Screening Pap Tests

Preventive Services Guide Screening Pap Tests Cervical cytology, also called a Pap test, looks for abnormal changes in cells in the cervix, which is part of a woman’s reproductive organs. Screening for cervical cancer via a Pap test is very [...]

PC-ACE

Provider Enrollment: Reduce Development Requests for Additional Action

Provider Enrollment: Reduce Development Requests for Additional Action In an effort to reduce the request of additional information and/or documentation on provider enrollment applications, verify all required actions are complete prior to [...]

Tobacco Counseling via Telehealth

Tobacco Counseling via Telehealth Health equity in telehealth is the opportunity for everyone to receive the health care they need and deserve, regardless of social or economic status. Telehealth helps improve access to healthcare for various [...]

Evaluation and Management Services

Evaluation and Management Services E/M services are professional face to face services rendered by a physician or NPP in various sites or POS. The nature and amount of physician work and documentation will vary by type of service, place of [...]

General Principles of Medical Record Documentation

What Should Be Provided if Medical Records Are Requested for Review? The following should be considered if applicable to the service being reviewed. This is not intended to be an all-inclusive list. Progress/visit notes Physician orders [...]

Related Resources

Related Resources MLN®Booklet: Evaluation and Management Services Guide AMA CPT Guidelines CMS IOM Publication 100-04, Medicare Claims Processing Manual,Chapter 12, Section 30.6 MLN®Fact Sheet: Complying with Medicare [...]

General Principles of Medical Record Documentation

General Principles of Medical Record Documentation   The medical record should be complete and legible. The documentation of each patient encounter should include: The reason for the encounter and relevant history, physical [...]

Diabetes Screening

Preventive Services Guide Diabetes Screening Table of Contents Diabetes Screening Eligibility for Diabetes Screening Category One Category Two Coverage Criteria and Frequency Limits HCPCS/CPT Coding Diagnosis Coding Cost [...]

Provider Enrollment: Completing the CMS-855B Paper Application

During this webinar, we'll provide an understanding of how to complete the CMS-855B provider enrollment paper application for a clinic, group, or supplier.

October 2024

In This Issue National Government Services Articles for Part A and Part B Providers Common Working File Host Dark Days for October 2024 Release LCD and Article Updates for August/September 2024 October 2024 EDI Front End Quarterly Release [...]

9/30/2024

Self-Service Pulse: What You Need To Know This Week As your MAC, National Government Services wants to provide you with a comprehensive source containing the most current information available for our self-service tools. ​​​​​​ The [...]

Diabetes Self-Management Training

Preventive Services Guide Diabetes Self-Management Training According to the Centers for Disease Control and Prevention, approximately 38.4 million Americans have diabetes and 27.2 million people aged 65 years or older (48.8%) have been [...]

Provider Enrollment: Completing the CMS-855A Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855A provider enrollment paper application.

CO-246

Avoiding/Correcting This Error This is not an error. The CPT/HCPCS code reported is used for reporting purposes only. These reporting codes are given by CMS for providers to use when documenting certain incentive plans, etc.

CO-246

Avoiding/Correcting This Error This is not an error. The CPT/HCPCS code reported is used for reporting purposes only. These reporting codes are given by CMS for providers to use when documenting certain incentive plans, etc.

CO-B7

Avoiding/Correcting This Error There is an issue with the billing and/or rendering provider credentialing information per provider enrollment, provider information submitted on the claim and/or or the services provided are not allowed per the [...]

CO-B7

Avoiding/Correcting This Error The billing or rendering provider NPI is not actively enrolled with Medicare on the date(s) of service billed on the claim. Please verify the provider's Medicare effective date in PECOS. If the provider shows [...]

CO-16

Avoiding/Correcting This Error The CPT/HCPCS code reported is not valid for the date(s) of service billed on the claim. This may also mean that the digits or alpha characters in the code are incorrectly reported. Please review the claim and [...]

OA-18

Avoiding/Correcting This Error A duplicate claim submission occurs when a provider resubmits a claim either on paper or electronically for a single encounter and the service is provided by the same provider to the: same beneficiary; for the [...]

OA-18

Avoiding/Correcting This Error A duplicate claim submission occurs when a provider resubmits a claim either on paper or electronically for a single encounter and the service is provided by the same provider to the: same beneficiary; for the [...]

