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4,603 Results for
  • Posting Date: 04/09/2025
    U5065

    Avoiding/Correcting This Error Check/verify the beneficiary's entitlement dates in the CWF. A Medicare beneficiary, or their authorized representative, may have requested a new MBI. Verify eligibility and MBI number, correct and return the claim.

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  • Posting Date: 04/09/2025
    38119

    Avoiding/Correcting This Error Verify the admission date and from date on this claim Verify the patient’s MBI to make sure that it has been correctly reported If the MBI is incorrect, this edit will be assigned If admission and from dates [...]

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  • Posting Date: 04/09/2025
    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: 04/09/2025
    U5065

    Avoiding/Correcting This Error Check/verify the beneficiary's entitlement dates in the CWF. A Medicare beneficiary, or their authorized representative, may have requested a new MBI. Verify eligibility and MBI number, correct and return the claim.

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  • Posting Date: 04/09/2025
    U5065

    Avoiding/Correcting This Error Check/verify the beneficiary's entitlement dates in the CWF. A Medicare beneficiary, or their authorized representative, may have requested a new MBI. Verify eligibility and MBI number, correct and return the claim.

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  • Posting Date: 04/09/2025
    U5065

    Avoiding/Correcting This Error HHH 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: 04/09/2025
    W7088

    Avoiding/Correcting This Error Each FQHC PPS claim must be billed with a qualifying visit code, and associated line-item charges, along with all other FQHC services furnished during the encounter. A qualifying visit code is the code that [...]

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  • Posting Date: 04/09/2025
    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: 04/09/2025
    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: 04/09/2025
    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: 04/09/2025
    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: 04/09/2025
    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: 04/09/2025
    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: 04/09/2025
    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: 04/09/2025
    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: 04/09/2025
    39928

    Avoiding/Correcting This Error To access the line level reason associated with this reason code providers should go to claim page (2) (MAP 1712) and F11 to MAP171D to see the line level denial codes for each line of the claim. If you disagree [...]

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  • Posting Date: 04/09/2025
    5ND07

    Avoiding/Correcting This Error To prevent this error, ensure all Medicare coverage and medical necessity requirements are met prior to billing. Providers can visit the CMS Coverage Database to review the NCDs and LCDs to determine the [...]

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  • Posting Date: 04/09/2025
    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: 04/09/2025
    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: 04/09/2025
    39928

    Avoiding/Correcting This Error To access the line level reason associated with this reason code providers should go to claim page (2) (MAP 1712) and F11 to MAP171D to see the line level denial codes for each line of the claim. If you disagree [...]

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  • Posting Date: 04/09/2025
    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: 04/09/2025
    56900

    Avoiding/Correcting This Error Regularly access claims in status locations SB6001, SB6098, or SB6099 to obtain a listing of claims for which records have not yet been received by the MAC (Medical Review Department). Look for information on the [...]

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  • Posting Date: 04/09/2025
    56900

    Avoiding/Correcting This Error Regularly access claims in status locations SB6001, SB6098, or SB6099 to obtain a listing of claims for which records have not yet been received by the MAC (Medical Review Department). Look for information on the [...]

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  • Posting Date: 04/09/2025
    5WEXC

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

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  • Posting Date: 04/09/2025
    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: 04/09/2025
    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: 04/09/2025
    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: 04/09/2025
    5WEXC

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

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  • Posting Date: 01/03/2024
    Download PC Print

    Download PC Print Please select from the two available versions of PC Print below. PC Print 7.1.5 PC Print 9.3.2 For the most current CARC/RARC code sets with full narrative and business scenarios, please download PC Print 9.3.2. and [...]

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  • Posting Date: 04/09/2025
    32243

    Avoiding/Correcting This Error Review the claim and either update the charges or remove the line containing zero or blank charges. Return the claim for processing. 

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  • Posting Date: 04/09/2025
    32415

    Avoiding/Correcting This Error Append the “A6” condition code to the claim and F9 or resubmit.  Related Content CMS Internet-Only Manual Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section [...]

