What Should Be Provided if Medical Records Are Requested for Review?

What Should Be Provided if Medical Records Are Requested for Review? The following should be considered if applicable to the service being reviewed. This is not intended to be an all-inclusive list. Progress/visit notes Physician orders [...]

Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate

Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate Table of Contents Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate Background: Standard Payment vs. [...]

Claims for Drugs Without a Product-Specific Code Assigned

Claims for Drugs Without a Product-Specific Code Assigned National Government Services has noticed that when a claim RTPs for additional information to be added to the Remarks field concerning certain drugs, some providers attempt to provide [...]

Denials for HCPCS G2211

NCCI editing for HCPCS G2211 code was updated on 12/05/2024 to require HCPCS G0463 as the primary code for G2211 add-on code. This has resulted in denials of claims for the add-code G2211 when billed with CPTs 99202-99205 and 99211-99215. [...]

Top J6 Part B Claim Errors are Available

Top J6 Part B Claim Errors are Available We conduct a comprehensive data analysis on a quarterly basis to update and disseminate the latest insights on the most common claim errors. This initiative provides: Claim Error Reason Code [...]

Coverage Criteria and Frequency Limits

Coverage Criteria and Frequency Limits Table of Contents Counseling to Prevent Tobacco Use Diagnosis Coding Cost Sharing Reimbursement Nonparticipating Providers Related Content [Return to Top] Counseling to Prevent Tobacco Use [...]

Counseling to Prevent Tobacco Use and Tobacco Related Diseases Job Aid

April 2025 EDI Front End Quarterly Release

April 2025 EDI Front End Quarterly Release Please be advised that while the Centers for Medicare & Medicaid Services mandated release for April 2025 was installed the weekend of 4/6/2025, the code set updates included with this release [...]

April 2025 EDI Front End Quarterly Release

April 2025 EDI Front End Quarterly Release Please be advised that while the Centers for Medicare & Medicaid Services mandated release for April 2025 was installed the weekend of 4/6/2025, the code set updates included with this release [...]

Social Security Income Ratios

Social Security Income Ratios The federal fiscal year 2023 SSI ratios for IPPS hospitals, IRF and LTCH were posted on the CMS website. IPPS IRF LTCH NGS will update the latest published 2023 SSI ratios in the Provider Specific File of [...]

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 [...]

59132

Avoiding/Correcting This Error RHCs should not bill codes G0108 or G0109. Related Content CMS Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 9, Section 70.5 - Diabetes Self-Management Training (DSMT) [...]

Standard Companion Guide Trading Partner Information

Standard Companion Guide Trading Partner Information Instructions Related to the X12 275 Claims Attachment Version 6020 and HL7 Consolidated Clinical Document Architecture R2.1 Companion Guide Version Number: 8.0 Revised: April 2025 Preface [...]

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. Verify the admission date, from, and through dates on the claim and compare the dates to the [...]

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. Verify the admission date, from, and through dates on the claim and compare the dates to 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.

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 [...]

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 [...]

C7010

Avoiding/Correcting This Error If services are unrelated to hospice stay, resubmit with condition code 07 (treatment of nonterminal illness for hospice patient). Verify hospice enrollment prior to claim submission by reviewing the CWF, the [...]