How to Avoid Duplicate Claim Denials

July 2023 Release "Dark Days" for the Common Working File Hosts

July 2023 Release "Dark Days" for the Common Working File Hosts For the upcoming July 2023 Release: For Production, CWF will be observing the Gray Day on Thursday, 6/29/2023 and Dark Days starting Friday, 6/30/2023 through Sunday, 7/2/2023 to [...]

Best Practices for a Successful Targeted Probe and Educate Review

End of the Public Health Emergency Frequently Asked Questions

End of the Public Health Emergency Frequently Asked Questions We’ve added new frequently asked questions to our website. We encourage our providers to view answers to questions about the End of the Public Health Emergency to ensure you have [...]

Drugs and Biologicals Frequently Asked Questions

Drugs and Biologicals Frequently Asked Questions We’ve added new frequently asked questions to our website. We encourage our providers to view answers to common questions about Drugs and Biologicals to ensure you have the information you need [...]

Government Efforts to Combat Cancer Deaths Related to Tobacco

Government Efforts to Combat Cancer Deaths Related to Tobacco Tobacco use is the leading preventable cause of cancer and cancer deaths. Lung cancer is what normally is thought of when talking about tobacco and cancer, but there are other [...]

Ways to Submit Requests

Ways to Submit Requests Suppliers have multiple options to submit PA requests to NGS. NGSConnex (preferred) Electronic submission of medical documentation (esMD) Fax JK: 315-442-4178 J6: 717-565-3840 U.S. Mail National [...]

Rhinoplasty and Related Services

General Documentation Requirements for Rhinoplasty and Related Services Checklist of prior authorization request (PAR) information to include: Medical documentation, with evaluation and management, supporting medical necessity of the [...]

MLN Connects® Newsletter: June 15, 2023

MLN Connects® Newsletter: June 15, 2023 News Inflation Reduction Act Continues to Lower Out-of-Pocket Prescription Drug Costs for Drugs with Price Increases Above Inflation CMS Announces Multi-State Initiative to Strengthen Primary Care [...]

Reactivating Reason Code 31755

Reactivating Reason Code 31755 As of 1/3/2023, reason code 31755 was reactivated per CMS instructions. This means the revenue code 0023 line-item date of service must match the date of service for the first home health visit on the claim. [...]

Manual Review of Claims for Replacement of Supplies and Accessories used with External Ventricular Assist Device

Manual Review of Claims for Replacement of Supplies and Accessories used with External Ventricular Assist Device VAD supplies and accessories are billed using HCPCS codes Q0507, Q0508 and Q0509 as applicable. When billing for VAD supplies, [...]

Claims Department Requires Additional Information for Processing Certain Services

Claims Department Requires Additional Information for Processing Certain Services Are you having difficulty with what must be provided when we ask for additional information to process your claim? If so, the following articles should assist in [...]

Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (Including Lipectomy) and Related Services

General Documentation Requirements for Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (Including Lipectomy) and Related Services Checklist of prior authorization request (PAR) information to include: Stable weight loss [...]

MLN Connects® Newsletter: June 22, 2023

MLN Connects® Newsletter: June 22, 2023 News CMS Roundup (June 16, 2023) Lower Endoscopy: Comparative Billing Report in June Medicare Physician Fee Schedule Database: July Update Behavioral Health Integration Services: Get Information [...]

Prior Authorization Request for Outpatient Services: Facet Joint Interventions

Dental Services 2023

Dental Services 2023 The CMS clarified what Medicare payments may be made for medically necessary dental services that are an integral part of a covered primary medical procedure. We’ve posted this new information in the Dental Services [...]

End of the Public Health Emergency

End of the Public Health Emergency We’ve received many questions related to end of the public health emergency and changes to waivers that CMS put in place during the COVID-19 PHE. To assist our providers, we’ve developed the CMS Waivers and [...]

COVID-19 Vaccine Administration Returning to Providers - Reason Code 32287

Claims for COVID-19 vaccine administration performed on the same DOS as another vaccine administration (e.g., PPV, flu or tetanus) are incorrectly being returned to providers with RC 32287.

Part A Anesthesia Claim Returning to Providers in Error

CMS has instructed all MACs to hold all Part A 13X and 85X TOBs for anesthesia services with DOS on or after 1/1/2022 until CMS fully implements a replacement file for these claims.

Temporary Holding for Some Part B Claims

The CMS billing instructions for G0378 indicate a single line of coding with a NOS of at least eight, with all UOS on a single line and the DOS being the date of the original observation order. Claim editing changes implemented in July, 2021 [...]