PR-B9

Avoiding/Correcting This Error When a Medicare beneficiary, or their authorized representative elects hospice all services related to the patient's terminal condition are handled by the hospice and not billed to Medicare Part B. If the patient [...]

PR-50

Avoiding/Correcting This Error The CPT/HCPCS code reported is not covered for the beneficiary, and the beneficiary is liable for these charges. If you have reported an incorrect code, or forgot a modifier, the claim will need to be reviewed as [...]

Medicare Preventive Services Resource Guide

Medicare Preventive Services Resource Guide Medicare covers many preventive services to keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep Medicare beneficiaries [...]

Anesthesia Modifiers

Anesthesia Modifiers Use Anesthesia Modifiers Appropriately National Government Services requires placement of pricing modifiers in the first modifier position to process your anesthesia claims correctly. Claims submitted incorrectly will [...]

Appropriate Usage of Modifier 99

Appropriate Usage of Modifier 99 Table of Contents Appropriate Usage of Modifier 99 Appropriate Usage Inappropriate Usage Related Content [Return to Top] Appropriate Usage of Modifier 99 Modifier 99 indicates multiple modifiers; [...]

Correct Usage of Modifier 79 for Multiple Procedures

Correct Usage of Modifier 79 for Multiple Procedures National Government Services Medical Review department has identified widespread problems with the use of modifier 79 for multiple procedures. The global surgical package was established by [...]

Co-Surgery/Team Surgery/Assistant Surgery Modifiers

Co-Surgery/Team Surgery/Assistant Surgery Modifiers Table of Contents Co-Surgery/Team Surgery/Assistant Surgery Modifiers Co-Surgery (Modifier 62) Team Surgery (Modifier 66) Assistant-at-Surgery Services Assistant Surgery Modifiers [...]

Modifier 51

Modifier 51 Table of Contents Modifier 51 Definitions Appropriate System Usage Inappropriate System Usage Additional Information Related Content [Return to Top] Modifier 51 Modifier 51 denotes more than one medical/surgical [...]

Modifier 59 and the Subset Modifiers XE, XP, XS, XU - Specific Modifiers for Distinct Procedural Services

Modifier 59 and the Subset Modifiers XE, XP, XS, XU – Specific Modifiers for Distinct Procedural Services Table of Contents Continued Use of Modifier 59 after 1/1/2015 Modifier 59 Appropriate Usage Modifier XE Modifier XP [...]

Proper Billing of Surgical Comanagement (Modifiers 54 and 55)

Proper Billing of Surgical Comanagement (Modifiers 54 and 55) Table of Contents Proper Billing of Surgical Comanagement (Modifiers 54 and 55) Exceptions Date(s) of Service Care Provided in Different Payment Localities 55 Modifier [...]

Critical Care Policy Clarification

Critical Care Policy Clarification The CMS implemented the new policy for critical care services as published in the Centers for Medicare & Medicaid Services Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, [...]

Critical Care Tip Sheet

Critical Care Tip Sheet Table of Contents Service and Medical Necessity The Following CMS Billing Consideration Guidelines Apply Provider Time Assessment and Documentation The Following CMS Billing Consideration Guidelines [...]

Critical Care Services: CPT Codes 99291-99292

Critical Care Services: CPT Codes 99291-99292 Table of Contents Definition Context Providers Who May Perform Critical Care Services and Medical Necessity Palliative and Hospice Patients Full Attention of the Provider and Provider [...]

Certification or Recertification of Medicare Covered Home Health Services

Certification or Recertification of Medicare Covered Home Health Services Billing HCPCS Codes G0180 and G0179 of Patient Eligibility for Medicare-covered Home Health Services under a Home Health Plan of Care Physician [...]

Initial Episode Clarified for Home Health Face-to-Face Encounter

Initial Episode Clarified for Home Health Face-to-Face Encounter CMS requires a patient receiving HH services under the Medicare HH benefit have a FTF encounter with the certifying physician for the initial episode. CMS has clarified that this [...]

Sacroiliac Joint Injections and Procedures

Sacroiliac Joint Injections and Procedures Table of Contents Sacroiliac Joint Injections and Procedures Diagnostic SIJI Diagnostic SIJI Limitations Therapeutic SIJI Therapeutic SIJI Limitations SIJ Denervation [...]