Search Results - NGSMEDICARE

Posting Date: 10/22/2024

56900

Avoiding/Correcting This Error This reason code can and should be prevented. When providers receive an ADR, respond according to the date listed in the ADR. Providers should start gathering the documentation being requested immediately. This [...]

Posting Date: 10/22/2024

56900

Avoiding/Correcting This Error This reason code can and should be prevented. When providers receive an ADR, respond according to the date listed in the ADR. Providers should start gathering the documentation being requested immediately. This [...]

Posting Date: 10/22/2024

55H1R

Avoiding/Correcting This Error Review coverage and billing guidelines for the NOE to ensure that your NOEs are accurately billed. Related Content CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 9, Section [...]

Posting Date: 10/22/2024

55H20

Avoiding/Correcting This Error This denial is based on review of a claim that was submitted as a demand bill. The charges on this claim are beneficiary liable. The beneficiary may be billed for these charges.

Posting Date: 10/22/2024

56900

Avoiding/Correcting This Error This reason code can and should be prevented. When providers receive an ADR, respond according to the date listed in the ADR. Providers should start gathering the documentation being requested immediately. This [...]

Posting Date: 10/22/2024

37236

Avoiding/Correcting This Error Verify eligibility of the attending/ordering physicians in PECOS. Print that verification and make it part of the medical record. If applicable, submit a reopen request to the Appeals Department indicating error [...]

Posting Date: 10/22/2024

32072

Avoiding/Correcting This Error The attending physician reported on your claim must be active in PECOS to be considered a valid attending physician for the home health patient.

Posting Date: 10/22/2024

55H1L

Avoiding/Correcting This Error Clinical progress notes should show evidence of a steady decline or downward trajectory in the beneficiary’s clinical status over time. Documentation should be objective, measurable and must support a life [...]

Posting Date: 10/22/2024

55B31

Avoiding/Correcting This Error Review coverage guidelines and patient records to determine if all appropriate documentation was sent for review that may have supported medical necessity. When you receive an ADR from National Government [...]

Posting Date: 10/22/2024

55B31

Avoiding/Correcting This Error Review coverage guidelines and patient records to determine if all appropriate documentation was sent for review that may have supported medical necessity. When you receive an ADR from National Government [...]

Posting Date: 10/22/2024

59118

Avoiding/Correcting This Error Review reason code 59118 in the Direct Data Entry system for applicable codes. Alternatively, review the latest Change Requests/MLN® Matters articles for relevant ICD-10 updates. The most current MLN Matters [...]

Posting Date: 10/22/2024

59118

Avoiding/Correcting This Error Review reason code 59118 in the Direct Data Entry system for applicable codes. Alternatively, review the latest Change Requests/MLN® Matters articles for relevant ICD-10 updates. The most current MLN Matters [...]

Posting Date: 10/22/2024

55S05

Avoiding/Correcting this Error The SNF should ensure that SNF services that are not covered are identified. After discussion with the beneficiary and/or representative you should properly issue an ABN and bill for the noncovered services [...]

Posting Date: 10/22/2024

54NCD

Avoiding/Correcting This Error Review coverage guidelines for the service being denied to ensure medical necessity of the services being provided to the beneficiary. Ensure all Medicare coverage and medical necessity requirements are met [...]

Posting Date: 10/22/2024

52NCD

Avoiding/Correcting This Error Ensure all Medicare coverage and medical necessity requirements are met prior to billing. If the provider determines that Medicare will not cover the services, consider submitting the charges as noncovered. [...]

Posting Date: 10/22/2024

52NCD

Avoiding/Correcting This Error Ensure all Medicare coverage and medical necessity requirements are met prior to billing. If the provider determines that Medicare will not cover the services, consider submitting the charges as noncovered. [...]

Posting Date: 10/22/2024

52MUE

Avoiding/Correcting This Error You have the right to submit an appeal when you believe the medical records support that the denied services were reasonable and medically necessary. Providers should review the information on the CMS website [...]

Posting Date: 10/22/2024

5ND07

Avoiding/Correcting This Error To prevent this error, ensure all Medicare coverage and medical necessity requirements are met prior to billing. Providers can visit the CMS Coverage Database to review the NCDs and LCDs to determine the [...]

Posting Date: 10/24/2024

Submit an Initial Enrollment Application

Table of Contents Step 1: Determine You are in the Right Place Step 2: Complete the Medicare Application Step 3: Submit the Required Documentation Related Content [Return to Top] Step 1: Determine You are in the Right Place The [...]

Posting Date: 10/24/2024

Submit an Initial Enrollment Application

Table of Contents Step 1: Determine You are in the Right Place Step 2: Complete the Medicare Application Step 3: Submit the Required Documentation Related Content [Return to Top] Step 1: Determine You are in the Right Place The [...]

Posting Date: 10/24/2024

Submit an Initial Enrollment Application

Table of Contents Step 1: Determine You are in the Right Place Step 2: Complete the Medicare Application Step 3: Submit the Required Documentation Related Content [Return to Top] Step 1: Determine You are in the Right Place The [...]

