CERT Awareness Week Two - Steps to Take if You Get a CERT Documentation Request

CERT Awareness Week Two - Steps to Take if You Get a CERT Documentation Request  The Part A, Part B, DME, home health and hospice, and Railroad Board MACs are working together to promote the importance of complying with CERT documentation [...]

Long-Term Care Hospitals: Preparing and Submitting Compliant Inpatient Claims

In this webinar, we will review Medicare's general inpatient billing requirements for Long-Term Care Hospitals including bill types, billing frequency, interim billing, benefits exhaust billing, billing when claims are paid by Medicare [...]

Medicare Part B Targeted Probe and Educate Process

During this webinar, we’ll help the Medicare provider community understand the targeted probe and educate program.

CAH, 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 in a review of top claim errors for your provider type based on recent data analysis [...]

Verify and Manage Signature(s)

Verify and Manage Signature(s) Verify signatures on all application(s) submitted including applications that were “Return for Corrections”, by returning to the enrollment box in PECOS. Important: The reassignments are viewed by selecting [...]

Using the Medicare Coverage Database: How to Find Important Medicare Coverage Information

Are you responsible for looking up whether a service is covered in the Medicare program at your facility but you're not sure where to look for the most relevant information? As a health care provider, you are responsible for understanding [...]

Contractor Advisory Committee Meeting

Contractor Advisory Committee Meeting As part of the 21st Century Cures Act, contractors are mandated to base an LCD on robust evidence. Part of the process is to convene SMEs as necessary to review the literature and provide input that [...]

Medicare Secondary Payer: A Review of the End-Stage Renal Disease with an Employer Group Health Plan Provision – Part 2

This is a two-part webinar; we suggest you attend both parts. In Part 1 on 7/29/2025, we will review the End-Stage Renal Disease with an EGHP Medicare Secondary Payer provision as it applies to patients eligible for Medicare based solely on [...]

Get PECOS Access to Maintain Medicare Provider Enrollment Records

Get PECOS Access to Maintain Medicare Provider Enrollment Records Do you need to work on behalf of an individual provider and/or entity to update or submit Medicare enrollment information electronically through PECOS? There are certain [...]

Get PECOS Access to Maintain Medicare Provider Enrollment Records

Get PECOS Access to Maintain Medicare Provider Enrollment Records Do you need to work on behalf of an individual provider and/or entity to update or submit Medicare enrollment information electronically through PECOS? There are certain [...]

Billing Telehealth Services for Part B Providers

During this webinar, we’ll provide you with insight into covered Medicare telehealth services and coverage requirements. We’ll discuss originating sites, distant sites and billing and payment guidelines.

Medicare Secondary Payer Provisions for Group and Nongroup Plans

Who pays first? This Medicare Secondary Payer learning session will be on the provisions of group health plans that include working aged, disability and end stage renal disease and nongroup health plans that include auto, liability, no-fault, [...]

NGSConnex Part B Claim Submissions and Claim Status Inquiry

This webinar is geared toward Part B providers who bill to Medicare on a CMS-1500 form. Submitting Medicare Part B claims can be simple and efficient through the NGSConnex portal. During this webinar, we’ll show you how. We’ll review claim [...]

Medicare Secondary Payer: A Review of the End-Stage Renal Disease with an Employer Group Health Plan Provision – Part 1

This is a two-part webinar; we suggest you attend both parts. In Part 1 on 7/29/2025, we will review the End-Stage Renal Disease with an EGHP Medicare Secondary Payer provision as it applies to patients eligible for Medicare based solely on [...]

The National Correct Coding Initiatives Procedure-to-Procedure and Medically Unlikely Edits

Centers for Medicare & Medicaid Services developed the National Correct Coding Initiative (NCCI) program to promote national correct coding. Incorrect coding often leads to improper payment and increases the paid claims error rate. If you [...]

NGSConnex: Part B Financials and Remittance Advice

This webinar is for current and future NGSConnex users who want to learn more about navigating through the financial and remittance advice sections of the NGSConnex provider portal.

APPLICATION FEE: Who needs to pay an application fee?

APPROVAL RECOMMENDATION STATUS: Whom can I contact for questions about an application in approval recommendation status?

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?

Medicare Part B Drugs and Biologicals

Medicare Part B covers certain drugs and biologicals, which require specific billing guidelines. During this webinar, we’ll assist NGS Part B providers in navigating proper billing for these services. There will be time following the [...]

Lets Chat about Federally Qualified Health Center Billing and Reimbursement

Need answers on FQHC billing and reimbursement without attending a full training? Join our 30-minute "Let's Chat" session. This informal discussion allows providers to engage with our Provider Outreach and Education team. You are [...]

NGSConnex: Appeals, Clerical Error Reopening and Prior Authorization Request

This webinar is geared toward Part B providers who bill to Medicare on a CMS-1500 form. Did you ever wonder what you need to do when a claim denies, or you might have made a clerical error on a claim? What about checking on prior authorization? [...]

Medicare Part B Top 10 Claim Denials

Each quarter, we host this webinar to address the top claim denials we receive. We research and identify common errors and offer solutions to prevent them, which has effectively reduced errors. There will be time following the presentation to [...]

