340B Drug Payment Policy Remedy Payment for CY 2018 to CY 2022

340B Drug Payment Policy Remedy Payment for CY 2018 to CY 2022 On 6/15/2022, the Supreme Court held in American Hospital Association v. Becerra that because CMS had not conducted a survey of hospitals’ acquisition costs, it could not vary the [...]

30-Day Home Health Therapy Reassessment Schedule

Intensive Outpatient Program

Medical Review

Provider Enrollment: Opioid Treatment Program

During this webinar, we’ll provide a brief overview of an Opioid Treatment Program (OTP) provider, an understanding of submitting the CMS-855A or CMS-855B paper application and how to complete the provider enrollment Internet-based Provider [...]

Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities

Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities The hospital is the entity required to bill POA indicators on all inpatient claims billed to Medicare. However, accurate coding of all diagnosis [...]

Hospital Acquired Conditions and Present on Admission Resource for Physicians

Hospital Acquired Conditions and Present on Admission Resource for Physicians Did you know that documentation about your patient’s inpatient stay is vital for accurate submission of an inpatient hospital claim to Medicare? This resource [...]

Revalidation Application Checklist

Revalidation Application Checklist Use the Revalidation Application Checklist to assist when revalidating your enrollment information. The general checklist will allow you to understand requirements while the PECOS and CMS-855 paper [...]

Verify Bank Account Information

National Government Services receives numerous electronic funds transfer banking rejections each year due to frozen or closed bank accounts. To prevent interruption in Medicare payment, billing providers verify an active bank account is [...]

November 2024

In This Issue National Government Services Articles for Part A and Part B Providers Local Coverage Determination Open Meeting Reminder – Beginning 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR NGSConnex: Overview, [...]

Prevent Revalidation Processing Delays

When National Government Services receives a revalidation application, we often determine additional information is needed to process the application. In those cases, a request for additional information is sent which is commonly referred to as [...]

How to Search on the Medicare Revalidation List Tool for Due Date

Table of Contents How to Search on the Medicare Revalidation List Tool for Due Date Find a Provider By NPI By Name Associated Datasets [Return to Top] How to Search on the Medicare Revalidation List Tool for Due Date [...]

Revalidate My Enrollment

Step 1: Determine You Are in the Right Place Medicare provider enrollment revalidation is part of the Patient Protection and Affordable Care Act, Section 6401(a), which established a requirement for all enrolled providers/suppliers to [...]

Revalidate My Enrollment

Step 1: Determine You Are in the Right Place Medicare provider enrollment revalidation is part of the Patient Protection and Affordable Care Act, Section 6401(a), which established a requirement for all enrolled providers/suppliers to [...]

Deactivation of Billing Privileges/Suspension of Payment

Reasons for Deactivation of Medicare Billing Privileges/Suspension of Payment (not all inclusive) Inactivity Failure to complete revalidation within required time frame Unreported provider address and/or bank information Inactivity [...]

Deactivation of Billing Privileges/Suspension of Payment

Reasons for Deactivation of Medicare Billing Privileges/Suspension of Payment (not all inclusive) Inactivity Failure to complete revalidation within required time frame Unreported provider address and/or bank information Inactivity [...]

Deactivation of Billing Privileges/Suspension of Payment

Reasons for Deactivation of Medicare Billing Privileges/Suspension of Payment (not all inclusive) Inactivity Failure to complete revalidation within required time frame Unreported provider address and/or bank information [Return to [...]

Complying with the Comprehensive Error Rate Testing Program

Do you know who the Comprehensive Error Rate Testing (CERT) contractor is? Have you been notified of CERT record requests and/or received CERT claim errors? The Centers for Medicare & Medicaid Services (CMS) established the CERT program to [...]

The “How To” in Avoiding Documentation-Related Claim Denials

Have you received claim denials for missing or incomplete documentation? Does your facility have difficulty responding timely to our additional development requests (ADRs)? Join us for a session that will focus on tips to prevent and [...]

Understanding Your Medicare Secondary Payer Responsibilities

All Medicare providers have responsibilities related to Medicare being the secondary payer including identifying payers primary to Medicare (per the Medicare Secondary Payer provisions, such as Employer Group Health Plans, No-Fault, WC, etc.), [...]

Let’s Get Familiar with National Correct Coding Initiatives Procedures

The Centers for Medicare & Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) program to promote national correct coding. Incorrect coding often leads to improper payment and increases the paid claims error rate. If [...]

Revalidate My Enrollment

Table of Contents Step 1: Determine You Are in the Right Place What’s ahead for your next Medicare enrollment revalidation? How will you know if you are due for revalidation? Step 2: Complete the Medicare Application Step 3: [...]

No Documentation Received

No Documentation Received National Government Services has experienced an increasing number of CERT errors due to “no documentation” received. The provider either does not respond to the CERT documentation request letter(s), or the provider [...]

Signature Requirements

Signature Requirements National Government Services has experienced an increasing number of CERT errors due to “signature requirements” not being met. Providers are not signing orders, certification/recertification forms or office visit notes. [...]

Appeals Process after Claims Correction or Denial

Appeals Process after Claims Correction or Denial CERT Process The CERT contractor randomly selects claims submitted to Medicare. Medical records are requested from the providers and then reviewed by health care professionals. The review is [...]

Physical Therapy Services

Physical Therapy Services Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means something was missing from the medical records. Below is a list of the most common reasons CERT determined there was [...]

Home Prothrombin Time International Normalized Ratio Monitoring for Anticoagulation Management

Home Prothrombin Time International Normalized Ratio Monitoring for Anticoagulation Management Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means that something was missing from the medical records. [...]

Psychological and Neuropsychological Testing

Psychological and Neuropsychological Testing Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means that something was missing from the medical records.  Below is a list of the most common reasons CERT [...]

Pulmonary Rehabilitation Program Services

Pulmonary Rehabilitation Program Services Insufficient Documentation Causes Most Improper Payments Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT [...]

Patient Discharge Disposition Code

Patient Discharge Disposition Code Improper payments due to discharge disposition codes are costly to the Medicare Program and are easily preventable. The CERT contractor has issued errors related to the discharge disposition codes that may [...]

Debridement Services

Debridement Services Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was [...]

Chronic Care Management

Chronic Care Management Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records.  Below is a list of the most common reasons CERT determined there was [...]

Total Joint Arthroplasty

Total Joint Arthroplasty Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records. Providers can help prevent CERT errors on total joint arthroplasty by [...]

Botulinum Toxin Injections for Chronic Headaches

Botulinum Toxin Injections for Chronic Headaches Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT [...]

Home Health Care Requirements for a Plan of Care

Home Health Care Requirements for a Plan of Care The HHA must be acting upon a physician plan of care that meets the requirements of this section for HHA services to be covered. For HHA services to be covered, the individualized plan of care [...]

Chiropractic Services

Chiropractic Services Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was [...]

Amending Medical Records

Amending Medical Records Amendments, Corrections and Delayed Entries in Medical Documentation    All services provided to beneficiaries are expected to be documented in the medical record at the time they are rendered. [...]

Continuous Cycling Peritoneal Dialysis

Continuous Cycling Peritoneal Dialysis We have experienced an increasing number of CERT errors due to documentation requirements not being met. Below is a list of the most common reasons CERT determined there was insufficient documentation [...]

Cologuard TM Multitarget Stool DNA Test

CologuardTM Multitarget Stool DNA Test Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined [...]

Hemodialysis Treatment

Hemodialysis Treatment Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient documentation that caused improper payments for [...]