Posting Date: 04/14/2022

View Existing Medicare ID (PTAN) in PECOS and Effective/End Dates for Reassignment

View Existing Medicare ID (PTAN) in PECOS and Effective/End Dates for Reassignment Important: If you recently submitted an application to request a PTAN, please verify the approval letter was received prior to submission of claims. Log [...]

Posting Date: 10/22/2024

34986

Avoiding/Correcting This Error The PN modifier is used on all claim lines for all services, procedures and/or surgeries provided at an excepted off-campus outpatient, PBD of a hospital. The PN modifier applies to a grandfather/excepted PBD for [...]

Posting Date: 10/22/2024

34986

Avoiding/Correcting This Error The PN modifier is used on all claim lines for all services, procedures and/or surgeries provided at an excepted off-campus outpatient, PBD of a hospital. The PN modifier applies to a grandfather/excepted PBD for [...]

Posting Date: 10/22/2024

34985

Avoiding/Correcting This Error The PO modifier is used on all claim lines for all services, procedures and/or surgeries provided at an excepted off-campus provider-based outpatient department (PBD). The PO modifier applies to a [...]

Posting Date: 10/22/2024

34985

Avoiding/Correcting This Error The PO modifier is used on all claim lines for all services, procedures and/or surgeries provided at an excepted off-campus provider-based outpatient department (PBD). The PO modifier applies to a [...]

Posting Date: 10/22/2024

38119

Avoiding/Correcting This Error Verify the admission date and from date on this claim Verify the patient’s MBI to make sure that it has been correctly reported If the MBI is incorrect, this edit will be assigned If admission and from dates [...]

Posting Date: 10/22/2024

38119

SNF inpatient claims have to be processed in sequence. That means that when the beneficiary is going to be in the SNF as an inpatient for several months in a row, claims for the months the beneficiary is in the SNF must be submitted one at a [...]

Posting Date: 10/22/2024

34977

Avoiding/Correcting This Error If you are billing for on-campus services only: Report the billing provider address only in the billing provider loop 2010AA Do not report any service facility location in loop 2310E (or in DDE MAP 171F [...]

Posting Date: 10/22/2024

34977

Avoiding/Correcting This Error If you are billing for on-campus services only: Report the billing provider address only in the billing provider loop 2010AA Do not report any service facility location in loop 2310E (or in DDE MAP 171F [...]

Posting Date: 10/22/2024

32402

Avoiding/Correcting This Error Verify HCPCS code using the FISS DDE Inquiries HCPCS file (option 14) to determine the allowable revenue codes based upon the date of service. Verify billing and, if appropriate, correct the claim using the [...]

Posting Date: 10/22/2024

32402

Avoiding/Correcting This Error Verify HCPCS code using the FISS Inquiries HCPCS file (option 14). Allowable revenue codes will be displayed based on DOS. Use the claims correction option to report the appropriate HCPCS/CPT code and resubmit [...]

Posting Date: 10/22/2024

32404

Verify HCPCS code using the FISS Inquiries HCPCS file (option 14). Allowable HCPCS codes will be displayed based on DOS. Avoiding/Correcting This Error Use the claims correction option to report the appropriate HCPCS/CPT code and resubmit the [...]

Posting Date: 10/22/2024

32266

Avoiding/Correcting This Error Report influenza virus, pneumococcal pneumonia virus, and COVID-19 vaccines (and administration) with your charges on the 77X claim for informational and data collection purposes only. Report revenue code 0771 [...]

Posting Date: 10/22/2024

31191

Avoiding/Correcting This Error: When submitting the NOA, all date fields must match. Since the NOA is the start of the admission period, the "From" date, "Through" date and "Admission" date should all be the same.

Posting Date: 10/22/2024

31197

Avoiding/Correcting This Error Verify that all information is keyed correctly according to the applicable entry in the SAMHSA Opioid Treatment Program directory and your Medicare Part A enrollment information. When corrections are completed, [...]

Posting Date: 03/22/2022

Connecticut

Connecticut Member Name Professional Title Association Business Name/Address Email Fitzgerald, Elizabeth Audit and Education Specialist Hartford Healthcare 181 Patricia Genova Drive Newington, CT [...]

Posting Date: 12/17/2021

General Information

General Information Certain diagnostic services provided by an IDTF are considered for Medicare payment when medically necessary. A referring/treating provider must order all covered services. The treating physician or nonphysician [...]

Posting Date: 05/23/2019

Performance Standards

Performance Standards If providers are credentialing as an IDTF, then the performance standards shall be reviewed thoroughly before submitting a Medicare application. Refer to the IDTF Performance Standards and Attachment 2 beginning on page [...]

Posting Date: 11/23/2021

Interpreting Physicians and Personnel (Technicians) Who Perform Tests

IDTF Billing Guide Interpreting Physicians and Personnel (Technicians) Who Perform Tests An IDTF may be either a mobile or stationary/fixed facility. Portable/Mobile Facility There are two types of mobile IDTFs. Each are large [...]