Medicare Coverage Exclusion: Dental Services

Medicare Coverage Exclusion: Dental Services Table of Contents Medicare Coverage Exclusion: Dental Services Dental Services Excluded Under Medicare Part B Exceptions to Dental Service Exclusion Inpatient Services in Connection With [...]

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 [...]

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction K HHH Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Home Health Medical Necessity N/A 55H3V– The documentation did not support the medical [...]

Best Practices for a Successful Targeted Probe and Educate Review

Best Practices for a Successful Targeted Probe and Educate Review Table of Contents Getting Started With TPE Notification Letter During the Review Process Post-Probe/Review Results Letter Prepare for Post-Probe Education [Return to [...]

Standard Companion Guide Health Care Claim: Dental (837D)

NGS Medical Review Process

NGS Medical Review Process Medicare contractors, like National Government Services, operate the medical review program to prevent improper payments and protect the Medicare Trust Fund. Medical reviews involve the collection and clinical review [...]

How to Prevent Common Skilled Nursing Facility Denials

How to Prevent Common Skilled Nursing Facility Denials This article was developed to increase awareness and educate SNFs on the top errors found by our Medical Review team. The information below includes suggestions to ensure documentation [...]

ADR Documentation List by Reason Code

The Exemption Process: Additional Documentation Request Suggested list of documentation for all services to submit to National Government Services Note: Please remember, this is not an all-inclusive list Blepharoplasty, Eyelid Surgery, Brow [...]

Exemption Process

Exemption Table of Contents Exemption Exemption Database Updates to the Exemption Process Annual Cycle Starting January 1 Quick Overview Detailed Overview Ten Claim Sample ADRs Prior Authorization Reminder Related Content [...]