Top Tobacco Counseling Claim Errors - Tips to Avoid and Correct Claim Errors

Top Tobacco Counseling Claim Errors - Tips to Avoid and Correct Claim Errors National Government Services is committed to reducing provider burden associated with Medicare claim denials and claim submission errors. Don’t wait until you receive [...]

The Medicare Hospice Benefit: Effects on Other Provider Types

The Medicare Hospice Benefit: Effects on Other Provider Types Table of Contents The Medicare Hospice Benefit: Effects on Other Provider Types What is Hospice Care Providing Services Related to the Terminal Condition Providing Services [...]

Main Menu Options

Main Menu Options The main menu and subsequent menus can be navigated by using your voice or using touch‐tone on your telephone keypad. You can also use touch‐tone entry for provider numbers, Medicare numbers, PTAN, NPI, TIN, dates of service, [...]

Avoid Return to Provider and Claim Rejections-Enhancing the Beneficiary Eligibility Verification Process

Avoid Return to Provider and Claim Rejections-Enhancing the Beneficiary Eligibility Verification Process Table of Contents Reason Codes T5052, N5052, U5210, U5220 and U5200 - Preventing RTP and Rejection Claims Why Is Beneficiary [...]

Identifying Payers Primary to Medicare

Section 4: Getting Ready to Bill Medicare Identifying Payers Primary to Medicare Information for All Providers Table of Contents Determine if Medicare is Primary Payer MSP Information Collection Requirements—Frequency Retirement [...]

Use Our Provider Self-Service Tools To Spend Less Time on the Phone

Use Our Provider Self-Service Tools To Spend Less Time on the Phone Did you know our PCC experiences high call volumes at the beginning and the ending of each month? To avoid experiencing prolonged hold times, you can use our provider [...]

Main Menu Options

table, td, th table { border-collapse: collapse; width: 50%; } Main Menu Options The main menu and subsequent menus can be navigated by using your voice or using touch‐tone on your telephone keypad. You can also use touch‐tone entry for [...]

Missing/Incomplete/Invalid Patient Identifier Remark Code N382

Missing/Incomplete/Invalid Patient Identifier Remark Code N382 If you receive a denial on your remittance with remark code ‘N382’ Missing/Incomplete/Invalid Patient Identifier, please use NGSConnex self-service option to verify the MBI number [...]

Interactive Voice Response Touch-Tone Instructions

Interactive Voice Response Touch-Tone Instructions Alpha-Numeric Touch-Tone Entries Use this function to enter elements that contain both alpha and numeric characters. Each button on a telephone keypad has a corresponding set of letters. Each [...]

The CY 2025 Medicare Physician Fee Schedule Is Now Available

The CY 2025 Medicare Physician Fee Schedule Is Now Available The CY 2025 MPFS is now available. You can view the new fees using the Fee Schedule Lookup tool page on NGSMedicare.com. Posted 12/2/2024

Start Your Morning with a Podcast - Navigating Medicare: Part A Insights for Providers

Start Your Morning with a Podcast - Navigating Medicare: Part A Insights for Providers Did you know we have a podcast channel on both Spotify and Apple Podcasts that are just for our providers? On your way to work each day, listen to these [...]

All Part B Providers – Register Now!

All Part B Providers – Register Now! Don't miss your chance to attend! Don't miss your chance to attend the National Government Services Medicare Part B 2024 Preventive Services Virtual Conference! Registration is happening now, and seats are [...]

Request a Redetermination

Request a Redetermination The first level of appeal is carried out by the affiliated contractor/MAC. Time limit to initiate = 120 days from date of receipt of the initial determination notice Time limit to complete the review = 60 days [...]

Submit a Reconsideration

Submit a Reconsideration The second level of appeal is the reconsideration request and is carried out by the QIC. Time limit to initiate = 180 days from date of receipt of redetermination decision Time limit to complete the review = 60 [...]

Medicare Appeals Council Review

Medicare Appeals Council Review The fourth level of appeal is carried out by the MAC; this may also be referred to as the Department Appeals Board or DAB. Time limit to initiate = 60 days from date of receipt of ALJ decision Time limit to [...]

Reopenings for Minor Errors and Omissions

Reopenings for Minor Errors and Omissions Providers may request a reopening of the original claims processing decision by contacting the TRU. The TRU can be used when you wish to revise the initial determination of a specific service or [...]

Reopening Request Timeframes

Reopening Request Timeframes According to the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 34, Section 10.6.2, Timeframes for Party Requested Reopenings: A party may request a contractor reopen and revise its initial [...]

ALJ Hearing

ALJ Hearing The third level of appeal is an ALJ hearing. Time limit to initiate = 60 days from the date of receipt of reconsideration (QIC decision) Time limit to complete the review = 90 days Amount in controversy = The amount that must [...]

