Search Results - NGSMEDICARE

Posting Date: 09/16/2020

Pricing <5>

table, td, th table { border-collapse: collapse; width: 50%; } Pricing <5> When Pricing is selected, the IVR will When Pricing is selected, the IVR will play the following: "To obtain pricing information, visit NGSMedicare.com and [...]

Posting Date: 10/27/2022

Submitting Electronic Medical Records via CD or Thumb Drive

Submitting Electronic Medical Records via CD or Thumb Drive National Government Services can accept medical records submitted on a CD or thumb drive however, submitting via our free, secure, web-based portal NGSConnex is preferred and far more [...]

Posting Date: 08/16/2021

Eligibility

Eligibility information is no longer available via the IVR. To obtain Eligibility information login to NGSConnex and select Eligibility Lookup. If you haven’t already registered for NGSConnex, you can obtain detailed step-by-step instructions [...]

Posting Date: 04/19/2022

Documentation Submission Responsibilities

Documentation Submission Responsibilities When medical records are requested, the billing provider is responsible to obtain sufficient documentation to support the medical necessity of the service(s) billed. If the documentation is [...]

Posting Date: 11/13/2024

Part B Claims Impacted by CWF CLIA File Issue

The CWF Host has recognized an issue in the CLIA file and has successfully reloaded the corrected CLIA file.

Posting Date: 11/13/2024

Correct or Adjust a Claim Due to an MSP-Related Issue

Table of Contents Background Step 1: Identify the Fiscal Intermediary Shared System Direct Data Entry Status Location of the Claim and the Reason for the Claim Correction or Change Status Location TB9997 (Returned to Provider Claims) [...]

Posting Date: 07/14/2024

Correcting Reason Code 37253

Correcting Reason Code 37253 To ensure home health claim information aligns with OASIS data, the iQIES OASIS claim data match is essential. If no matching assessment is found in iQIES when a claim is submitted, it will be returned with reason [...]

Posting Date: 10/27/2022

Hospital Acquired Conditions and Present on Admission Resource for Physicians

Hospital Acquired Conditions and Present on Admission Resource for Physicians Did you know that documentation about your patient’s inpatient stay is vital for accurate submission of an inpatient hospital claim to Medicare? This resource [...]

Posting Date: 07/31/2019

Revalidation Application Checklist

Revalidation Application Checklist Use the Revalidation Application Checklist to assist when revalidating your enrollment information. The general checklist will allow you to understand requirements while the PECOS and CMS-855 paper [...]

Posting Date: 11/13/2024

Verify Bank Account Information

National Government Services receives numerous electronic funds transfer banking rejections each year due to frozen or closed bank accounts. To prevent interruption in Medicare payment, billing providers verify an active bank account is [...]

Posting Date: 10/31/2024

November 2024

In This Issue National Government Services Articles for Part A and Part B Providers Local Coverage Determination Open Meeting Reminder – Beginning 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR NGSConnex: Overview, [...]

Posting Date: 11/15/2024

Prevent Revalidation Processing Delays

When National Government Services receives a revalidation application, we often determine additional information is needed to process the application. In those cases, a request for additional information is sent which is commonly referred to as [...]

Posting Date: 11/15/2024

How to Search on the Medicare Revalidation List Tool for Due Date

Table of Contents How to Search on the Medicare Revalidation List Tool for Due Date Find a Provider By NPI By Name Associated Datasets [Return to Top] How to Search on the Medicare Revalidation List Tool for Due Date [...]

Posting Date: 11/15/2024

Revalidate My Enrollment

Step 1: Determine You Are in the Right Place Medicare provider enrollment revalidation is part of the Patient Protection and Affordable Care Act, Section 6401(a), which established a requirement for all enrolled providers/suppliers to [...]

Posting Date: 11/15/2024

Revalidate My Enrollment

Step 1: Determine You Are in the Right Place Medicare provider enrollment revalidation is part of the Patient Protection and Affordable Care Act, Section 6401(a), which established a requirement for all enrolled providers/suppliers to [...]

Posting Date: 11/14/2024

Deactivation of Billing Privileges/Suspension of Payment

Reasons for Deactivation of Medicare Billing Privileges/Suspension of Payment (not all inclusive) Inactivity Failure to complete revalidation within required time frame Unreported provider address and/or bank information Inactivity [...]

Posting Date: 11/14/2024

Deactivation of Billing Privileges/Suspension of Payment

Reasons for Deactivation of Medicare Billing Privileges/Suspension of Payment (not all inclusive) Inactivity Failure to complete revalidation within required time frame Unreported provider address and/or bank information [Return to [...]

