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 [...]

Medicare Coverage at Rural Health Clinics for Primary Health Care Services for Medicare Patients

Medicare Coverage at Federally Qualified Health Centers for Primary Health Care Services for Medicare Patients

About PA RSNAT Model

  About PA RSNAT Model Table of Contents About PA RSNAT Model Background How it Works Ambulance HCPCS Codes [Return to Top] About PA RSNAT Model The Centers for Medicare & Medicaid Services implemented a prior [...]

2020 Changes Driven by You – National Government Services Self-Service Tools

2020 Changes Driven by You – National Government Services Self-Service Tools We are committed to improving your experience while using our secure self-service tools which includes our NGSConnex portal, our NGSMedicare.com website and our IVR [...]

Hospice Certification and Recertification

Hospice Certification and Recertification We have experienced an increasing number of CERT errors due to documentation requirements not being met. Below is the documentation required for hospice certification and recertification. The hospice [...]

Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated and Advance Payments for Part A Providers and Part B Suppliers Frequently Asked Questions

Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated and Advance Payments for Part A Providers and Part B Suppliers Frequently Asked Questions Please see the below for the latest FAQs related to the CHOPD Accelerated and Advance [...]

Top Tobacco Counseling Claim Errors - Tips to Avoid and Correct Claim Errors

Top Tobacco Counseling Claim Errors - Tips to Avoid and Correct Claim Errors National Government Services is committed to reducing provider burden associated with Medicare claim denials and claim submission errors. Don’t wait until you receive [...]

The Medicare Hospice Benefit: Effects on Other Provider Types

The Medicare Hospice Benefit: Effects on Other Provider Types Table of Contents The Medicare Hospice Benefit: Effects on Other Provider Types What is Hospice Care Providing Services Related to the Terminal Condition Providing Services [...]

Main Menu Options

Main Menu Options The main menu and subsequent menus can be navigated by using your voice or using touch‐tone on your telephone keypad. You can also use touch‐tone entry for provider numbers, Medicare numbers, PTAN, NPI, TIN, dates of service, [...]

Prepare and Submit an MSP Conditional Claim

Table of Contents Background Step 1: Determine if You Can Submit a Conditional Claim Step 2: Prepare a Conditional Claim Conditional Billing Code Table Step 3: Check for a Matching MSP Record for the Beneficiary in the Common [...]

Home Health Top Claim Errors

Do you see the same rejections and returned to providers (RTPs) over and over? Do you know how to correct the most common errors and more importantly how to avoid them in the future? In this session we’ll review the most common reason codes [...]

Hospice Top Claim Errors

Do you see the same rejections and return to providers (RTPs) over and over? Do you know how to correct the most common errors and more importantly how to avoid them in the future? In this session we’ll review the most common reason codes [...]

Avoid Return to Provider and Claim Rejections-Enhancing the Beneficiary Eligibility Verification Process

Avoid Return to Provider and Claim Rejections-Enhancing the Beneficiary Eligibility Verification Process Table of Contents Reason Codes T5052, N5052, U5210, U5220 and U5200 - Preventing RTP and Rejection Claims Why Is Beneficiary [...]

Identifying Payers Primary to Medicare

Section 4: Getting Ready to Bill Medicare Identifying Payers Primary to Medicare Information for All Providers Table of Contents Determine if Medicare is Primary Payer MSP Information Collection Requirements—Frequency Retirement [...]

Use Our Provider Self-Service Tools To Spend Less Time on the Phone

Use Our Provider Self-Service Tools To Spend Less Time on the Phone Did you know our PCC experiences high call volumes at the beginning and the ending of each month? To avoid experiencing prolonged hold times, you can use our provider [...]

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 FISS Provider [...]

U5200

Avoiding/Correcting This Error Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS/DDE Provider Online System or NGSConnex to verify [...]

Attention Home Health Agencies Receiving C7010 Billing Error

Attention Home Health Agencies Receiving C7010 Billing Error Over the past several months one of the top RTP reason codes for home health claims is C7010 – overlap with a hospice election period. The following information will help you avoid [...]

Main Menu Options

table, td, th table { border-collapse: collapse; width: 50%; } Main Menu Options The main menu and subsequent menus can be navigated by using your voice or using touch‐tone on your telephone keypad. You can also use touch‐tone entry for [...]

Missing/Incomplete/Invalid Patient Identifier Remark Code N382

Missing/Incomplete/Invalid Patient Identifier Remark Code N382 If you receive a denial on your remittance with remark code ‘N382’ Missing/Incomplete/Invalid Patient Identifier, please use NGSConnex self-service option to verify the MBI number [...]