CERT Awareness Week Four – We Appreciate Your Efforts

CERT Awareness Week Four – We Appreciate Your Efforts The Part A, Part B, DME, home health and hospice, and Railroad Board MACs are working together to promote the importance of complying with CERT documentation requests. This is the final in [...]

Submit Medicare Secondary Payer Claims Correctly the First Time!

Submit Medicare Secondary Payer Claims Correctly the First Time! If you're facing challenges related to MSP claim submissions for Medicare Part B, then this information is important for you. Ensuring that claims are submitted correctly the [...]

Provider Enrollment: Opioid Treatment Program

During this webinar, we’ll provide a brief overview of an Opioid Treatment Program (OTP) provider, an understanding of submitting the CMS-855A or CMS-855B paper application and how to complete the provider enrollment Internet-based Provider [...]

Method II CAH Claims Not Paying Professional Services with Revenue Codes 096x-098x

Certain CAH claims (TOB 85X) with professional service revenue codes 096x – 098X did not process for payment because the fee amount was not correctly retrieved during processing. The affected claims have receipt/processed dates in October 2024.

View our Educational Frequently Asked Questions

View our Educational Frequently Asked Questions Our educational FAQs have been reviewed and 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 [...]

Part A Ambulance Transport: Understanding the Basics

The purpose of this presentation is to give Medicare Part A Ambulance providers a better understanding of who is responsible to report services to Medicare.

55H20

Avoiding/Correcting This Error This denial is based on review of a claim that was submitted as a demand bill. The charges on this claim are beneficiary liable. The beneficiary may be billed for these charges.

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: Criterion [...]

17729

Avoiding/Correcting This Error This edit is applied if the NPI and first four letters of the physician’s last name submitted on the claim in the Attending field do not match the physician’s NPI and first four letters of the physician’s last [...]

17730

Avoiding/Correcting This Error This edit is applied if the NPI and first four letters of the physician’s last name submitted on the claim in the Referring field do not match the physician’s NPI and first four letters of the physician’s last [...]

55H1S

Avoiding/Correcting This Error Include all face-to-face encounter attestations for the third benefit period and after with your medical record submission to the ADR. Ensure that the CMS requirements for the face-to-face encounter have been met [...]

17730

Avoiding/Correcting This Error This edit is applied if the NPI and first four letters of the physician’s last name submitted on the claim in the Referring field do not match the physician’s NPI and first four letters of the physician’s last [...]

55H1R

Avoiding/Correcting This Error Review coverage and billing guidelines for the NOE to ensure that your NOEs are accurately billed. Related Content CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 9, Section [...]

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 [...]

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 [...]

32072

Avoiding/Correcting This Error The attending physician reported on your claim must be active in PECOS to be considered a valid attending physician for the home health patient.

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 [...]

56900

Avoiding/Correcting This Error This reason code can and should be prevented. When providers receive an ADR, respond according to the date listed in the ADR. Providers should start gathering the documentation being requested immediately. This [...]

56900

Avoiding/Correcting This Error This reason code can and should be prevented. When providers receive an ADR, respond according to the date listed in the ADR. Providers should start gathering the documentation being requested immediately. This [...]

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 [...]

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:   [...]

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 [...]

38055

Avoiding/Correcting This Error Verify the claim history using the FFS/DDE Provider Online system, your remittance advice and/or the CWF to determine the episode claim that is causing the overlap If there are services that should have been [...]

39934

Avoiding/Correcting This Error You can find line level information by accessing MAP171D in the FISS/DDE Provider Online System: Hit <F2>/<PF2> once or <F11>/<PF11> twice from Claim Page 02 of the claim to access [...]

38050

Avoiding/Correcting This Error Check your remittance advice or the claims processing system for a previously submitted/processed claim before submitting any new billing.

Collaborative Wheelchair Options and Accessories Webinar Coming September 30, 2025

Collaborative Wheelchair Options and Accessories Webinar Coming September 30, 2025 This is your opportunity to hear directly from the Medicare contractors regarding Medicare’s criteria necessary for the coverage of wheelchair options and [...]

Learning Medicare Secondary Payer Interactively

Join us for an interactive learning webinar where you can engage and have fun at the same time! It’s all about learning the Part B Medicare Secondary Payer (MSP) provisions with live case scenarios. Providers will understand their [...]

Ambulance Duplicate Claim Denials

Ambulance Duplicate Claim Denials Duplicate trips may be reported on the same claim if the ZIP code for the point of pick-up for both trips is the same. If separate claims are submitted for the same beneficiary on the same day with the same [...]

Ambulance Services and the Advance Beneficiary Notice of Noncoverage

Ambulance Services and the Advance Beneficiary Notice of Noncoverage To follow are Medicare’s guidelines regarding the use of an ABN for ambulance services. Per the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) [...]

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 [...]

Ambulance Physician Certification Statement Guidelines

Ambulance Physician Certification Statement Guidelines Certification Type Certification Required? Yes/No Who May Sign the Certification Timeframe Other Information /Resources Nonemergency, scheduled, [...]

Coverage of Rural Air Ambulance Services

Coverage of Rural Air Ambulance Services Section 415 of the Medicare Modernization Act of 2003 provides coverage for rural air ambulance services that are reasonable and necessary and ordered by qualified personnel. Medicare considers the [...]