Inpatient Psychiatric Certification/Recertification/Delayed Certification

Inpatient Psychiatric Certification/Recertification/Delayed Certification Physicians are required to certify the medical necessity of inpatient services. This is required on admission and if the service is needed for an extended period of [...]

Physician Documentation Requirements for Certification of Home Health Care

Physician Documentation Requirements for Certification of Home Health Care Medicare has changed the physician documentation requirements for certification of home health care for dates of service effective 1/1/2015. While clinicians still need [...]

SNF Inpatient Stays

SNF Inpatient Stays The CERT contractor has seen increased denials of SNF inpatient stays due to missing or incomplete physician certification statement of medical necessity. Certification of medical necessity of inpatient skilled nursing [...]

Physician Orders to Admit to Inpatient Hospital or for Observation Services

Physician Orders to Admit to Inpatient Hospital or for Observation Services Lack of a formal order for inpatient admission or observation services results in an increase of the CERT error rate for National Government Services. CERT auditors [...]

Pacemakers and Cardiac Defibrillators

Pacemakers and Cardiac Defibrillators National Government Services would like to alert providers that although coverage indications of pacemakers and implantable cardiac defibrillators was revised and expanded effective with dates of service [...]

MLN Connects® Newsletter: November 14, 2024

MLN Connects® Newsletter: November 14, 2024 News 2025 Medicare Parts A & B Premiums and Deductibles Medicare Participation for CY 2025 Ambulance Fee Schedule: CY 2025 Final Policies Prior Authorization Review Timeframe Change [...]

November 21st is The Great American Smokeout

November 21st is The Great American Smokeout You Can Help Your Patients Quit Smoking Smoking is one of the leading causes of heart disease and stroke. At least 70% of cigarette smokers see a clinician annually and many want to quit. Each [...]

Part B Claims Denied with Error 524B

An error in CWF processing has not yet been fully corrected. The error is occurring when Demo Codes A5 (Making Care Primary-MCP) or A6 (Guiding an Improved Dementia Experience-GUIDE) are on the claim and the HIC on the claim has an active MSP [...]

IVR Conversion Table

Conversion Chart for Patient Names Conversion Chart for Beneficiary HICN/MBI/PTAN/DCN Letter Conversion Letter Conversion A 2 A *21 B 2 B *22 C 2 C *23 [...]

Using the IVR

Table of Contents MBI Phonetic Alphabet Now Available Tips MBI Phonetic Alphabet IVR Conversion Tool [Return to Top] MBI Phonetic Alphabet Now Available To assist you when speaking the MBI, we have implemented the MBI phonetic [...]

When to Use the Provider Contact Center Versus Self-Service Tools

When to Use the Provider Contact Center Versus Self-Service Tools The CMS requires contractors to provide self-service and electronic communication technologies as efficient, cost effective means of disseminating Medicare provider information, [...]

Prothrombin Time

Prothrombin Time 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 that caused improper [...]

Diagnostic Mammography

Diagnostic Mammography 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 [...]

Prolonged Services

Prolonged 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 [...]

Annual Wellness Visit

Annual Wellness Visit 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 an [...]

Hyperbaric Oxygen Therapy Treatment

Hyperbaric Oxygen Therapy Treatment Insufficient documentation is documentation that was incomplete, inaccurate or was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient [...]

Surgery Services

Surgery Services 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 [...]

Medication Administration

Medication Administration Insufficient documentation means 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 [...]

Ambulance Services

Ambulance Services 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 [...]

Stereotactic Body Radiation Therapy

Stereotactic Body Radiation Therapy Insufficient documentation means that something was missing from the medical records. Below are the most common reasons CERT determined there was insufficient documentation that caused improper payments for [...]

Anesthesia Services

Anesthesia Services Insufficient documentation means 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 [...]

Diagnostic Testing Services

Diagnostic Testing Services Insufficient documentation means 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 [...]

Transcatheter Aortic Valve Replacement

Transcatheter Aortic Valve Replacement The CMS CERT program produces a national Medicare FFS error rate, as required by the Improper Payments Information Act. CMS strives to eliminate improper payments in the Medicare Program to maintain the [...]

