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 [...]

39934

Avoiding/Correcting This Error You can find line level information by accessing MAP171D in the FISS/DDE Provider Online System: Hit <F2>/<PF2> once or <F11>/<PF11> twice from Claim Page 02 of the claim to access [...]

U5200

Avoiding/Correcting This Error Verify that the MBI on the claim is for the correct beneficiary. If the MBI is correct, verify the beneficiary’s entitlement information, correct, and resubmit if appropriate. If the MBI is incorrect, submit [...]

U5211

Avoiding/Correcting This Error Verify the MBI and dates of service. If appropriate, correct the information and submit a new claim or update returned claim. If the actual date of death was reported in error to the Social Security office, [...]

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 [...]

U5600

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 [...]

37364

Avoiding/Correcting This Error There was an issue with NOAs incorrectly editing for U537F. Once the system was fixed, NOAs could be resubmitted and subsequently processed. NOAs submitted late due to this issue may have affected more than one [...]

38055

Avoiding/Correcting This Error Verify the claim history using the FFS/DDE Provider Online system, your remittance advice and/or the CWF to determine the episode claim that is causing the overlap If there are services that should have been [...]

38200

Avoiding/Correcting This Error This reason code may be applied when an NOA and period of care claim are submitted at the same time or when an NOA and one is already in the system. If the NOA and claim were submitted at the same time, and no [...]

39934

Avoiding/Correcting This Error You can find line level information by accessing MAP171D in the FISS/DDE Provider Online System: Hit <F2>/<PF2> once or <F11>/<PF11> twice from Claim Page 02 of the claim to access [...]

U5210

Avoiding/Correcting This Error Each beneficiary should be screened for eligibility. Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the IVR system, the [...]

U5220

Avoiding/Correcting This Error Verify the MBI and date(s) of service. If services were provided prior to the date the beneficiary was entitled to Medicare, no further action is necessary. Otherwise, correct and resubmit.

Supporting Documentation Information

Supporting documentation with the submission of an application is very important. The paper CMS-855A identifies applicable information under section 17. Here’s a list when applicable for initial enrollment, change of information or [...]

Anesthesia Billing Modifiers

Anesthesia Billing Modifiers Table of Contents Physician Anesthesia Modifiers Qualified Nonphysician Anesthetist Modifiers Monitored Anesthesia Care (MAC) MAC Deep Complex Complicated Teaching Physicians Anesthesia Furnished in [...]

Anesthesia

Anesthesia General Anesthesia Information Anesthesia is the administration of a drug or gas to induce partial or complete loss of consciousness. Services involving administration of anesthesia should be reported by the use of the CPT [...]

Concurrent, Medical Direction and Supervision

Concurrent, Medical Direction and Supervision Table of Contents Concurrent Medically Directed Procedures Medical Direction and Temporary Relief Medical Directed Rate Medically Supervised Related Content [Return to Top] [...]

Group/Member Practice Responsibilities

Group/Member Practice Responsibilities Table of Contents Members of a Group More than One Teaching Physician Related Content [Return to Top] Members of a Group If anesthesiologists are in a group practice, one physician member may [...]

Local Coverage Determinations

Local Coverage Determinations General An LCD is a decision by Medicare, whether to cover, and under what circumstances to cover, a particular item or service in our jurisdiction in accordance with Section 1862(a) (1) (A) of the Social [...]

Moderate (Conscious) Sedation

Moderate (Conscious) Sedation Moderate sedation codes 99143‒99150 were deleted and replaced with codes 99151‒99157 in 2017. 99151‒99157: Are not used to report administration of medications for pain control, minimal sedation, deep sedation, [...]

National Coverage Determinations

National Coverage Determinations General Medicare coverage is limited to items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category). NCDs [...]

Teaching Anesthesiology Services

Teaching Anesthesiology Services Table of Contents Teaching Anesthesiology Services Anesthesia Services and Teaching CRNA Physician Personally Performed and Personally Performed with CRNA and AA Related Content [Return to Top] [...]

Resources and References

Resources and References Anesthesia Guidelines and Regulations CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 12 Section 50 CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 10 CMS [...]

Anesthesia Billing Codes

Anesthesia Billing Codes Table of Contents Anesthesia Not Otherwise Classified Codes Add-On Codes for Anesthesia Related Content [Return to Top] Anesthesia Body Area CPT Codes Head 00100‒00222 [...]

Daily Management and Pain Management

Daily Management and Pain Management Table of Contents Daily Management of Continuous Pain Control Techniques Pain Management Consultations Postoperative Pain Control Procedures [Return to Top] Daily Management of Continuous [...]

Monitoring Anesthesia Services

Monitoring Anesthesia Services Monitored Anesthesia Monitored anesthesia care involves intraoperative monitoring by a physician or qualified individual under the medical direction of a physician or of the patient’s vital physiological signs [...]

Payment and Reimbursement

Payment and Reimbursement Table of Contents Anesthesia Claim Billing Instructions Multiple Anesthesia Procedures Multiple CRNAs Same Procedure Payment at Personally Performed Rate Payment at Medically Directed Rate Payment at [...]

Provider Qualifications

Provider Qualifications Table of Contents General State Licensing Physician – Anesthesiologist (Specialty 05) Medical and Surgical Services Performed with Anesthesia by an Anesthesiologist Qualified Nonphysician Anesthetists [...]

Counseling to Prevent Tobacco Use

In an effort to raise awareness and increase utilization of tobacco use counseling, we’ll focus on the effects of nicotine dependence including affected health consequences during this webinar. Medicare coverage, coding, billing and [...]

Counseling to Prevent Tobacco Use

In an effort to raise awareness and increase utilization of tobacco use counseling, we’ll focus on the effects of nicotine dependence including affected health consequences during this webinar. Medicare coverage, coding, billing and [...]

