error Verify billing and if appropriate, correct and resubmit the claim. To prevent this error on future claims: Ensure that the correct bill type is submitted once you have received all charges from all [...]

Posting Date: 07/18/2025

38032

Avoiding/Correcting This Error If duplicate claim was submitted in error, no additional provider action is necessary. If it is determined that the claim was due to additional charges for a patient for a specific date of service, wait for the [...]

Posting Date: 07/18/2025

39929

Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]

Posting Date: 07/18/2025

7K073

Avoiding/Correcting This Error If the beneficiary is entitled to Medicare Part B, an ancillary claim may be submitted to your MAC. Related Content Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) [...]

Posting Date: 07/18/2025

C7010

Avoiding/Correcting This Error If services are unrelated to hospice stay, resubmit with condition code 07 (treatment of nonterminal illness for hospice patient). Verify hospice enrollment prior to claim submission by reviewing the CWF, HETS [...]

Posting Date: 07/18/2025

U5200

Avoiding/Correcting This Error Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS/DDE Provider Online System, HETS or NGSConnex to verify [...]

Posting Date: 07/18/2025

U5233

Avoiding/Correcting This Error Verify the admission date, from, and through dates on the claim and compare the dates to the MAO/HMO entitlement dates. Outpatient facilities and IPPS and IRF hospitals, or LTCH billing services within an [...]

Posting Date: 07/17/2025

Prior Authorization Outpatient Department Claim Billing

Prior Authorization Outpatient Department Claim Billing Providers may observe an increase in claim denials for PA services due to a mismatch of information provided on the PAR compared to the information supplied on the claim. Prior [...]

Posting Date: 06/14/2023

Facet Joint Interventions for Pain Management Best Practices

Facet Joint Interventions for Pain Management Best Practices Table of Contents Indications and/or Medical Necessity Coverage Documentation Requirements Diagnostic Facet Joint Injections (IA or MBB) Therapeutic Facet Joint Injection [...]

Posting Date: 10/26/2022

Prior Authorization OPD Alerts

Prior Authorization OPD Alerts Month/Year Topic July 2025 Prior Authorization Outpatient Department Claim Billing July 2025 Prior Authorization Outpatient Department Exemption and ABN ADRs [...]

Posting Date: 07/17/2025

MLN Connects® Newsletter: July 17, 2025

MLN Connects® Newsletter: July 17, 2025 News CMS Announces Resources, Flexibilities to Assist with Public Health Emergency in State of Texas Skilled Nursing Facilities: Revalidation Deadline Extended to January 1 Join an Accountable Care [...]

Posting Date: 07/18/2025

52MUE

Avoiding/Correcting This Error You have the right to submit an appeal when you believe the medical records support that the denied services were reasonable and medically necessary. Providers should review the information on the CMS website [...]

Posting Date: 07/18/2025

52NCD

Avoiding/Correcting This Error Ensure all Medicare coverage and medical necessity requirements are met prior to billing. If the provider determines that Medicare will not cover the services, consider submitting the charges as noncovered. [...]

Posting Date: 07/18/2025

52NCD

Avoiding/Correcting This Error Ensure all Medicare coverage and medical necessity requirements are met prior to billing. If the provider determines that Medicare will not cover the services, consider submitting the charges as noncovered. [...]

Posting Date: 07/18/2025

55B31

Avoiding/Correcting This Error Review coverage guidelines and patient records to determine if all appropriate documentation was sent for review that may have supported medical necessity. When you receive an ADR from National Government [...]

Posting Date: 07/18/2025

55B31

Avoiding/Correcting This Error Review coverage guidelines and patient records to determine if all appropriate documentation was sent for review that may have supported medical necessity. When you receive an ADR from National Government [...]

Posting Date: 07/18/2025

54NCD

Avoiding/Correcting This Error Review coverage guidelines for the service being denied to ensure medical necessity of the services being provided to the beneficiary. Ensure all Medicare coverage and medical necessity requirements are met [...]

Posting Date: 07/18/2025

55S05

Avoiding/Correcting this Error The SNF should ensure that SNF services that are not covered are identified. After discussion with the beneficiary and/or representative you should properly issue an ABN and bill for the noncovered services [...]

Posting Date: 07/18/2025

55S29

Avoiding/Correcting This Error Respond promptly to a MAC, CERT, RAC, SMRC, or UPIC request for additional documentation. Documentation is necessary to verify compliance with a benefit category requirement. Ensure that all records, [...]

Posting Date: 07/18/2025

59118

Avoiding/Correcting This Error Review reason code 59118 in the Direct Data Entry system for applicable codes. Alternatively, review the latest Change Requests/MLN® Matters articles for relevant ICD-10 updates. The most current MLN Matters [...]

Posting Date: 07/18/2025

59118

Avoiding/Correcting This Error Review reason code 59118 in the Direct Data Entry system for applicable codes. Alternatively, review the latest Change Requests/MLN® Matters articles for relevant ICD-10 updates. The most current MLN Matters [...]

Posting Date: 07/18/2025

59301

Avoiding/Correcting This Error You have the right to submit an appeal when you believe the medical records support that the denied services were reasonable and medically necessary. To prevent similar denials, ensure that all coverage [...]

Posting Date: 07/18/2025

5ND07

Avoiding/Correcting This Error To prevent this error, ensure all Medicare coverage and medical necessity requirements are met prior to billing. Providers can visit the CMS Coverage Database to review the NCDs and LCDs to determine the [...]

Posting Date: 07/18/2025

31836

Avoiding/Correcting This Error Verify billing and, if appropriate, correct and resubmit the claim for payment. Related Content CMS PFS Look-up Tool Overview

Posting Date: 07/18/2025

32243

Avoiding/Correcting This Error Review the claim and either update the charges or remove the line containing zero or blank charges. Return the claim for processing.