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  • Posting Date: 04/09/2025
    31836

    Avoiding/Correcting This Error Verify billing and, if appropriate, correct and resubmit the claim for payment. Related Content CMS PFS Look-up Tool Overview

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  • Posting Date: 04/09/2025
    31836

    Avoiding/Correcting This Error Verify billing and, if appropriate, correct and resubmit the claim for payment. Related Content MLN® Booklet: How to Use the PFS Look-up Tool

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  • Posting Date: 04/09/2025
    Acute Care Hospitals: Advance Beneficiary Notice of Noncoverage (CMS-R-131 Form) for Outpatient Services

    Acute care hospitals: Do you understand when and how to issue an Advance Beneficiary Notice of Noncoverage (ABN) for outpatient services? Join this session to learn more about the voluntary and mandatory ABN, three payment liability conditions, [...]

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  • Posting Date: 04/10/2025
    NGSConnex: Part B Redetermination Electronic Notification Letters

    National Government Services will discontinue mailing paper Medicare Redetermination Notices (MRNs) when Part B redetermination requests are submitted through NGSConnex beginning in March 2025. During this webinar, we’ll share information and [...]

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  • Posting Date: 05/27/2021
    Submitting a Medicare GME Affiliation Agreement

    Submitting a Medicare GME Affiliation Agreement Table of Contents Submitting a Medicare GME Affiliation Agreement Jurisdiction K MAC (NGS) Jurisdiction 6 MAC (NGS) Submitting a Medicare GME Affiliation Agreement In [...]

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  • Posting Date: 04/09/2025
    Part A Top Reason Code changes

    Part A Top Reason Code changes National Government Services, Inc. updates the Top Claim Errors on our website each quarter to ensure our Part A providers have the latest information on top claim errors including denials, return to provider, [...]

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  • Posting Date: 05/15/2024
    Stay of Enrollment

    Stay of Enrollment The individual provider or authorized/delegated official of a group/facility agrees to adhere to all Medicare requirements when enrolling. CMS implemented a preliminary, interim status representing a pause in enrollment [...]

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  • Posting Date: 04/10/2025
    Stay of Enrollment

    Stay of Enrollment The individual provider or authorized/delegated official of a group/facility agrees to adhere to all Medicare requirements when enrolling. CMS implemented a preliminary, interim status representing a pause in enrollment [...]

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  • Posting Date: 04/10/2025
    Prohibition of AI Assistant Usage for Recording Medicare Sessions

    Prohibition of AI Assistant Usage for Recording Medicare Sessions National Government Services has observed a rise in attempts to use various AI assistants during NGS-hosted sessions. It is important to note that the CMS has a longstanding [...]

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  • Posting Date: 04/10/2025
    Benefits of Quitting Tobacco

    Benefits of Quitting Tobacco Quitting tobacco use in any form is one of the most important actions people can take to improve their health. This is true regardless of their age or how long they have been using tobacco products. While quitting [...]

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  • Posting Date: 05/30/2024
    ABF - Promo 1 (Think Green Go Paperless)

    Think Green Go Paperless /web/ngs/edi-solutions?selectedArticleId=907003

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  • Posting Date: 04/10/2025
    NGSConnex: Appeals, Clerical Error Reopenings and Prior Authorization Request

    This webinar is geared toward Part B providers who bill to Medicare on a CMS-1500 form. Did you ever wonder what you need to do when a claim denies, or if you made a clerical error on a claim? What about the time it takes to mail additional [...]

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  • Posting Date: 04/10/2025
    NGSConnex: Claim Status and Details, Remittance Advice and Submitting General Inquiries

    We aim to help providers maximize the benefits of NGSConnex, particularly in claims review. NGSConnex provides an in-depth view of claims submitted to and adjudicated by National Government Services. During this webinar, we’ll highlight its [...]

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  • Posting Date: 04/10/2025
    NGSConnex: Claim Status and Details, Remittance Advice and Submitting General Inquiries

    We aim to help providers maximize the benefits of NGSConnex, particularly in claims review. NGSConnex provides an in-depth view of claims submitted to and adjudicated by National Government Services. During this webinar, we’ll highlight its [...]