Federal Court Review

Federal Court Review The fifth level of appeal is carried out by the Federal District Court (U.S. District Court). Time limit to initiate = 60 days from date of receipt of Medicare Appeals Council decision Amount in Controversy = The [...]

MLN Connects® Newsletter: November 21, 2024

MLN Connects® Newsletter: November 21, 2024 News Medicare-Funded Physician Residency Positions CMS Roundup (November 15, 2024) Hepatitis B Vaccine: Billing Requirement Update Effective January 1 Hospitals: Use Renewed Beneficiary Notices [...]

Prolonged Preventive Services

Preventive Services Guide Prolonged Preventive Services Effective for claims with dates of service on or after 1/1/2018, prolonged preventive services will be payable by Medicare when billed as an add-on to an applicable preventive service [...]

Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)

Obtaining Beneficiary Eligibility Information Through NGSConnex

Obtaining Beneficiary Eligibility Information Through NGSConnex  As a reminder, our Customer Service Representatives aren’t permitted to share eligibility information because it’s available through NGSConnex. If you need help, we [...]

Physicians: Are You Ordering Surgical Dressings for Your Patient?

Physicians: Are You Ordering Surgical Dressings for Your Patient? In order for a DME supplier to provide surgical dressings to your patients, there are actions you can take to make sure that all the required supporting medical record [...]

Practitioners: Are You Ordering Nebulizers and Inhalation Medication for Your Patient?

Practitioners: Are You Ordering Nebulizers and Inhalation Medication for Your Patient? Medicare will consider coverage of a nebulizer, compressor and related accessories when the patient’s medical record verifies that the patient has a [...]

Physicians: Are You Ordering Glucose Monitors and Supplies for Your Patients?

Physicians: Are You Ordering Glucose Monitors and Supplies for Your Patients? The CERT program has noted claim errors for glucose monitors. The following information is provided to assist you in reducing these types of errors. Medicare will [...]

Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)

Durable Medical Equipment, Prosthetics, Orthotics and Supplies To help providers and suppliers gain a better understanding of the roles of billing, coverage, documentation requirements and medical necessity when providing DMEPOS to Medicare [...]

Clinicians: Are You Ordering PAP Devices and Related Accessories for Your Patients?

Clinicians: Are You Ordering PAP Devices and Related Accessories for Your Patients? Medicare can make payment for PAP devices and related accessories when the patient’s medical record shows the patient has OSA and meets medical documentation, [...]

Practitioners: Are You Ordering Spinal Orthoses for Your Patient?

Practitioners: Are You Ordering Spinal Orthoses for Your Patients? The DME MACs are providing helpful guidance to assist the supplier in providing a spinal orthosis to your patient. Medicare must be able to verify there is supporting medical [...]

Clinicians: Are You Ordering Oxygen for Your Patient?

Clinicians: Are You Ordering Oxygen for Your Patient? Home use of oxygen and oxygen equipment is eligible for Medicare reimbursement only when a beneficiary meets all of the requirements set out in the CMS IOM, Publication 100-03, Medicare [...]

Clinicians: Are You Ordering Diabetic Shoes for Your Patients?

Clinicians: Are You Ordering Diabetic Shoes for Your Patients? The following section outlines roles of various practitioners that are involved in the decision-making and provision process for diabetic shoes: Certifying physician: The [...]

Physicians Ordering Oxygen and Oxygen Equipment - Quick Tips

Physicians Ordering Oxygen and Oxygen Equipment - Quick Tips The following is a quick reference guide for physicians and nonphysician practitioners concerning Medicare’s coverage of oxygen and oxygen equipment. For Medicare to consider [...]

Physicians: Are You Ordering DMEPOS for Your Patients?

Physicians: Are You Ordering DMEPOS for Your Patients? Physicians provide the foundation for correctly billing services and/or supplies to Medicare. DMEPOS suppliers rely on prescribing providers to substantiate the need for services and/or [...]

Physicians: Are You Ordering External Breast Prostheses for Your Patient?

Physicians: Are You Ordering External Breast Prostheses and Supplies for Your Patient? Following this guidance will help your patients and the Medicare Program by verifying there is medical documentation to support the provision of external [...]

Long-Term Care Hospital

Reminder: The Self-Service Pulse Has Ended

Reminder: The Self-Service Pulse Has Ended We sincerely thank you for being a loyal reader of our Self-Service Pulse each week. To continue receiving updates on our latest self-service tools and services, please subscribe to our general Email [...]

Health Equity Vaccination Efforts: Achieving the Highest Level of Health and Well-Being for Your Patients

Health Equity Vaccination Efforts: Achieving the Highest Level of Health and Well-Being for Your Patients Health equity is the concept that all people should have a fair and just chance to be as healthy as possible, regardless of their [...]