Posting Date: 11/15/2024

Revalidate My Enrollment

Table of Contents Step 1: Determine You Are in the Right Place What’s ahead for your next Medicare enrollment revalidation? How will you know if you are due for revalidation? Step 2: Complete the Medicare Application Step 3: [...]

Posting Date: 01/21/2021

No Documentation Received

No Documentation Received National Government Services has experienced an increasing number of CERT errors due to “no documentation” received. The provider either does not respond to the CERT documentation request letter(s), or the provider [...]

Posting Date: 09/20/2019

Signature Requirements

Signature Requirements National Government Services has experienced an increasing number of CERT errors due to “signature requirements” not being met. Providers are not signing orders, certification/recertification forms or office visit notes. [...]

Posting Date: 01/29/2021

Appeals Process after Claims Correction or Denial

Appeals Process after Claims Correction or Denial CERT Process The CERT contractor randomly selects claims submitted to Medicare. Medical records are requested from the providers and then reviewed by health care professionals. The review is [...]

Posting Date: 09/20/2022

Physical Therapy Services

Physical Therapy Services Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means something was missing from the medical records. Below is a list of the most common reasons CERT determined there was [...]

Posting Date: 05/18/2020

Home Prothrombin Time International Normalized Ratio Monitoring for Anticoagulation Management

Home Prothrombin Time International Normalized Ratio Monitoring for Anticoagulation Management Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means that something was missing from the medical records. [...]

Posting Date: 08/23/2021

Psychological and Neuropsychological Testing

Psychological and Neuropsychological Testing Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT [...]

Posting Date: 05/11/2021

Pulmonary Rehabilitation Program Services

Pulmonary Rehabilitation Program Services Insufficient Documentation Causes Most Improper Payments Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT [...]

Posting Date: 11/04/2020

Patient Discharge Disposition Code

Patient Discharge Disposition Code Improper payments due to discharge disposition codes are costly to the Medicare Program and are easily preventable. The CERT contractor has issued errors related to the discharge disposition codes that may [...]

Posting Date: 09/29/2020

Debridement Services

Debridement Services Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was [...]

Posting Date: 09/24/2020

Chronic Care Management

Chronic Care Management Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was [...]

Posting Date: 07/09/2020

Total Joint Arthroplasty

Total Joint Arthroplasty Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records. Providers can help prevent CERT errors on total joint arthroplasty by [...]

Posting Date: 05/12/2020

Botulinum Toxin Injections for Chronic Headaches

Botulinum Toxin Injections for Chronic Headaches Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT [...]

Posting Date: 05/05/2020

Home Health Care Requirements for a Plan of Care

Home Health Care Requirements for a Plan of Care The HHA must be acting upon a physician plan of care that meets the requirements of this section for HHA services to be covered. For HHA services to be covered, the individualized plan of care [...]

Posting Date: 03/30/2020

Chiropractic Services

Chiropractic Services Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was [...]

Posting Date: 05/18/2020

Amending Medical Records

Amending Medical Records Amendments, Corrections and Delayed Entries in Medical Documentation All services provided to beneficiaries are expected to be documented in the medical record at the time they are rendered. [...]

Posting Date: 12/17/2019

Continuous Cycling Peritoneal Dialysis

Continuous Cycling Peritoneal Dialysis We have experienced an increasing number of CERT errors due to documentation requirements not being met. Below is a list of the most common reasons CERT determined there was insufficient documentation [...]

Posting Date: 11/01/2019

Cologuard TM Multitarget Stool DNA Test

CologuardTM Multitarget Stool DNA Test Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined [...]

Posting Date: 01/29/2021

Hemodialysis Treatment

Hemodialysis Treatment Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient documentation that caused improper payments for [...]

Posting Date: 01/29/2021

Psychiatry and Psychology Services

Psychiatry and Psychology Services CERT has determined that insufficient documentation caused improper payments for psychiatry and psychotherapy; insufficient documentation means that information was missing from the medical [...]

Posting Date: 05/28/2020

Hospital Discharge Summary: Insufficient Documentation Causes Most Improper Payments

Hospital Discharge Summary: Insufficient Documentation Causes Most Improper Payments Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there [...]

Posting Date: 01/29/2021

Bill Inpatient or Outpatient Services

Bill Inpatient or Outpatient Services To help avoid denials, National Government Services has compiled information regarding references that will aid in determining whether to bill inpatient or outpatient services. CMS Medicare Learning [...]

Posting Date: 01/29/2021

Process for Requesting Medical Records

Process for Requesting Medical Records Additional Documentation Requests INITIAL ADR letters for CERT are sent to the address on file with the NSC for DMEPOS suppliers, or the MAC for the provider/supplier that billed/submitted the [...]