Search Results - NGSMEDICARE

Posting Date: 10/25/2024

U5200

Avoiding/Correcting This Error Verify that the MBI on the claim is for the correct beneficiary. If the MBI is correct, verify the beneficiary’s entitlement information, correct, and resubmit if appropriate. If the MBI is incorrect, submit [...]

Posting Date: 10/25/2024

U5211

Avoiding/Correcting This Error Verify the MBI and dates of service. If appropriate, correct the information and submit a new claim or update returned claim. If the actual date of death was reported in error to the Social Security office, [...]

Posting Date: 10/25/2024

U5233

Avoiding/Correcting This Error Collect all insurance information from the beneficiary when admitted to your HHA. Talk to the beneficiary about insurance changes and check CWF before billing Medicare. Many times a claim will overlap an MAO [...]

Posting Date: 10/25/2024

U5600

Avoiding/Correcting This Error Providers should develop and implement a process to ensure that duplicate claims are not being submitted. If the claim is truly a duplicate, no action is necessary If this is not a duplicate and the provider [...]

Posting Date: 10/25/2024

37364

Avoiding/Correcting This Error There was an issue with NOAs incorrectly editing for U537F. Once the system was fixed, NOAs could be resubmitted and subsequently processed. NOAs submitted late due to this issue may have affected more than one [...]

Posting Date: 10/25/2024

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 [...]

Posting Date: 10/25/2024

38200

Avoiding/Correcting This Error This reason code may be applied when an NOA and period of care claim are submitted at the same time or when an NOA and one is already in the system. If the NOA and claim were submitted at the same time, and no [...]

Posting Date: 10/25/2024

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 [...]

Posting Date: 10/25/2024

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 IVR system, the [...]

Posting Date: 10/25/2024

U5220

Avoiding/Correcting This Error Verify the MBI and date(s) of service. If services were provided prior to the date the beneficiary was entitled to Medicare, no further action is necessary. Otherwise, correct and resubmit.

Posting Date: 11/01/2024

Supporting Documentation Information

Supporting documentation with the submission of an application is very important. The paper CMS-855A identifies applicable information under section 17. Here’s a list when applicable for initial enrollment, change of information or [...]

Posting Date: 11/10/2021

Anesthesia Billing Modifiers

Anesthesia Billing Modifiers Table of Contents Physician Anesthesia Modifiers Qualified Nonphysician Anesthetist Modifiers Monitored Anesthesia Care (MAC) MAC Deep Complex Complicated Teaching Physicians Anesthesia Furnished in [...]

Posting Date: 11/10/2021

Anesthesia

Anesthesia General Anesthesia Information Anesthesia is the administration of a drug or gas to induce partial or complete loss of consciousness. Services involving administration of anesthesia should be reported by the use of the CPT [...]

Posting Date: 11/10/2021

Concurrent, Medical Direction and Supervision

Concurrent, Medical Direction and Supervision Table of Contents Concurrent Medically Directed Procedures Medical Direction and Temporary Relief Medical Directed Rate Medically Supervised Related Content [Return to Top] [...]

Posting Date: 11/10/2021

Group/Member Practice Responsibilities

Group/Member Practice Responsibilities Table of Contents Members of a Group More than One Teaching Physician Related Content [Return to Top] Members of a Group If anesthesiologists are in a group practice, one physician member may [...]

Posting Date: 11/10/2021

Local Coverage Determinations

Local Coverage Determinations General An LCD is a decision by Medicare, whether to cover, and under what circumstances to cover, a particular item or service in our jurisdiction in accordance with Section 1862(a) (1) (A) of the Social [...]

Posting Date: 11/10/2021

Moderate (Conscious) Sedation

Moderate (Conscious) Sedation Moderate sedation codes 99143‒99150 were deleted and replaced with codes 99151‒99157 in 2017. 99151‒99157: Are not used to report administration of medications for pain control, minimal sedation, deep sedation, [...]

Posting Date: 11/10/2021

National Coverage Determinations

National Coverage Determinations General Medicare coverage is limited to items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category). NCDs [...]

Posting Date: 11/10/2021

Teaching Anesthesiology Services

Teaching Anesthesiology Services Table of Contents Teaching Anesthesiology Services Anesthesia Services and Teaching CRNA Physician Personally Performed and Personally Performed with CRNA and AA Related Content [Return to Top] [...]

Posting Date: 11/10/2021

Resources and References

Resources and References Anesthesia Guidelines and Regulations CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 12 Section 50 CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 10 CMS [...]