Physicians: Are You Ordering External Breast Prostheses for Your Patient?

Physicians: Are You Ordering External Breast Prostheses and Supplies for Your Patient? Following this guidance will help your patients and the Medicare Program by verifying there is medical documentation to support the provision of external [...]

Long-Term Care Hospital

Reminder: The Self-Service Pulse Has Ended

Reminder: The Self-Service Pulse Has Ended We sincerely thank you for being a loyal reader of our Self-Service Pulse each week. To continue receiving updates on our latest self-service tools and services, please subscribe to our general Email [...]

Health Equity Vaccination Efforts: Achieving the Highest Level of Health and Well-Being for Your Patients

Health Equity Vaccination Efforts: Achieving the Highest Level of Health and Well-Being for Your Patients Health equity is the concept that all people should have a fair and just chance to be as healthy as possible, regardless of their [...]

Who May File an Appeal?

Who May File an Appeal? Who May File an Appeal? Appointment of Representative Who May Be a Representative How to Make and Revoke an Appointment Attorney Representatives Required Elements When to Submit the Appointment Validity of an [...]

About Appeals

About Appeals Providers, suppliers and beneficiaries have the right to appeal claim determinations made by National Government Services. The purpose of the appeals process is to ensure the correct adjudication of claims. Appeals activities [...]

MSP Overpayments

MSP Overpayments If you are appealing or correcting a claim that you have received an overpayment on because Medicare paid as the primary insurer and another insurance carrier should be the primary payer, follow the instructions on the [...]

What Documents are Needed

What Documents are Needed? What Documents are Needed? Medical Records to Support an Appeal Anesthesia Biofeedback Blepharoplasty Cardiac Rehabilitation Services Chiropractic Services Concurrent Care Cosmetic [...]

Submit an Appeal Electronically with NGSConnex

Submit an Appeal Electronically with NGSConnex You can submit redetermination or reopening requests electronically through NGSConnex. To determine if your appeal qualifies as a reopening or redetermination, access the About Appeals page. All [...]

Submit an Appeal Electronically via esMD

Submit an Appeal Electronically via esMD CMS developed a mechanism for contractors to receive first level appeals electronically from providers via a secure gateway known as Electronic Submission of Medical Documentation, or esMD. Some [...]

Get Help Submitting a Appeal Hard Copy

Get Help Submitting a Appeal Hard Copy All levels of appeals may be submitted by mail. The only types of appeals submitted to National Government Services are reopening and redetermination requests. For information on other types of appeals, [...]

How to Avoid Costly Appeals

How to Avoid Costly Appeals This table includes helpful information to help avoid costly appeals. Use the initial submission tips and resources to help reduce claim denials and improve revenue cycle workflow issues within your office. [...]

How to Prevent Duplicate Appeal and Clerical Error Reopening Requests in NGSConnex

How to Prevent Duplicate Appeal and Clerical Error Reopening Requests in NGSConnex Do you currently submit your appeal requests and reopening requests through NGSConnex? If so, did you know you are required to verify whether a request was [...]

Five Levels of Appeals

Levels of Appeals and Time Limits for Filing Table of Contents Five Levels of Appeals: Overview Level One – Redetermination Level Two – Reconsideration (QIC) Level Three – Administrative Law Judge (ALJ) Level Four – Medicare [...]

Medical Review Portal in NGSConnex

Medical Review Portal in NGSConnex If you submit fee-for-service claims to National Government Services and you are a registered NGSConnex account holder, you can respond to Medical Review ADRs and submit supporting documentation [...]

Medical Documentation Signature Requirements

Medical Documentation Signature Requirements Table of Contents Medical Documentation Signature Requirements Missing Signature Illegible Signature Signatures for Amendments, Corrections and Delayed Entries Related Content [Return to [...]

Address Corrections for Providers

Address Corrections for Providers An ADR is sent to the provider’s or physician’s address that is listed in PECOS. This is the last address that was submitted to the MAC’s Provider Enrollment Department and approved by CMS. Questions [...]

Additional Developmental Request Letters Overview

Additional Development Request Letters Overview National Government Services may require additional information in order to appropriately process claims submitted to the Medicare Program. These requests for additional information letters are [...]