CLAIMS: When submitting an ambulance claim, do the base and mileage codes need to have the same ZIP code for the same trip?

CLAIMS: What is the correct way to submit a beneficiary name on a claim?

CLAIMS: On a screening Pap smear test claim, which pointer does my diagnosis code need to be in?

CLAIMS: Medicare is the beneficiary's secondary payer and I am receiving denials when submitting using the CMS-1500 form. How can I resolve this?

CLAIMS: I file all my Medicare claims electronically except for Medicare Secondary Payer (MSP) claims because I thought I had to attach the primary Explanation of Benefits (EOB). Is this the correct process?

CLAIMS: How do I submit documentation for an additional development request (ADR)?

CLAIMS: I am receiving inconsistent payments on claims billed for the same drug. How can I prevent this?

CLAIMS: How do I prevent monthly End Stage Renal Disease claims from denying?

CLAIMS: How do I know if a HCPCS/CPT code is subject to MUE (medically unlikely edit)?

CLAIMS: During the patient check in process, may we have the patient check a box on a form at each visit stating they agree to allow us to bill Medicare and have that serve as the patient’s acceptance for our filing a claim?

When billing for waste on a single use vial would you round units up or down for a half unit?

When billing an unclassified drug code such as J3490, are the units of service on the claim always equal to one?

What is the proper way to submit professional physician claim with multiple NDC numbers for the same drug code?

J3357, Ustekinumab (Stelara) is listed on the Self-Administered Drug Exclusion List: Medical Policy Article A53021, and it says “acceptable”. Does this mean it is excluded or not?

What is the correct way to bill an unlisted drug or biological?

Is the shingles vaccine covered by Medicare?

Is the GY modifier required on the drug code and the administration code for noncovered self-administered drugs?

Have the payable diagnoses for IVIG and Rituximab changed? I don’t see all of the previously payable diagnoses in the applicable drug local coverage determinations (LCDs) and articles.

How do I bill a bilateral joint injection and HCPCS J1040 for two units?

Do all established drug HCPCS codes require the dosage amount in its description on the claim?

Does the waste with the JW modifier appended always go on the second line regardless of the billed amount? For example, the billed amount for the waste is higher than the administered amount.

Are unclassified drug codes included in average sales price (ASP) files?

Can chemotherapy be split into two doses on two different dates of service if the patient was unable to complete a full dose in one day? For example, the patient's port was not functioning properly.

Does Medicare Part B make payment for the unused portion of a multi-dose vial of a drug/biological?

Can Medicare Part B providers who bill on the professional CMS-1500 claim form, and electronic equivalent, bill unclassified drug code C9399?

Additional Events Links

Resources Education Partnership Request Form Five Steps to Webinar Success Provider Outreach and Education Reminders

Additional Events Links

Resources Education Partnership Request Form Five Steps to Webinar Success Provider Outreach and Education Reminders

MEDICAL REVIEW: Why did I receive a Comparative Billing Report?

MEDICAL REVIEW: Where can I get answers to billing questions?

MEDICAL REVIEW: Where can I find more details about the reasons my claims were denied?

MEDICAL REVIEW: What constitutes a valid signature?

MEDICAL REVIEW: What mailing address does NGS use to send Medical Review additional documentation requests (ADRs) to providers?

MEDICAL REVIEW: We are a large group and could potentially have many providers on TPE review. We have difficulty managing the process for each provider. Does NGS have any guidance for large groups?

MEDICAL REVIEW: The Medical Review Department did a post payment review of my Medicare claim and it was denied. How do I pay the money back to NGS Medicare?

MEDICAL REVIEW: My claim was denied “56900 Documentation not received”; however, I did send in documentation. What now?

MEDICAL REVIEW: My claim was reopened or adjusted by Medical Review. Does this impact the appeal window?

MEDICAL REVIEW: How do I sign up for the CMS and NGS Listserv messages?

MEDICAL REVIEW: I am under TPE review and my claims were denied, who can I speak to about this?

MEDICAL REVIEW: I’m appealing my claim but received a letter to recoup funds from the TPE denial. What do I do about these letters?