APPEALS: What are the top appeals submitted to NGS?

APPEALS: Can one appeal a claim that rejected with MA130?

APPEALS: Is there a reference sheet to determine what constitutes an appeal?

APPEALS: What is a Medicare appeal?

APPEALS: What is the solution to avoiding claim denials?

APPEALS: What is the appeal process?

APPEALS: What is the best way to get duplicate denials paid on appeal?

MLN Connects® Newsletter: March 25, 2025

MLN Connects® Newsletter: March 25, 2025 News ESRD: Payment for Phosphate Binders Effective January 1, 2025 Hospitals: Apply for Additional Residency Positions by March 31 Skilled Nursing Facilities: Revalidation Deadline is May 1 [...]

APPEALS: Is documentation required for an appeal?

APPEALS: Another denial we see is “This service has been provided at a frequency that is more than the medically appropriate indication by policy or regulation.” How can we avoid these denials?

APPEALS: We are a large group with many physicians and nonphysician practitioners. When we submit claims for nonphysician practitioners working in different sub-specialties, we get claim denials that state: “D463: New patient qualifications were not met or M13: Only one initial visit is covered per specialty per medical group.” How can we avoid these?

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction K Part A Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Debridement, subcutaneous tissue (includes epidermis and dermis, if performed) 11042, 11045 [...]

Radiopharmaceutical Reimbursement

Radiopharmaceutical Reimbursement National Government Services has reviewed the radiopharmaceutical pricing methodology set forth in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Section 303(h) which states that [...]

Hospital-Based Ambulance Basic Billing Guidelines

Hospital-Based Ambulance Basic Billing Guidelines For hospital-based ambulance billing under Medicare, services should be billed on the UB-04 form using the ambulance service-specific NPI, not the acute hospital NPI, and claims for inpatient [...]

About Appeals

About Appeals Table of Contents About Appeals Reopening vs. Redetermination Reopening Redetermination [Return to Top] About Appeals Providers and beneficiaries have the right to appeal claim determinations made by National [...]

Understanding the Approval Recommendation Process for Certified Providers

Understanding the Approval Recommendation Process for Certified Providers The certified provider completes and submits a CMS-855 enrollment application and all supporting documentation to its MAC, including any state require documentation [...]

About Us

National Government Services, Inc., a subsidiary of Elevance Health, Inc., has a long history of supporting federal health agencies, including CMS. Throughout the country, NGS has served as a Medicare contractor since the inception of the [...]

REMITTANCE: What do the two-letter codes on my remittance advice mean?

REMITTANCE: Can I post the electronic remittance advice information into my accounts receivable system?

REMITTANCE: Do I need special computer software to use the electronic remittance advice?