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:   [...]

31287

Avoiding/Correcting This Error Hospice claims are required to be billed monthly. Verify the month beginning and ending date and the ‘From’ and ‘To’ dates on your claim. The claim must span the entire month for continuing care claims.

30993

Verify the MBI submitted on the claim matches the MBI in the Common Working File. If a new MBI has been assigned, follow the guidelines regarding the claim submission: For dates of service before the MBI change date use old or new MBI If [...]

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 [...]

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 [...]

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 [...]

How to Avoid and Correct Duplicate Claim Denials

How to Avoid and Correct Duplicate Claim Denials A duplicate claim submission occurs when a physician or other qualified healthcare professional resubmits a claim either on paper or electronically for a single encounter and the service is [...]

Portable X-Ray Cost Analysis Survey

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction K Part B Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Paring or Cutting of Benign Hyperkeratotic Lesion 11055, 11056, 11057 A07 – The [...]

Getting Access to PECOS

During this webinar, we’ll discuss how to obtain access to the Internet-based Provider Enrollment Chain & Ownership System (PECOS) and gain connection to provider enrollment record as well as understand other Centers for Medicare & [...]

MLN Connects® Newsletter: April 24, 2025

MLN Connects® Newsletter: April 24, 2025 News Open Payments: Review Your Data by May 15 Medicare Shared Savings Program: Application Toolkit Materials MLN Matters® Articles Inpatient Psychiatric Facilities: Return to Provider Claims [...]

(CORRECTION) Some Claims Editing for Reason Code U537I, HH Claim Falls Outside of an HH Admission Period for the Same Provider

The CWF can only hold the 36 most recent periods of care for any beneficiary. CWF also contains the indicator of when the HH admission (NOA) was processed. This indicator allows CWF to determine whether an HH admission period is on file with [...]

REVALIDATION: How do I know I need to revalidate?

REVALIDATION: Where is the revalidation notification letter sent?

SIGNATURES: Who signs the CMS applications and forms for an entity? (ex. 855A, 855B, 20134, 460, 588)

SIGNATURES: Who signs the CMS applications and forms for an entity? (ex. 855A, 855B, 20134, 460, 588)

APPLICATION FEE: Who needs to pay an application fee?

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?

APPLICATION STATUS: Where can I find the status of a submitted application?

DETERMINATION LETTER: How can I get a copy of the determination (approval/denial) letter for a submitted application?

DETERMINATION LETTER: Where are the determination (approval/denial) letters sent?

PECOS: I received an email to sign an application; how do I do this?

REVALIDATION: How do I know I need to revalidate?

SIGNATURES: Who signs the CMS applications and forms for an entity? (ex. 855A, 855B, 20134, 460, 588)

SIGNATURES: Who signs the CMS-855I application?

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?

DETERMINATION LETTER: How can I get a copy of the determination (approval/denial) letter for a submitted application?

DETERMINATION LETTER: Where are the determination (approval/denial) letters sent?

PECOS: I received an email to sign an application; how do I do this?

PECOS: In PECOS, how do I know if the authorized/delegated official or individual provider signed the application?

PECOS: In PECOS, please advise how to respond when the MAC needs additional information or supporting documentation for a submitted application.

REVALIDATION: Where is the revalidation notification letter sent?

REVALIDATION: Do I need to revalidate if it has not been five years since my last revalidation?

PECOS: In PECOS, how do you find an enrollment to submit an application?

PECOS: In PECOS, please advise how to respond when the MAC needs additional information or supporting documentation for submitted application.

PECOS: In PECOS, how do I submit an application?

PECOS: In PECOS, how do I know what enrollment information Medicare currently has on file for a provider or supplier?

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

REVALIDATION: Do I need to revalidate if it has not been five years since my last revalidation?

PECOS: In PECOS, how do I know if the authorized/delegated official or individual provider signed the application?

Steps to Claim Corrections

This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

NGSConnex: Part B Redetermination Notifications

National Government Services will discontinue mailing paper Medicare Redetermination Notices (MRNs) when Part B redetermination requests are submitted through NGSConnex beginning in March 2025. During this webinar, we’ll share information and [...]

