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  • Posting Date: 11/19/2021
    Supervising Physicians

    Supervising Physicians Supervision means the imaging is done under the physician’s overall control and direction and the licensed supervising physician is directly overseeing and ensuring the quality of medical care. An IDTF must have one or [...]

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  • Posting Date: 11/19/2021
    Code Level Supervision

    Code Level Supervision The supervision level required for diagnostic services is assigned by CMS. A list of diagnostic procedures and the supervision level required for each service is available in the CMS Medicare Physician Fee Schedule [...]

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  • Posting Date: 06/15/2021
    Lung Cancer Screening

    Lung Cancer Screening Early detection by screening is an important strategy for patients with a high risk for lung cancer. The LDCT is an additional preventive service benefit under the Medicare program. CMS established NCD for lung cancer [...]

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  • Posting Date: 05/14/2019
    Claim Guidelines

    Claim Guidelines The name and NPI of the referring/ordering provider must be in Items 17 and 17b of the CMS-1500 claim form or the EMC equivalent. An IDTF shall not be allowed to bill for any CPT or HCPCS codes that are solely therapeutic. [...]

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  • Posting Date: 12/02/2021
    Credentialing, Enrollment and Revalidation

    Credentialing, Enrollment and Revalidation Table of Contents Requirements Facilities that are not qualified Qualifications Application Forms You Will Need Required Application Fee Documentation State Survey, Tie-in Notice [...]

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  • Posting Date: 11/14/2024
    Electronic Funds Transfer

    EFT allows for claim payments to be electronically transferred to your bank in place of a hard copy check mailed to the facility. Medicare payments due a provider or supplier of services may be sent to a bank (or similar financial institution) [...]

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  • Posting Date: 10/24/2024
    Electronic Funds Transfer Form and Instructions

    Table of Contents Electronic Funds Transfer Form and Instructions Submitting the EFT Form CMS-588 EFT Completion Tips for Sole Proprietors, Sole Owners, Clinic/Groups, Organizations, Providers and Suppliers [Return to Top] Electronic [...]

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  • Posting Date: 10/23/2024
    Medicare Part B Top Claim Denials

    During this webinar, we’ll review the current top ten claim denials which are identified by internal claim data and provide guidance for correcting them, and solutions to prevent them from occurring on future claims. There will be time for your [...]

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  • Posting Date: 10/29/2024
    Top Claim Errors Reviewed and Updated

    Top Claim Errors Reviewed and Updated Using data analysis, we review and update the Top Claim Errors on a quarterly basis and provide: the error reason code; a description of the error; the error type; details that include steps you [...]

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  • Posting Date: 10/24/2024
    Frequently Asked Questions Have Been Reviewed and Updated

    Frequently Asked Questions Have Been Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Topics available are: ASCA Appeals CAR T-cell [...]

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  • Posting Date: 10/29/2024
    Frequently Asked Questions Have Been Reviewed and Updated

    Frequently Asked Questions Have Been Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Please take time to review these FAQs for answers to [...]

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  • Posting Date: 10/23/2024
    W7010

    Avoiding/Correcting This Error Condition Code 21 is appropriate to use to submit on a “no pay” claim when seeking a denial from Medicare to facilitate payment by subsequent insurers.  This denial allows the subsequent insurer to consider [...]

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  • Posting Date: 10/23/2024
    5WEXC

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

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  • Posting Date: 10/23/2024
    5WEXC

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

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  • Posting Date: 10/23/2024
    56900

    Avoiding/Correcting This Error Regularly access claims in status locations SB6001, SB6098, or SB6099 to obtain a listing of claims for which records have not yet been received by the MAC (Medical Review Department). Look for information on the [...]

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  • Posting Date: 10/23/2024
    56900

    Avoiding/Correcting This Error Regularly access claims in status locations SB6001, SB6098, or SB6099 to obtain a listing of claims for which records have not yet been received by the MAC (Medical Review Department). Look for information on the [...]

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  • Posting Date: 10/23/2024
    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 [...]

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  • Posting Date: 10/23/2024
    39928

    Avoiding/Correcting This Error To access the line level reason associated with this reason code providers should go to claim page (2) (MAP 1712) and F11 to MAP171D to see the line level denial codes for each line of the claim. If you disagree [...]

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  • Posting Date: 10/23/2024
    39928

    Avoiding/Correcting This Error To access the line level reason associated with this reason code providers should go to claim page (2) (MAP 1712) and F11 to MAP171D to see the line level denial codes for each line of the claim. If you disagree [...]

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  • Posting Date: 10/23/2024
    59132

    Avoiding/Correcting This Error RHCs should not bill codes G0108 or G0109. Related Content CMS Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 9, Section 70.5 - Diabetes Self-Management Training (DSMT) [...]

