Search Results - NGSMEDICARE

Posting Date: 11/15/2021

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses For the P.O. Box mailing addresses, please visit the Contact Us page on our website. Reviewed 10/21/2024

Posting Date: 11/15/2021

Patient Protection and Affordable Care Act of 2010

Patient Protection and Affordable Care Act of 2010 For information related to the HIPAA Privacy and Security Rules, visit the Office for Civil Rights website. The Privacy and Security Rules are available for download, and you will find [...]

Posting Date: 11/16/2021

Physician Quality Payment Program

Physician Quality Payment Program The MACRA ended the SGR formula for clinician payment under the MPFS and established a quality payment incentive program, the QPP. This program provides clinicians with two ways to participate: through [...]

Posting Date: 11/16/2021

Provider Contact Center

Provider Contact Center For information about the Provider Contact Center, please visit the Contact Us page on our website. Reviewed 10/21/2024

Posting Date: 11/16/2021

Provider Enrollment

Provider Enrollment The Provider Enrollment Customer Service Department has direct telephone lines available for provider enrollment inquiries. Toll-Free Provider Enrollment Numbers Please use the following toll-free provider enrollment [...]

Posting Date: 11/16/2021

Reconsideration (Second Level of Appeal)

Reconsideration (Second Level of Appeal) A written reconsideration request must be filed with a QIC within 180 days of receipt of the redetermination. When providers receive an unfavorable redetermination, providers shall follow the [...]

Posting Date: 11/16/2021

Recovery Audit Program

Recovery Audit Program The Recovery Audit Program’s mission is to identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services provided to Medicare [...]

Posting Date: 11/16/2021

Redetermination (First Level of Appeal)

Redetermination (First Level of Appeal) A redetermination is an examination of a claim by National Government Services personnel who are different from the personnel who made the initial claim determination. The appellant (the provider filing [...]

Posting Date: 11/16/2021

U.S. Government Printing Office

U.S. Government Printing Office The GPO is responsible for the production and distribution of information products and services including the official publications of Congress, the White House and other federal agencies in digital and print [...]

Posting Date: 11/16/2021

Washington Publishing Company

Washington Publishing Company Washington Publishing Company, Inc. is a private company categorized under the commercial Printing and Newspaper Publishing Combined company that is an established health care IT and consulting company. WPC [...]

Posting Date: 01/14/2022

Meeting Schedules

Meeting Schedule Jurisdiction 6 ‒ Home Health and Hospice (Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Jersey, New York, Northern Mariana Island, Oregon, Puerto Rico, U.S. Virgin [...]

Posting Date: 10/22/2024

Utilizing Third Party Billing Companies

During this webinar, we’ll provide education related to using third party billers for your Medicare claims. We’ll identify vulnerabilities, share how to identify inappropriate third-party activities and reduce costs.

Posting Date: 07/20/2023

Contractor Advisory Committee Meeting

Contractor Advisory Committee Meeting As part of the 21st Century Cures Act, contractors are mandated to base an LCD on robust evidence. Part of the process is to convene SMEs as necessary to review the literature and provide input that [...]

Posting Date: 09/07/2021

CMS-1500 Claim Form Completion Instructions

CMS-1500 Claim Form Completion Instructions Table of Contents General Information Claim Filing Instructions for Paper and Electronic Submission Regulations on Charging for Claim Form Completion Optical Character Recognition System [...]

Posting Date: 01/27/2022

General E/M Information

General E/M Information Please explain the terms “auxiliary personnel” and “clinical staff” in the context of Medicare services. Answer: These terms are often used in defining which staff members can perform Medicare services [...]

Posting Date: 10/22/2024

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.

Posting Date: 10/22/2024

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 [...]

Posting Date: 10/22/2024

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 [...]

Posting Date: 10/22/2024

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

Posting Date: 10/22/2024

31605

Avoiding/Correcting This Error The occurrence span code 77 should only be used to indicate the span of days that were not covered on claims. Related Content Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77

Posting Date: 10/22/2024

37402

Avoiding/Correcting This Error Hospice – This error occurs when a claim is submitted and the previous month's claim has not been found in the system or there is a gap between Through date of the previous claim and From date on this claim. [...]

