Avoid Return to Provider and Claim Rejections-Enhancing the Beneficiary Eligibility Verification Process

Avoid Return to Provider and Claim Rejections-Enhancing the Beneficiary Eligibility Verification Process Table of Contents Reason Codes T5052, N5052, U5210, U5220 and U5200 - Preventing RTP and Rejection Claims Why Is Beneficiary [...]

Identifying Payers Primary to Medicare

Section 4: Getting Ready to Bill Medicare Identifying Payers Primary to Medicare Information for All Providers Table of Contents Determine if Medicare is Primary Payer MSP Information Collection Requirements—Frequency Retirement [...]

Use Our Provider Self-Service Tools To Spend Less Time on the Phone

Use Our Provider Self-Service Tools To Spend Less Time on the Phone Did you know our PCC experiences high call volumes at the beginning and the ending of each month? To avoid experiencing prolonged hold times, you can use our provider [...]

U5210

Avoiding/Correcting This Error Each beneficiary should be screened for eligibility. Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS Provider [...]

U5200

Avoiding/Correcting This Error Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS/DDE Provider Online System or NGSConnex to verify [...]

Attention Home Health Agencies Receiving C7010 Billing Error

Attention Home Health Agencies Receiving C7010 Billing Error Over the past several months one of the top RTP reason codes for home health claims is C7010 – overlap with a hospice election period. The following information will help you avoid [...]

Main Menu Options

table, td, th table { border-collapse: collapse; width: 50%; } Main Menu Options The main menu and subsequent menus can be navigated by using your voice or using touch‐tone on your telephone keypad. You can also use touch‐tone entry for [...]

Missing/Incomplete/Invalid Patient Identifier Remark Code N382

Missing/Incomplete/Invalid Patient Identifier Remark Code N382 If you receive a denial on your remittance with remark code ‘N382’ Missing/Incomplete/Invalid Patient Identifier, please use NGSConnex self-service option to verify the MBI number [...]

Physical/Occupational Therapy Billing

Join us as we review billing guidelines for physical and occupational therapy. We'll review when to apply the KX modifier and the importance of appropriate medical documentation. National Government Services has a Local Coverage Determination [...]

Interactive Voice Response Touch-Tone Instructions

Interactive Voice Response Touch-Tone Instructions Alpha-Numeric Touch-Tone Entries Use this function to enter elements that contain both alpha and numeric characters. Each button on a telephone keypad has a corresponding set of letters. Each [...]

Intensive Behavioral Therapy for Obesity and Screening for Depression and Alcohol Misuse Screening

During this webinar, we''ll review the Medicare coverage, coding and billing guidelines for intensive behavioral therapy for obesity and screening for depression in adults.

The CY 2025 Medicare Physician Fee Schedule Is Now Available

The CY 2025 Medicare Physician Fee Schedule Is Now Available The CY 2025 MPFS is now available. You can view the new fees using the Fee Schedule Lookup tool page on NGSMedicare.com. Posted 12/2/2024

Start Your Morning with a Podcast - Navigating Medicare: Part A Insights for Providers

Start Your Morning with a Podcast - Navigating Medicare: Part A Insights for Providers Did you know we have a podcast channel on both Spotify and Apple Podcasts that are just for our providers? On your way to work each day, listen to these [...]

Medicare Part B Ambulance Coverage, Basics and Billing

During this webinar, we'll educate new staff, or those needing a refresher on basic Medicare Part B ambulance billing guidelines.

Medicare Diabetes Prevention Program

Stop diabetes before it begins. Join us and learn about the Medicare diabetes program to help people with Medicare stay healthy and prevent diabetes.

All Part B Providers – Register Now!

All Part B Providers – Register Now! Don't miss your chance to attend! Don't miss your chance to attend the National Government Services Medicare Part B 2024 Preventive Services Virtual Conference! Registration is happening now, and seats are [...]

Request a Redetermination

Request a Redetermination The first level of appeal is carried out by the affiliated contractor/MAC. Time limit to initiate = 120 days from date of receipt of the initial determination notice Time limit to complete the review = 60 days [...]

Submit a Reconsideration

Submit a Reconsideration The second level of appeal is the reconsideration request and is carried out by the QIC. Time limit to initiate = 180 days from date of receipt of redetermination decision Time limit to complete the review = 60 [...]

Medicare Appeals Council Review

Medicare Appeals Council Review The fourth level of appeal is carried out by the MAC; this may also be referred to as the Department Appeals Board or DAB. Time limit to initiate = 60 days from date of receipt of ALJ decision Time limit to [...]