Part A to Part B Claims (Rebilling) Submissions

Submitting Part A to Part B Claims (Rebilling) Submissions Administrator’s Ruling CMS 1455-R The Administrator’s Ruling CMS 1455-R, issued on 3/13/2013 established an interim process for hospitals to use to submit claims for Part B [...]

Inpatient Hospital Surgery

Inpatient Hospital Surgery National Government Services would like to alert providers on one of the highest dollar and most avoidable denials from the CERT contractor: submitting documentation relating to inpatient hospital surgeries.  [...]

Redetermination/Reopening Requests Online with NGSConnex

Redetermination/Reopening Requests Online with NGSConnex The NGSConnex web application allows providers/suppliers the ability to electronically submit and check the status of all redeterminations and/or reopenings requests online with no costs [...]

Selecting the Appropriate Principal Diagnosis for Inpatient Services

Selecting the Appropriate Principal Diagnosis for Inpatient Services CERT analysis indicates providers are not coding the principal diagnosis to the highest level of specificity and/or selecting the most appropriate code for the inpatient [...]

Complete Blood Count with Differential CPT Code 85025

Complete Blood Count with Differential CPT Code 85025 Error code 31 services incorrectly coded have been increasing in relation to CPT code 85025 - Complete blood count with differential (CBC w/Diff). Review of the CERT data shows that the [...]

Evaluation and Management Codes

Evaluation and Management Codes E/M services are the most common CERT errors found with Medicare Part B claims. The medical records that were provided either do not support the level of service billed or do not indicate the service was [...]

Diagnosis-Related Group Claims Reviewed for IPPS Providers

Diagnosis-Related Group Claims Reviewed for IPPS Providers This notice is intended to educate IPPS providers on the CERT program findings for DRG claims reviewed. Trending analysis disclose that the top errors are related to medical necessity [...]

Therapy Checklist

Therapy Checklist National Government Services would like to thank all providers for their cooperation in providing requested medical records to the CDC. We at NGS appreciate your effort and encourage your continued assistance in the program. [...]

Urgent: Beginning Monday 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR

Urgent: Beginning Monday 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR As we’ve communicated, beginning Monday 11/18/2024, beneficiary eligibility information will not be offered on the IVR. This includes all [...]

Urgent: Starting Today 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR

Urgent: Starting Today 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR As we’ve communicated, starting today, 11/18/2024, you won’t have access to beneficiary eligibility information on the IVR. This includes all [...]

Hospital

Hospital Billing for Beneficiaries Enrolled in Option Code C Medicare Advantage Organization Plans

Hospital Billing for Beneficiaries Enrolled in Option Code C Medicare Advantage Organization Plans  A Medicare beneficiary can choose to enroll in an option code C MAO plan. If they do, that plan replaces their original Medicare. Original [...]

Service Specific Post Payment Review of Darbepoetin Alfa Injection, 1 microgram (Non-ESRD Use)

National Government Services Part B MR Department analyzes national and local data to identify possible improper payment for Medicare services. In an effort to reduce the Part B CERT error rate, the MR Department will be conducting a service [...]

Announcing Service Specific Post-Payment Audits of Hyperbaric Oxygen (HBO) Services for J6 A Regions: IL, WI, and MN

Edit Reason Code: 5FPJP Bill Type = 13X CPT/HCPCS/Modifiers: G0277 Overview The Medical Review Department of National Government Services will be performing service specific post-payment reviews for claims submitted to Medicare Part A. When a [...]

Hospice Beneficiary Election Statement Addendum Frequently Asked Questions

Hospice Beneficiary Election Statement Addendum Frequently Asked Questions National Government Services, in collaboration with Palmetto GBA, CGS and CMS, developed these FAQs to assist providers in a better understand of the federal [...]

Multi-Jurisdictional Contractor Advisory Committee (CAC)/Subject Matter Expert Meeting

Multi-Jurisdictional Contractor Advisory Committee (CAC)/Subject Matter Expert Meeting March 10, 2022 Topic: SIJ Interventions and Procedures Questions for SIJ Interventions For all questions, answers must be based on clinical literature [...]

MLN Connects® Special Edition for Thursday, January 7, 2021

MLN Connects® Special Edition for Thursday, January 7, 2021 Physician Fee Schedule Update On December 27, the Consolidated Appropriations Act, 2021 modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS): Provided a [...]