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  • Posting Date: 04/10/2025
    NGSConnex: Part B Financial Information

    If you manage finances for a Medicare Part B provider practice, NGSConnex offers valuable tools for organizing and settling payments, including overpayments. Local Security Officers can also access and print electronic versions of 1099 forms. [...]

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  • Posting Date: 04/10/2025
    NGSConnex: Part B Financial Information

    If you manage finances for a Medicare Part B provider practice, NGSConnex offers valuable tools for organizing and settling payments, including overpayments. Local Security Officers can also access and print electronic versions of 1099 forms. [...]

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  • Posting Date: 04/10/2025
    NGSConnex: Beneficiary Eligibility, Look Up and MBI Look Up

    This webinar is geared toward all lines of business. Knowing if your patient is Medicare-eligible is important for correct claims processing. Please join us for this NGSConnex portal webinar where we will review beneficiary eligibility and look [...]

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  • Posting Date: 04/10/2025
    Maintaining Your Provider Files

    During this webinar, we'll share information to aid you in maintaining accurate provider enrollment files for the internet-based CMS systems: Identity & Access Management System (I&A), National Plan & Provider Enumeration System (NPPES), and [...]

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  • Posting Date: 04/10/2025
    Overview of Evaluation and Management Services

    We've seen major changes to the evaluation and management code set over the last few years. In 2021, the AMA implemented changes to the office/other outpatient services codes. After working with those changes for two years the next phase was [...]

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  • Posting Date: 04/10/2025
    Medicare Global Surgery

    Global surgery policy was introduced into Medicare over thirty years ago and still today some of the concepts can be confusing. During this webinar, we'll go through the global surgery policy as it stands today, and cover when the global [...]

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  • Posting Date: 04/10/2025
    Medicare Part B - Submitting Medical Documentation Electronically

    During this webinar, we'll cover the enrollment, registration and methods available for submitting medical documentation to National Government Services. There will be time for your questions following the presentation.

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  • Posting Date: 04/10/2025
    Critical Care and Medicare Billing Compliance

    While critical care codes did not change with the 2021 or 2023 AMA CPT updates, there are a lot of guidelines for billing these services. During this webinar, we'll discuss critical care coding, what is and is not critical care, how to document [...]

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  • Posting Date: 04/10/2025
    Using NGSConnex to Prevent Eligibility Denials and Rejections

    During this webinar, we'll examine common eligibility denials and rejections for National Government Services Part B claims and provide strategies from NGSConnex to prevent them in future submissions. There will be time following the [...]

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  • Posting Date: 04/10/2025
    Medicare Review Contractors

    During this webinar, we'll assist Medicare providers with knowing the difference between the Medicare review contractors and understanding their role in the Medicare review process. We'll discuss the Supplemental Medical Review Contractor [...]

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  • Posting Date: 04/11/2025
    Medicare Compliance With the Incident To Provision

    Do you have nonphysician practitioners that are, or could be, providing services incident to the physicians in the practice? Are you following the Centers for Medicare & Medicaid Services (CMS) regulations for this program? Staying compliant [...]

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  • Posting Date: 04/11/2025
    Medicare Part B Targeted Probe and Educate Process

    Are you familiar with targeted probe and educate? Perhaps you've heard of it but are not sure what it entails. Either way, consider attending this webinar as we cover this important topic. We'll discuss everything you need to know so if you're [...]

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  • Posting Date: 04/11/2025
    Laboratory Part B Billing

    During this webinar, we'll review the Centers for Medicare & Medicaid Services billing requirements for laboratory and pathology services and includes appropriate modifier usage when submitting claims for laboratory/pathology services. There [...]

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  • Posting Date: 04/11/2025
    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 will also review proper modifiers to use to avoid denials. There will be time following the [...]

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  • Posting Date: 04/11/2025
    Fraud Prevention and Detection

    Please join us to increase your awareness of integrity issues and prevention of potential fraudulent and abusive practices against the Medicare Program. We will also review real life fraud cases. There will be time following the presentation to [...]

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