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Posting Date: 07/13/2021
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 [...]
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Posting Date: 02/02/2021
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 [...]
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Posting Date: 02/02/2021
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 [...]
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Posting Date: 02/02/2021
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 [...]
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Posting Date: 02/02/2021
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 [...]
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Posting Date: 02/02/2021
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, [...]
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Posting Date: 12/15/2021
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. [...]
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Posting Date: 04/25/2024
MLN Connects® Newsletter: April 25, 2024 (UPDATE)
MLN Connects® Newsletter: April 25, 2024 (UPDATE) Editor's Note: CMS updated a message because we delayed the effective date that physicians who certify hospice services must enroll in or opt-out of Medicare until 6/3/2024. You may have to [...]
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Posting Date: 04/29/2024
LCD and Article Updates for April/May 2024
LCD and Article Updates for April/May 2024 Billing and Coding Articles Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin (A59311) [...]
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Posting Date: 04/29/2024
Billing for Drug Wastage: JW and JZ Modifier
Billing for Drug Wastage: JW and JZ Modifier Properly billing for drug wastage and associated modifiers helps to prevent claims processing errors and denials while ensuring you receive correct reimbursement. Providers and suppliers are to [...]
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Posting Date: 04/29/2024
National Government Services Proposed LCDs for Comment (4/25/2024-6/8/2024)
National Government Services Proposed LCDs for Comment (4/25/2024-6/8/2024) The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 4/25/2024 through [...]
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Posting Date: 04/29/2024
What Are the Recovery Auditors' Responsibilities_Part A-B-FQHC-HHH
What Are the Recovery Auditors' Responsibilities? What Are the Recovery Auditors' Responsibilities? Recovery Auditors review claims on a postpayment basis using the same Medicare policies as MACs: NCDs LCDs and CMS manuals/regulations To ensure [...]
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Posting Date: 04/29/2024
How Will I Know When a Payment Determination Has Been Issued_Part A-B-FQHC-HHH
How Will I Know When a Payment Determination Has Been Issued? How Will I Know When a Payment Determination Has Been Issued? When a Recovery Auditor finds that improper payments have been made, they will submit claim adjustments to your MAC. The [...]
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Posting Date: 04/29/2024
ALOB_What Are My Options When I Receive the Recovery Auditor Demand Letter
What Are My Options When I Receive the Recovery Auditor Demand Letter? What Are My Options When I Receive the Recovery Auditor Demand Letter? If you agree with the Recovery Auditor’s determination you can: repay the overpayment amount by check; [...]
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Posting Date: 03/26/2024
Covered Medicare Part B Drugs/Biologicals
Covered Medicare Part B Drugs/Biologicals Each drug and biologic that can be considered for coverage under Medicare Part B has its own set of coverage guidelines. Below are examples of covered Medicare Part B drugs and biologicals, which may [...]
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Posting Date: 04/30/2024
Biomarker Testing for Prostate Cancer Diagnosis
Biomarker Testing for Prostate Cancer Diagnosis N/A L37733 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=37733 A56609 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56609 A59220 [...]
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Posting Date: 12/10/2021
Maximum Payment Limits for Rural Health Centers
Maximum Payment Limits for Rural Health Centers Payment Limit Annual Adjustment Period Covered $190.00 TBD 1/1/2028–12/31/2028 $178.00 TBD 1/1/2027–12/31/2027 $165.00 TBD [...]
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Posting Date: 04/30/2024
2024 Medicare Cost Report Due Dates
2024 Medicare Cost Report Due Dates FYE 12/31/2023 cost reports are due by 5/31/2024. We strongly encourange early filing of the cost report. Early-filed cost reports that are rejected will receive a grace period to re-submit prior to [...]
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Posting Date: 04/30/2024
Water Vapor Thermal Therapy for LUTS/BPH
Water Vapor Thermal Therapy for LUTS/BPH N/A L37808 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=37808 A56590 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56590 A59340 [...]
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