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4,555 Results for
  • Posting Date: 01/25/2025
    17730

    Avoiding/Correcting This Error This edit is applied if the NPI and first four letters of the physician’s last name submitted on the claim in the Referring field do not match the physician’s NPI and first four letters of the physician’s last [...]

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  • Posting Date: 01/25/2025
    55H1S

    Avoiding/Correcting This Error Include all face-to-face encounter attestations for the third benefit period and after with your medical record submission to the ADR. Ensure that the CMS requirements for the face-to-face encounter have been met [...]

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  • Posting Date: 01/25/2025
    U5601

    Avoiding/Correcting This Error Verify the dates of service on your claim. If the information on your claim is correct, contact the other provider to have them correct their claim. If the information on your claim is incorrect, resubmit your [...]

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  • Posting Date: 01/25/2025
    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 [...]

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  • Posting Date: 01/25/2025
    U5113

    Avoiding/Correcting This Error The 8xB (NOTR) transaction should only be submitted when the beneficiary revokes the hospice benefit or is discharged alive and there is no final claim in the system indicating termination of the hospice benefit. [...]

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  • Posting Date: 01/25/2025
    31644

    Avoiding/Correcting This Error Hospice room and board denials should be submitted as non-covered charges with revenue code 0659, HCPCS A9270, and the ‘GY’ modifier. Review the information submitted on your claim, correct, and resubmit.

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  • Posting Date: 01/25/2025
    32005

    Avoiding/Correcting This Error No dates of service prior to the provider effective date can be billed to Medicare. Verify the dates of service billed on your claim are on or after the agency’s Medicare effective date, correct and resubmit.

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  • Posting Date: 01/25/2025
    U537I

    Avoiding/Correcting This Error All dates of service reported on a period of care claim must be on or after the date of admission. Verify the from and through dates billed and all line item dates of service to ensure the dates are within the [...]

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  • Posting Date: 01/25/2025
    U523A

    Avoiding/Correcting This Error This reason code is a notification to the provider of a VBID patient. For more information, including calendar-year specific downloadable lists of service area PBPs and contact information, please refer to the [...]

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  • Posting Date: 01/25/2025
    W7010

    Avoiding/Correcting This Error This edit is applied to claims submitted with condition code 21 for an insurance denial.  If the services were not meant to be sent for insurance denial, you will need to go through the appropriate [...]

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  • Posting Date: 01/25/2025
    17729

    Avoiding/Correcting This Error This edit is applied if the NPI and first four letters of the physician’s last name submitted on the claim in the Attending field do not match the physician’s NPI and first four letters of the physician’s last [...]

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  • Posting Date: 01/25/2025
    17730

    Avoiding/Correcting This Error This edit is applied if the NPI and first four letters of the physician’s last name submitted on the claim in the Referring field do not match the physician’s NPI and first four letters of the physician’s last [...]

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  • Posting Date: 01/25/2025
    38032

    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 [...]

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  • Posting Date: 01/25/2025
    39929

    Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Providers can see line details in NGSConnex and hover over the line item reason code(s) for [...]

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  • Posting Date: 01/25/2025
    U5065

    Avoiding/Correcting This Error HH+H may only bill services provided to the patient after the effective date of their Medicare coverage. Verify the effective date(s) for the MBI of the beneficiary prior to billing. If a new MBI has been issued [...]

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  • Posting Date: 01/25/2025
    56900

    Avoiding/Correcting This Error This reason code can and should be prevented. When providers receive an ADR, respond according to the date listed in the ADR. Providers should start gathering the documentation being requested immediately. This [...]

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  • Posting Date: 01/25/2025
    56900

    Avoiding/Correcting This Error This reason code can and should be prevented. When providers receive an ADR, respond according to the date listed in the ADR. Providers should start gathering the documentation being requested immediately. This [...]

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  • Posting Date: 01/25/2025
    32072

    Avoiding/Correcting This Error The attending physician reported on your claim must be active in PECOS to be considered a valid attending physician for the home health patient.

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  • Posting Date: 01/25/2025
    37236

    Avoiding/Correcting This Error Verify eligibility of the attending/ordering physicians in PECOS. Print that verification and make it part of the medical record. If applicable, submit a reopen request to the Appeals Department indicating error [...]

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  • Posting Date: 01/25/2025
    55H1L

    Avoiding/Correcting This Error Clinical progress notes should show evidence of a steady decline or downward trajectory in the beneficiary’s clinical status over time. Documentation should be objective, measurable and must support a life [...]

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  • Posting Date: 01/25/2025
    55H1R

    Avoiding/Correcting This Error Review coverage and billing guidelines for the NOE to ensure that your NOEs are accurately billed. Related Content CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 9, Section [...]

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  • Posting Date: 01/25/2025
    52MUE

    Avoiding/Correcting This Error You have the right to submit an appeal when you believe the medical records support that the denied services were reasonable and medically necessary. Providers should review the information on the CMS website [...]