U5233

Avoiding/Correcting This Error Verify the admission date, from, and through dates on the claim and compare the dates to the HMO entitlement dates. Outpatient facilities and inpatient noninpatient PPS and IRF hospitals, or LTCH billing [...]

U5233

Avoiding/Correcting This Error Verify the admission date, from, and through dates on the claim and compare the dates to the HMO entitlement dates. Outpatient facilities and inpatient noninpatient PPS and IRF hospitals, or LTCH billing [...]

U5233

Avoiding/Correcting This Error Verify the admission date, from, and through dates on the claim and compare the dates to the HMO entitlement dates. Outpatient facilities and inpatient noninpatient PPS and IRF hospitals, or LTCH billing [...]

34293

Avoiding/Correcting This Error Review your beneficiary’s enrollment in a Medicare HMO/MAO prior to providing services. A beneficiary may drop MAO coverage; review the CWF, IVR, NGSConnex, or HETS to identify a termination date for the MAO [...]

U538Q

Avoiding/Correcting This Error Medicare does not pay for medical items/services furnished to an alien beneficiary who was not lawfully present in the United States on the date of service that the items/services were furnished. Related Content [...]

The National Correct Coding Initiative and Medically Unlikely Edits for Part B Providers

This webinar will assist Part B providers with navigating tables for the National Correct Coding Initiative and the medically unlikely edits. We'll also review proper modifiers to use to avoid denials. There will be time for your questions [...]

Illinois, Minnesota, Wisconsin

Member Name Group Email Aldrich, Elizabeth IPW (Independent Physicians of Wisconsin), Allen Family Practice ealdrich@ipw-offices.org Anderson, Benita Aurora Health Care Benita.Anderson@aurora.org [...]

10/28/2024

table, td, th table { border-collapse: collapse; width: 50%; } Self-Service Pulse: What You Need To Know This Week As your MAC, National Government Services wants to provide you with a comprehensive source containing the most [...]

National Government Services Guide for New Providers

National Government Services Guide for New Providers

National Government Services Guide for New Providers

National Government Services Guide for New Providers

Ambulance Services and Establishing Medical Necessity for Part B Providers

This webinar will help the ambulance community understand the importance of medical necessity as it pertains to Medicare’s coverage guidelines.

A/B DME MAC Collaborative Lower Limb Orthoses Webinar

A/B DME MAC Collaborative Lower Limb Orthoses Webinar This is your opportunity to hear directly from the Medicare contractors regarding Medicare’s criteria necessary for the coverage of lower limb orthoses. Representatives from all four DME [...]

Cervical Fusion with Disc Removal Best Practices

Cervical Fusion with Disc Removal Best Practices Table of Contents Introduction Coverage General Documentation Requirements Medical Necessity Criteria for Each Indication Limitations and Exceptions to Conservative Therapy [Return to [...]

Home Health Billing

Avoiding Reason Code 38200

CR 9189 Transmittal 602: Medical Review of Home Health Services

Contractor Advisory Committee

Assist National Government Services in the Development of Local Coverage Determinations Background CMS released Change Request 10901 and the companion MLN® Matters MM10901: Local Coverage Determinations (LCDs) article to expand the parameters [...]

Medicare Overpayments Process

Ensure that you are compliant and avoid financial penalties by understanding the Medicare overpayment regulations. This session will focus on identifying overpayments, using the proper forms and procedures, the timelines for repayment and the [...]

Proper Medicare Part B Claim Submissions

This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments or denials. We will guide you through the CMS-1500 claim form and the electronic equivalent loops [...]

Proper Medicare Part B Claim Submissions

This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments or denials. We will guide you through the CMS-1500 claim form and the electronic equivalent loops [...]

PECOS: View and Manage Reassignments through Group Enrollment

During this webinar, we’ll provide an understanding of how to view and manage reassignments through the group enrollment in Provider Enrollment, Chain and Ownership System (PECOS), including to add or terminate reassignments. Individual [...]

Provider Enrollment: Completing the CMS-855I Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855I provider enrollment paper application for a group member, sole proprietor or sole owner and we’ll also focus on reassigning Medicare benefits.

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction 6 Part B Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or [...]

How to Avoid Duplicate Claims

Duplicate denials continue to be one of the top billing errors. Unnecessary duplicate filing of Medicare claims cost the provider's office valuable time and resources, as well as Medicare's time and money to process them. Please join us for [...]

NGS Office of Congressional Affairs Welcome Letter

Dear Members of Congress and Staff: As your work continues in the 118th Congress, National Government Services, Inc. maintains its dedicated role in serving your district/state as a Medicare contractor for Original Medicare. We are your [...]

Getting Access to PECOS

During this webinar, we’ll discuss how to obtain access to the Internet-based Provider Enrollment Chain & Ownership System (PECOS) and gain connection to provider enrollment record as well as understand other Centers for Mediacre & Medicaid [...]

Provider Enrollment: Completing the CMS-855B Paper Application

During this webinar, we'll provide an understanding of how to complete the CMS-855B provider enrollment paper application for a clinic, group, or supplier.

Medicare Part B Secondary Payer Post-Pay Overpayments

This session is intended to educate providers and office staff on the Medicare Secondary Payer (MSP) post-pay overpayment process. During this webinar, providers and office staff members will learn about the Medicare Part B overpayments process [...]

Contractor Advisory Committee Meeting Records

Contractor Advisory Committee (CAC) Meeting Records Jurisdiction 6 and Jurisdiction K CAC Meeting Records Meeting Date Audio Transcript Key Questions Bibliography 10/17/2024 ‒ Topic: Superficial Radiation [...]