Search Results - NGSMEDICARE

Posting Date: 10/31/2024

Top Claim Errors Reviewed and Updated

Top Claim Errors Reviewed and Updated Using data analysis, we review and update the Top Claim Errors on a quarterly basis and provide: the error reason code; a description of the error; the error type; details that include steps you [...]

Posting Date: 01/24/2025

Hospitals Must Correctly Code Claims Involving Chimeric Antigen Receptor T-cell and Other Immunotherapy to Receive Proper Payment

Hospitals Must Correctly Code Claims Involving Chimeric Antigen Receptor T-cell and Other Immunotherapy to Receive Proper Payment We have noticed that inpatient hospital claims for CAR T-cell and other immunotherapy are not always coded [...]

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 [...]

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 [...]

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 [...]

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 [...]

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. [...]

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.

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 [...]

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 [...]