Physical/Occupational Therapy Billing

Join us as we review billing guidelines for physical and occupational therapy. We'll review when to apply the KX modifier and the importance of appropriate medical documentation. National Government Services has a Local Coverage Determination [...]

Interactive Voice Response Touch-Tone Instructions

Interactive Voice Response Touch-Tone Instructions Alpha-Numeric Touch-Tone Entries Use this function to enter elements that contain both alpha and numeric characters. Each button on a telephone keypad has a corresponding set of letters. Each [...]

Intensive Behavioral Therapy for Obesity and Screening for Depression and Alcohol Misuse Screening

During this webinar, we''ll review the Medicare coverage, coding and billing guidelines for intensive behavioral therapy for obesity and screening for depression in adults.

The CY 2025 Medicare Physician Fee Schedule Is Now Available

The CY 2025 Medicare Physician Fee Schedule Is Now Available The CY 2025 MPFS is now available. You can view the new fees using the Fee Schedule Lookup tool page on NGSMedicare.com. Posted 12/2/2024

Start Your Morning with a Podcast - Navigating Medicare: Part A Insights for Providers

Start Your Morning with a Podcast - Navigating Medicare: Part A Insights for Providers Did you know we have a podcast channel on both Spotify and Apple Podcasts that are just for our providers? On your way to work each day, listen to these [...]

Medicare Part B Ambulance Coverage, Basics and Billing

During this webinar, we'll educate new staff, or those needing a refresher on basic Medicare Part B ambulance billing guidelines.

Medicare Diabetes Prevention Program

Stop diabetes before it begins. Join us and learn about the Medicare diabetes program to help people with Medicare stay healthy and prevent diabetes.

All Part B Providers – Register Now!

All Part B Providers – Register Now! Don't miss your chance to attend! Don't miss your chance to attend the National Government Services Medicare Part B 2024 Preventive Services Virtual Conference! Registration is happening now, and seats are [...]

Request a Redetermination

Request a Redetermination The first level of appeal is carried out by the affiliated contractor/MAC. Time limit to initiate = 120 days from date of receipt of the initial determination notice Time limit to complete the review = 60 days [...]

Submit a Reconsideration

Submit a Reconsideration The second level of appeal is the reconsideration request and is carried out by the QIC. Time limit to initiate = 180 days from date of receipt of redetermination decision Time limit to complete the review = 60 [...]

Medicare Appeals Council Review

Medicare Appeals Council Review The fourth level of appeal is carried out by the MAC; this may also be referred to as the Department Appeals Board or DAB. Time limit to initiate = 60 days from date of receipt of ALJ decision Time limit to [...]

Reopenings for Minor Errors and Omissions

Reopenings for Minor Errors and Omissions Providers may request a reopening of the original claims processing decision by contacting the TRU. The TRU can be used when you wish to revise the initial determination of a specific service or [...]

Reopening Request Timeframes

Reopening Request Timeframes According to the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 34, Section 10.6.2, Timeframes for Party Requested Reopenings: A party may request a contractor reopen and revise its initial [...]

ALJ Hearing

ALJ Hearing The third level of appeal is an ALJ hearing. Time limit to initiate = 60 days from the date of receipt of reconsideration (QIC decision) Time limit to complete the review = 90 days Amount in controversy = The amount that must [...]

Federal Court Review

Federal Court Review The fifth level of appeal is carried out by the Federal District Court (U.S. District Court). Time limit to initiate = 60 days from date of receipt of Medicare Appeals Council decision Amount in Controversy = The [...]

MLN Connects® Newsletter: November 21, 2024

MLN Connects® Newsletter: November 21, 2024 News Medicare-Funded Physician Residency Positions CMS Roundup (November 15, 2024) Hepatitis B Vaccine: Billing Requirement Update Effective January 1 Hospitals: Use Renewed Beneficiary Notices [...]

Bone Mass Measurements, Colorectal and Prostate Cancer Screenings

During this webinar, we'll review the coverage, coding and billing guidelines for bone mass measurements, colorectal and prostate cancer screenings.

Top Part B Claim Errors for Preventive Services

Join us for a discussion of the top Part B claim denials for preventive services. We'll share the denial reasons, how to correct the denials, and solutions to prevent them from occurring on future claim submissions.

Medicare Telehealth Changes for 2022

Medicare Telehealth Changes for 2022 The CY 2022 MPFS Final Rule indicated that Section 123 of the CAA removed the geographic restrictions and added the home of the beneficiary as a permissible originating site for telehealth services [...]

Telehealth Services

Telehealth Services Table of Contents General Information Originating Site Distant Site List of Covered Medicare Telehealth Services Billing Facility Fee for Originating Site Payment for Professional Fee Place of [...]