Reopenings for Minor Errors and Omissions

Reopenings for Minor Errors and Omissions Providers may request a reopening of the original claims processing decision by contacting the TRU. The TRU can be used when you wish to revise the initial determination of a specific service or [...]

Reopening Request Timeframes

Reopening Request Timeframes According to the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 34, Section 10.6.2, Timeframes for Party Requested Reopenings: A party may request a contractor reopen and revise its initial [...]

ALJ Hearing

ALJ Hearing The third level of appeal is an ALJ hearing. Time limit to initiate = 60 days from the date of receipt of reconsideration (QIC decision) Time limit to complete the review = 90 days Amount in controversy = The amount that must [...]

Federal Court Review

Federal Court Review The fifth level of appeal is carried out by the Federal District Court (U.S. District Court). Time limit to initiate = 60 days from date of receipt of Medicare Appeals Council decision Amount in Controversy = The [...]

MLN Connects® Newsletter: November 21, 2024

MLN Connects® Newsletter: November 21, 2024 News Medicare-Funded Physician Residency Positions CMS Roundup (November 15, 2024) Hepatitis B Vaccine: Billing Requirement Update Effective January 1 Hospitals: Use Renewed Beneficiary Notices [...]

Bone Mass Measurements, Colorectal and Prostate Cancer Screenings

During this webinar, we'll review the coverage, coding and billing guidelines for bone mass measurements, colorectal and prostate cancer screenings.

Top Part B Claim Errors for Preventive Services

Join us for a discussion of the top Part B claim denials for preventive services. We'll share the denial reasons, how to correct the denials, and solutions to prevent them from occurring on future claim submissions.

Medicare Telehealth Changes for 2022

Medicare Telehealth Changes for 2022 The CY 2022 MPFS Final Rule indicated that Section 123 of the CAA removed the geographic restrictions and added the home of the beneficiary as a permissible originating site for telehealth services [...]

Telehealth Services

Telehealth Services Table of Contents General Information Originating Site Distant Site List of Covered Medicare Telehealth Services Billing Facility Fee for Originating Site Payment for Professional Fee Place of [...]

Medicare Telehealth Changes for 2024/2025

Medicare Telehealth Changes for 2024/2025 Table of Contents Major Medicare Telehealth Flexibilities Not Affected by the End of the PHE Reporting Home Address Expiration of PHE Flexibilities for Direct Supervision Requirements Teaching [...]

Counseling to Prevent Tobacco Use

In an effort to raise awareness and increase utilization of tobacco use counseling, we’ll focus on the effects of nicotine dependence including affected health consequences during this webinar. Medicare coverage, coding, billing and [...]

NGSConnex: Overview, Access, Navigation and Eligibility Look Up

This webinar is geared toward all lines of business. Come join us and see how NGSConnex can make your life a little easier. We’ll review what NGSConnex has to offer, including registration, access, navigation and beneficiary eligibility look [...]

NGSConnex: Overview, Access, Navigation and Eligibility Look Up

This webinar is geared toward all lines of business. Come join us and see how NGSConnex can make your life a little easier. We’ll review what NGSConnex has to offer, including registration, access, navigation and beneficiary eligibility look [...]

NGSConnex: Overview, Access, Navigation and Eligibility Look Up

This webinar is geared toward all lines of business. Come join us and see how NGSConnex can make your life a little easier. We’ll review what NGSConnex has to offer, including registration, access, navigation and beneficiary eligibility look [...]

Prolonged Preventive Services

Preventive Services Guide Prolonged Preventive Services Effective for claims with dates of service on or after 1/1/2018, prolonged preventive services will be payable by Medicare when billed as an add-on to an applicable preventive service [...]

Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)

Counseling to Prevent Tobacco Use and Lung Cancer Screening

During this webinar, we'll review the coverage, coding and billing guidelines for the Medicare preventive services benefits of counseling to prevent tobacco use.

2024 Health Equity Services

With the addition of health equity services in 2024, we are raising awareness on the benefits available for Medicare beneficiaries. During this webinar, we’ll discuss the new care management services that were included for Medicare coverage in [...]

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.

Obtaining Beneficiary Eligibility Information Through NGSConnex

Obtaining Beneficiary Eligibility Information Through NGSConnex  As a reminder, our Customer Service Representatives aren’t permitted to share eligibility information because it’s available through NGSConnex. If you need help, we [...]

Targeted Probe and Educate

During this webinar, we'll help the Medicare provider community understand the targeted probe and educate program.