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  • Posting Date: 01/25/2025
    52NCD

    Avoiding/Correcting This Error Ensure all Medicare coverage and medical necessity requirements are met prior to billing. If the provider determines that Medicare will not cover the services, consider submitting the charges as noncovered. [...]

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  • Posting Date: 01/25/2025
    52NCD

    Avoiding/Correcting This Error Ensure all Medicare coverage and medical necessity requirements are met prior to billing. If the provider determines that Medicare will not cover the services, consider submitting the charges as noncovered. [...]

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  • Posting Date: 01/25/2025
    54NCD

    Avoiding/Correcting This Error Review coverage guidelines for the service being denied to ensure medical necessity of the services being provided to the beneficiary. Ensure all Medicare coverage and medical necessity requirements are met [...]

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  • Posting Date: 01/25/2025
    55B31

    Avoiding/Correcting This Error Review coverage guidelines and patient records to determine if all appropriate documentation was sent for review that may have supported medical necessity. When you receive an ADR from National Government [...]

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  • Posting Date: 01/25/2025
    55B31

    Avoiding/Correcting This Error Review coverage guidelines and patient records to determine if all appropriate documentation was sent for review that may have supported medical necessity.  When you receive an ADR from National Government [...]

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  • Posting Date: 01/25/2025
    55S05

    Avoiding/Correcting this Error The SNF should ensure that SNF services that are not covered are identified. After discussion with the beneficiary and/or representative you should properly issue an ABN and bill for the noncovered services [...]

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  • Posting Date: 01/25/2025
    55S29

    Avoiding/Correcting This Error Respond promptly to a MAC, CERT, RAC, SMRC, or UPIC request for additional documentation.  Documentation is necessary to verify compliance with a benefit category requirement. Ensure that all records, [...]

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  • Posting Date: 01/25/2025
    59118

    Avoiding/Correcting This Error Review reason code 59118 in the Direct Data Entry system for applicable codes. Alternatively, review the latest Change Requests/MLN® Matters articles for relevant ICD-10 updates. The most current MLN Matters [...]

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  • Posting Date: 01/25/2025
    59118

    Avoiding/Correcting This Error Review reason code 59118 in the Direct Data Entry system for applicable codes. Alternatively, review the latest Change Requests/MLN® Matters articles for relevant ICD-10 updates. The most current MLN Matters [...]

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  • Posting Date: 01/27/2025
    Frequently Asked Questions Have Been Reviewed and Updated

    Frequently Asked Questions Have Been Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Topics available are: ASCA Appeals CAR T-cell [...]

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  • Posting Date: 01/25/2025
    Overpayment: How Should I Respond?

    Table of Contents Overpayment: How Should I Respond? What Action Should I Take? Complete a Voluntary Refund Where Should I Send my Forms and Payments? [Return to Top] Overpayment: How Should I Respond? An overpayment may be [...]

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  • Posting Date: 01/25/2025
    Request an Immediate Recoupment

    National Government Services has implemented a standardized “immediate recoupment” process that gives you the option to avoid interest from accruing on claims overpayments when the debt is recouped in full prior to or by the 30th day from the [...]

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  • Posting Date: 01/25/2025
    Complete a Voluntary Refund

    A voluntary refund is when you have self-identified you have been overpaid and you need to refund the excess funds to Medicare. All checks are made payable to National Government Services. Whenever possible, the refund to Medicare should be [...]

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  • Posting Date: 01/25/2025
    Set Up an Extended Repayment Schedule

    If repaying an overpayment would constitute a “hardship” on the provider, a request for an ERS should be submitted immediately. While you may request an ERS at any time during the debt-collection process, timely submission of a valid request [...]

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  • Posting Date: 12/19/2016
    Payment Withholding Information

    Payment Withholding Information What Is a Payment Withholding? Why Are Payments Withheld? Who Can I Contact for Further Assistance? What About Cost Report Interim and Final Settlement Withholdings? What Is a Payment Withholding? An [...]

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  • Posting Date: 01/25/2025
    MSP Post-Pay Adjustments

    If you have received an overpayment because Medicare paid as the primary insurer and another insurance carrier should be the primary payer, follow the instructions on the Part A voluntary refund form. A separate refund form is needed for [...]

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  • Posting Date: 12/19/2016
    Refunds Due to Beneficiaries by Providers

    Refunds Due to Beneficiaries by Providers In some situations, providers are responsible for refunding monies to beneficiaries that have paid for services providers have determined to be noncovered and nonpayable by Medicare. When an ABN has [...]

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  • Posting Date: 01/27/2025
    Credit Balance Reporting

    Table of Contents What is a Credit Balance? What Should I Do When I Have a Credit Balance? Additional Tips for a Successful Credit Balance Report Submission [Return to Top] What is a Credit Balance? Generally, when a provider [...]

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