Posting Date: 07/18/2025

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 [...]

Posting Date: 07/18/2025

32402

Avoiding/Correcting This Error Verify HCPCS code using the FISS Inquiries HCPCS file (option 14). Allowable revenue codes will be displayed based on DOS. Use the claims correction option to report the appropriate HCPCS/CPT code and resubmit [...]

Posting Date: 07/18/2025

38032

Avoiding/Correcting This Error If duplicate claim was submitted in error, no additional provider action is necessary. If it is determined that the claim was due to additional charges for a patient for a specific date of service, wait for the [...]

Posting Date: 07/18/2025

38312

Avoiding/Correcting This Error If appropriate, correct and resubmit a new claim. To prevent this error on future claims: Ensure you have received all charges from all departments and that no claim has been submitted for the same DOS [...]

Posting Date: 07/18/2025

39929

Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]

Posting Date: 07/18/2025

39934

Avoiding/Correcting This Error Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]

Posting Date: 07/18/2025

39934

Avoiding/Correcting This Error Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]

Posting Date: 07/18/2025

You Asked, We Listened - Introducing the Modifier Lookup Tool

You Asked, We Listened - Introducing the Modifier Lookup Tool We value and appreciate the feedback from our providers, which drives continuous improvement to enhance your experience. We're pleased to announce the launch of our new Modifier [...]

Posting Date: 07/18/2025

7K073

Avoiding/Correcting This Error If the beneficiary is entitled to Medicare Part B, an ancillary claim may be submitted to your MAC. Related Content Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) [...]

Posting Date: 07/18/2025

U5200

Avoiding/Correcting This Error Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS Provider Online System, HETS or NGSConnex to verify beneficiary [...]

Posting Date: 07/18/2025

U5210

Avoiding/Correcting This Error Each beneficiary should be screened for eligibility. Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS Provider [...]

Posting Date: 07/18/2025

Medical Policy and Billing and Coding Updates

Medical Policy and Billing and Coding Updates LCDs in Notice Period (7/24/2025-9/6/2025) L38367 - Fluid Jet System Treatment for LUTS/BPH Based on a Reconsideration Request, the Indications of Coverage have been revised by removing the [...]

Posting Date: 07/18/2025

CERT Awareness Week Three – Verify Your Medical Records Correspondence Address

CERT Awareness Week Three – Verify Your Medical Records Correspondence Address The Part A, Part B, DME, home health and hospice and RRB MACs are working together to promote the importance of complying with CERT documentation requests. This is [...]

Posting Date: 07/21/2025

Reducing Unprocessable Claims

When claims are submitted with invalid, incomplete or incorrect information, our claims processing system will detect these errors and will reject claims as unprocessable. Our goal is to assist our providers in submitting claims correctly the [...]

Posting Date: 07/21/2025

Alcohol Misuse, Counseling to Prevent Tobacco Use and Lung Cancer Screening

During this webinar, we’ll review the coverage, coding and billing guidelines for the Medicare Part B preventive services benefits of alcohol misuse, counseling to prevent tobacco use and lung cancer screening.

Posting Date: 09/24/2021

Inpatient Psychiatric Facilities Billing When Benefits Exhaust Job Aid

Inpatient Psychiatric Facilities Billing When Benefits Exhaust Job Aid Table of Contents Inpatient Psychiatric Facilities Billing When Benefits Exhaust Job Aid Benefits Exhaust Date Submitting Claims Through the Benefits Exhaust Date [...]

Posting Date: 01/05/2024

Intensive Outpatient Program

Intensive Outpatient Program Table of Contents IOP vs. Partial Hospitalization Program Provider Types Eligible to Provide IOP Medicare Beneficiary Eligible for IOP Services Active Treatment and Treatment Plan Covered IOP Services [...]

Posting Date: 09/04/2024

Psychotherapy Services

Psychotherapy Services Medicare Regulations Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 6, Section 70.1 Local Coverage Determination (LCD): [...]

Posting Date: 03/04/2020

PECOS Enrollment Process and Advantages

PECOS Enrollment Process and Advantages The Internet-based PECOS can be used in lieu of the paper enrollment application. Submitting the application via PECOS is the preferred method. Advantages of Online Enrollment: Lets you submit [...]

Posting Date: 08/21/2018

Paper Enrollment Process

Paper Enrollment Process Enrollment via paper is an option, but PECOS is the preferred method to process the application with streamlining features. Paper-based enrollment applications are available. Determine which CMS Paper Form you will [...]

Posting Date: 01/17/2020

Enrollment Application Forms

Enrollment Application Forms You have two options for submitting your Part B Enrollment application to Medicare. You can choose to submit: Electronic application through PECOS, or CMS paper application forms Also view Understanding [...]

Posting Date: 05/04/2021

For First Time Users: Request a User ID and Connection

For First Time Users: Request a User ID and Connection Instructions for accessing PECOS: If you are unsure if you have a user ID, select “Forgot User ID?” from PECOS. Connect to the Identity & Access (I&A) Management System, [...]

Posting Date: 12/05/2016

Complete All Topics

Complete All Topics Instructions for completing all PECOS topics: Select the ‘Topic View’ tab and add information in every topic Note: The electronic funds transfer (EFT) topic must be completed by: groups suppliers sole owner group [...]

Posting Date: 11/15/2021

Resolve All Errors and Verify Warnings

Resolve all Errors and Verify Warnings Instructions for resolving all errors and warnings: Select the ‘Errors/Warning Check’ Tab. Correct all errors identified and verify any warnings. Related Content Resolving PECOS [...]