Search Results - NGSMEDICARE

Posting Date: 10/27/2022

Submit Medical Record Documentation Electronically

Submit Medical Record Documentation Electronically Table of Contents Submit Medical Record Documentation Electronically What do you need to get started? What are the Attachment Transactions? Who can use the Attachment Transactions? [...]

Posting Date: 11/03/2022

Using the Medicare Part B PWK Fax-Mail-esMD Cover Sheet

Using the Medicare Part B PWK Fax-Mail-esMD Cover Sheet JK and J6 providers have the option of electronically submitting, mailing, or faxing documentation for electronically-submitted claims that require additional documentation for purposes [...]

Posting Date: 10/10/2022

Anesthesia for Pain Management Procedures

Anesthesia for Pain Management Procedures The use of moderate or deep sedation, general anesthesia, and MAC is rarely indicated for pain management procedures and is not considered reasonable and necessary. The ASA provides guidelines for [...]

Posting Date: 11/29/2021

Remittance Advice

Remittance Advice Table of Contents General Information Electronic Remittance Advice Remittance Message Codes Standard Paper Remittance General Information Once Medicare has processed a claim, the provider will receive a notice [...]

Posting Date: 10/14/2021

Requesting an Exception to Timely Filing

Requesting an Exception to Timely Filing Table of Contents Requesting an Exception to Timely Filing No Appeal Rights for Claims Denied Based on Timely Filing Limit Provider Liability Exceptions that May Allow the Time Limit to be [...]

Posting Date: 10/19/2022

Outpatient Services for Registered Inpatients

Outpatient Services for Registered Inpatients There are occasional circumstances in which a registered inpatient may require a service that is not available at the inpatient facility. These inpatient facilities include acute-care hospitals [...]

Posting Date: 10/19/2022

Allergen Immunotherapy Preparation (95144-95165)

Allergen Immunotherapy Preparation (95144‑95165) National Government Services will allow the preparation and provision of antigen for allergen immunotherapy, codes 95144 through 95165 when performed incident to by auxiliary personnel. However, [...]

Posting Date: 10/19/2022

CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy

CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy CMS created the Medicare Physician Fee Schedule Look-up Tool for MACs to follow when processing claims. CMS listed CPT code 15830 as a [...]

Posting Date: 10/19/2022

Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid

Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid Table of Contents Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid Fee-For-Time Compensation Arrangements Reciprocal Billing Arrangements Related [...]

Posting Date: 10/19/2022

Answers to Common Fee-for-Time Compensation Arrangements Questions

Answers to Common Fee-for-Time Compensation Arrangements Questions Does a fee-for-time compensation arrangement physician need to enroll with Medicare prior to acting as a physician? Answer: Currently, a fee-for-time compensation [...]

Posting Date: 10/19/2022

Nonphysician Practitioners Billing for Surgical Procedures

Nonphysician Practitioners Billing for Surgical Procedures Several providers have asked about the Medicare guidance for NPPs include billing for surgical procedures. For the purpose of this education, NPPs include NPs, PA, and CNSs. State law [...]

Posting Date: 10/20/2022

Professional Services During a Patient Hospice Election

Professional Services During a Patient Hospice Election Table of Contents Article Overview Hospice Election Medicare Payment During Hospice Election Determining the Correct Entity to Bill Separately Payable Part B Services Hospice and [...]

Posting Date: 10/19/2022

Proper Billing for Finger and Toe Procedures

Proper Billing for Finger and Toe Procedures When billing for procedures that are performed on the fingers and/or toes, it’s essential to append the appropriate anatomical modifier for the service rendered. This allows the patient history to [...]

Posting Date: 10/19/2022

Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements

Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements Table of Contents Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements Fee-For-Time Compensation [...]

Posting Date: 09/08/2021

Proper Use of Taxonomy Codes

Proper Use of Taxonomy Codes A taxonomy code is a unique ten-character code that designates your classification and specialization and enables providers to identify their specialty at the claim level. CMS developed a crosswalk of [...]

Posting Date: 10/19/2022

Common Reciprocal Billing Questions and Answers

Common Reciprocal Billing Questions and Answers If a practice, the same specialty as ours, wants us to take calls for them for two weeks, can we bill under their number as a reciprocal billing arrangement? Answer: No. In a reciprocal [...]

Posting Date: 10/19/2022

Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans

Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans Background It has been noted that a high volume of PET scan claims falling between the CPT code range 78811–78816 are being denied upon original claim submission due [...]

Posting Date: 10/19/2022

Unlisted and Not Otherwise Classified Procedure Codes

Unlisted and Not Otherwise Classified Procedure Codes Table of Contents Unlisted and Not Otherwise Classified Procedure Codes Proper Billing for NOC Procedures Electronic Claims Paper Claims The following tips will help you bill [...]

Posting Date: 03/17/2023

Fiscal Year/Calendar Year Claim Split

Fiscal Year/Calendar Year Claim Split Part A/B Type of Bill Fiscal Year Split Calendar Year Splint Part A – 11X, 21X prospective payment system (PPS*) No No Part A – 11X, 18X, 21X, non-PPS Yes [...]

Posting Date: 12/16/2020

The Medicare Home Infusion Therapy Benefit and Home Health Agencies

The Medicare Home Infusion Therapy Benefit and Home Health Agencies If you are a HHA that wants to provide and bill Medicare HIT professional services starting in CY 2021, you are required to enroll with the Part B Medicare Administrative [...]