Search Results - NGSMEDICARE

Posting Date: 03/26/2025

APPEALS: Is documentation required for an appeal?

Posting Date: 03/26/2025

APPEALS: Another denial we see is “This service has been provided at a frequency that is more than the medically appropriate indication by policy or regulation.” How can we avoid these denials?

Posting Date: 03/26/2025

APPEALS: We are a large group with many physicians and nonphysician practitioners. When we submit claims for nonphysician practitioners working in different sub-specialties, we get claim denials that state: “D463: New patient qualifications were not met or M13: Only one initial visit is covered per specialty per medical group.” How can we avoid these?

Posting Date: 07/18/2023

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 [...]