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  • Posting Date: 04/22/2021
    J6 Part A

    J6 Part A Member Name Facility State Albaitis, Susan DaVita Kidney Care Multiple states (ESRD) Anderson, Brian Advocate Aurora Illinois Anderson, Keith Southern Illinois Healthcare [...]

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  • Posting Date: 10/23/2024
    Steps to Claim Corrections

    This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

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  • Posting Date: 10/23/2024
    Steps to Claim Corrections

    This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

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  • Posting Date: 10/23/2024
    31836

    Avoiding/Correcting This Error Verify billing and, if appropriate, correct and resubmit the claim for payment. Related Content MLN® Booklet: How to Use the PFS Look-up Tool

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  • Posting Date: 10/23/2024
    32243

    Avoiding/Correcting This Error Review the claim and either update the charges or remove the line containing zero or blank charges. Return the claim for processing. 

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  • Posting Date: 10/23/2024
    37098

    Avoiding/Correcting This Error Verify billing and, if appropriate, correct and return the claim. Related Content Billing for FQHC MAO Plan Supplemental Payment (PPS Providers) CMS Internet-Only Manual 100-04, Medicare Claims Processing [...]

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  • Posting Date: 10/23/2024
    W7088

    Avoiding/Correcting This Error Each FQHC PPS claim must be billed with a qualifying visit code, and associated line-item charges, along with all other FQHC services furnished during the encounter. A qualifying visit code is the code that [...]

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  • Posting Date: 10/23/2024
    W7088

    Avoiding/Correcting This Error Each FQHC PPS claim must be billed with a qualifying visit code, and associated line-item charges, along with all other FQHC services furnished during the encounter. A qualifying visit code is the code that [...]

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  • Posting Date: 10/23/2024
    U5065

    Avoiding/Correcting This Error Check/verify the beneficiary's entitlement dates in the CWF. A Medicare beneficiary, or their authorized representative, may have requested a new MBI. Verify eligibility and MBI number, correct and return the claim.

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  • Posting Date: 10/23/2024
    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 [...]

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  • Posting Date: 10/23/2024
    E0401

    Avoiding/Correcting This Error Prior to billing, ensure that the correct provider number and bill type combination is being billed.  

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  • Posting Date: 10/23/2024
    W7089

    Avoiding/Correcting This Error Payment for a FQHC encounter requires a medically necessary face-to-face visit. Each FQHC specific payment code (G0466-G0470) must have a corresponding service line with a HCPCS code that describes the qualifying [...]

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  • Posting Date: 10/23/2024
    W7089

    Avoiding/Correcting This Error Payment for a FQHC encounter requires a medically necessary face-to-face visit. Each FQHC specific payment code (G0466-G0470) must have a corresponding service line with a HCPCS code that describes the qualifying [...]

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  • Posting Date: 10/24/2024
    Provider Enrollment Revalidation Overview

    During this webinar, learn about important changes in the revalidation process, how to determine Medicare enrollment revalidation due date and information to avoid disruption in Medicare billing.

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  • Posting Date: 10/24/2024
    9/18/2024 Part B POE Advisory Group Meeting

    9/18/2024 Part B POE Advisory Group Meeting Meeting Minutes Meeting Time: 10:00 a.m.‒12:00 p.m. ET Member Attendees: Elizabeth Aldrich, Dawson Ballard, Doris Barnes, Aurelia Barraco, Sheila Bembeneck, Madelon Berger, Todd Bergstrom, Louise [...]

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  • Posting Date: 10/24/2024
    Notification of the 2025 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review

    Notification of the 2025 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review The amount that must remain in controversy for ALJ hearing requests filed on or [...]

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  • Posting Date: 10/24/2024
    39910

    Avoiding/Correcting This Error Verify billing. If appropriate, correct and resubmit the claim.

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  • Posting Date: 11/08/2024
    Introduction to Medicare Contractors

    Medicare Administrative Contractors (MACs) are responsible for processing claims, managing policy and payment, and establishing regional policy guidelines. Are you aware that the Centers for Medicare & Medicaid Services (CMS) also uses several [...]

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  • Posting Date: 10/24/2024
    MLN Connects® Newsletter: October 24, 2024

    MLN Connects® Newsletter: October 24, 2024 News CMS Roundup (October 18, 2024) Rural Health Clinic & Federally Qualified Health Center: Final CY 2024 Payment Policies Claims, Pricers, & Codes Home Health Consolidated [...]

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  • Posting Date: 06/03/2021
    PECOS Correct and Resubmit Application Instructions

    PECOS Correct and Resubmit Application Instructions Login to PECOS and select the following: My Associates View Enrollment for applicable enrollment under Existing Associates Correct and Resubmit for applicable [...]

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