Posting Date: 10/22/2024

37402

Avoiding/Correcting This Error Hospice – This error occurs when a claim is submitted and the previous month's claim has not been found in the system or there is a gap between Through date of the previous claim and From date on this claim. [...]

Posting Date: 10/22/2024

W7113

Avoiding/Correcting This Error Prevent future similar errors by checking the I/OCE and ICD-10 official guidelines prior to claim submission. Verify the diagnosis codes reported; correct and resubmit. Related Content The I/OCE Quarterly [...]

Posting Date: 10/22/2024

U523A

Avoiding/Correcting This Error Hospice – This reason code is a notification to the provider of a VBID patient. For more information, including calendar-year specific downloadable lists of service area plan benefit packages (PBPs) and contact [...]

Posting Date: 10/22/2024

U5181

Avoiding/Correcting This Error Ensure the usage of an appropriate certification or recertification date in accordance with occurrence code 27. Related Content Avoiding Reason Code U5181: Appropriate Use of Occurrence Code 27/Occurrence [...]

Posting Date: 10/22/2024

U5111

Avoiding/Correcting This Error The 8xB (NOTR) transaction should only be submitted when the beneficiary revokes the hospice benefit or is discharged alive and there is no final claim in the system indicating termination of the hospice benefit. [...]

Posting Date: 10/22/2024

U5111

Avoiding/Correcting This Error Hospice – When submitting a hospice Notice of Termination/Revocation (TOB 8XB) or a Cancel Notice of Election (TOB 8XD) ensure that the From date on the transaction matches the Start date posted on CWF for that [...]

Posting Date: 10/22/2024

U5109

Avoiding/Correcting This Error When submitting a transaction to indicate the beneficiary’s election to revoke the hospice benefit, transfer the patient, cancel the election, or a change of ownership, the information on the transactional bill [...]

Posting Date: 10/22/2024

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.

Posting Date: 10/22/2024

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.

Posting Date: 10/22/2024

N5052

Avoiding/Correcting This Error The beneficiary’s name listed on the claim has to be an exact match to what is posted on CWF. Be sure that any special characters (including apostrophes, dashes, commas) and suffixes (Jr., Sr., III) that are [...]

Posting Date: 10/22/2024

U537F

Avoiding/Correcting This Error Always verify billing before submitting a new NOA for a beneficiary admission. There should not already be an NOA in the system pending processing or finalized prior to submitting a new NOA for a beneficiary. [...]

Posting Date: 10/22/2024

U5233

Avoiding/Correcting This Error Collect all insurance information from the beneficiary when admitted to your HHA. Talk to the beneficiary about insurance changes and check CWF before billing Medicare. Many times a claim will overlap an MAO [...]

Posting Date: 10/22/2024

U5106

Avoiding/Correcting This Error When the hospice NOE was received it fell within a previously established election period. Verify that the NOE is billed with correct dates. If benefit period from the previous hospice is still open, allow [...]

Posting Date: 10/22/2024

U5166

Avoiding/Correcting This Error If a transfer occurred, verify that all claims and notices are submitted in order. The transferring-from hospice agency needs to submit their final claim prior to the transferring-to hospice agency submitting [...]

Posting Date: 10/22/2024

U5065

Avoiding/Correcting This Error HHH may only bill services provided to the patient after the effective date of their Medicare coverage. Verify the effective date(s) for the MBI of the beneficiary prior to billing. If a new MBI has been issued [...]

Posting Date: 10/22/2024

U537F

Avoiding/Correcting This Error Always verify billing before submitting a new NOA for a beneficiary admission. There should not already be an NOA in the system pending processing or finalized prior to submitting a new NOA for a beneficiary. [...]

Posting Date: 10/22/2024

U5194

Avoiding/Correcting This Error In instances where a NOE is not timely-filed, the days of hospice care from the hospice admission date to the date the NOE is submitted to and subsequently processed by the Medicare contractor will not be [...]

Posting Date: 10/22/2024

U5106

Avoiding/Correcting This Error When the hospice NOE was received it fell within a previously established election period. Verify that the NOE is billed with correct dates. If benefit period from the previous hospice is still open, allow [...]

Posting Date: 10/22/2024

7C625

Avoiding/Correcting This Error Hospice – Clarify reason for discharge. Claim is being returned for one of the following reasons: Remarks are not present or do not indicate valid reason for discharge/transfer. Remarks indicate beneficiary [...]