NGSConnex: Part B Redetermination Notifications

National Government Services will discontinue mailing paper Medicare Redetermination Notices (MRNs) when Part B redetermination requests are submitted through NGSConnex beginning in March 2025. During this webinar, we’ll share information and [...]

Opioid Treatment Program

An opioid treatment program (OTP) is a clinic offering medication-assisted treatment for individuals with opioid use disorder. During this webinar, we’ll review background and coverage details, including key billing requirements for proper [...]

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.

NGSConnex: Part B Redetermination Notifications

National Government Services will discontinue mailing paper Medicare Redetermination Notices (MRNs) when Part B redetermination requests are submitted through NGSConnex beginning in March 2025. During this webinar, we’ll share information and [...]

NGSConnex: Part B Redetermination Notifications

National Government Services will discontinue mailing paper Medicare Redetermination Notices (MRNs) when Part B redetermination requests are submitted through NGSConnex beginning in March 2025. During this webinar, we’ll share information and [...]

Chiropractic Billing and Documentation

During this webinar, we will discuss chiropractic coverage, coding guidelines and the importance of documentation in order to support billing for these services.

What is the Part A Provider Outreach and Education Advisory Group and How Can You Help?

Each of our Provider Outreach and Education Advisory Groups (POE AG) is a primary communication vehicle between the provider community and National Government Services. Our POE AG members serve as a provider education resource to our POE [...]

Billing Telehealth in Federally Qualified Health Centers and Rural Health Centers

During this webinar, we’ll provide you with insight into covered Medicare telehealth services and coverage requirements for federally qualified health center (FQHC) and rural health clinic (RHC) providers. We’ll discuss originating sites, [...]

Medicare Overpayment Process

Ensure that you are compliant and avoid financial penalties by understanding the Medicare overpayment regulations. This session will focus on identifying overpayments, using the proper forms and procedures, the timelines for repayment and the [...]

Skilled Nursing Facility Billing Basics

This session will focus on the basics of skilled nursing facility (SNF) inpatient billing, including the required fields on SNF claims, timeframes for claim submission and how proper billing impacts payment.

Targeted Probe and Educate: Where to Find the Information Needed for a Successful Review

Do you know where to look on our website for current Part A Targeted Probe and Educate (TPE) topics? Are you receiving claim denials for TPE reviews and need more resources? Join us for a session where we will dive into our website to show you [...]

The Initial Preventive Physical Examination: Promoting Good Health Through Disease Prevention and Detection

Medicare covers many preventive services to keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep your patients from getting certain diseases. Register today for an [...]

Rural Health Clinic Coverage and Payment

This session is focused on the basics of rural health clinics (RHCs) – requirements to be an RHC, what types of Medicare services are covered and non-covered in this facility type and an overview of how RHCs are reimbursed. Helpful [...]

The National Correct Coding Initiative and Medically Unlikely Edits for Part B Providers

This webinar will assist Part B providers with navigating tables for the National Correct Coding Initiative and the medically unlikely edits. We'll also review proper modifiers to use to avoid denials. There will be time for your questions [...]

Counseling to Prevent Tobacco Use

In an effort to raise awareness and increase utilization of tobacco use counseling, we’ll focus on the effects of nicotine dependence including affected health consequences during this webinar. Medicare coverage, coding, billing and [...]

Counseling to Prevent Tobacco Use

In an effort to raise awareness and increase utilization of tobacco use counseling, we’ll focus on the effects of nicotine dependence including affected health consequences during this webinar. Medicare coverage, coding, billing and [...]

Medicare Secondary Payer Payment Methodology

Please join us for this learning session on how MSP payments are calculated. It’s essential for providers and their staff members to be able to determine the beneficiary’s responsibility to ensure that claims are being submitted to the Medicare [...]

How to Avoid Duplicate Claims

Duplicate denials continue to be one of the top billing errors. Unnecessary duplicate filing of Medicare claims cost the provider's office valuable time and resources, as well as Medicare's time and money to process them. Please join us [...]