Physician Documentation Requirements for Certification of Home Health Care

Physician Documentation Requirements for Certification of Home Health Care Medicare has changed the physician documentation requirements for certification of home health care for dates of service effective 1/1/2015. While clinicians still need [...]

SNF Inpatient Stays

SNF Inpatient Stays The CERT contractor has seen increased denials of SNF inpatient stays due to missing or incomplete physician certification statement of medical necessity. Certification of medical necessity of inpatient skilled nursing [...]

Physician Orders to Admit to Inpatient Hospital or for Observation Services

Physician Orders to Admit to Inpatient Hospital or for Observation Services Lack of a formal order for inpatient admission or observation services results in an increase of the CERT error rate for National Government Services. CERT auditors [...]

Pacemakers and Cardiac Defibrillators

Pacemakers and Cardiac Defibrillators National Government Services would like to alert providers that although coverage indications of pacemakers and implantable cardiac defibrillators was revised and expanded effective with dates of service [...]

MLN Connects® Newsletter: November 14, 2024

MLN Connects® Newsletter: November 14, 2024 News 2025 Medicare Parts A & B Premiums and Deductibles Medicare Participation for CY 2025 Ambulance Fee Schedule: CY 2025 Final Policies Prior Authorization Review Timeframe Change [...]

November 21st is The Great American Smokeout

November 21st is The Great American Smokeout You Can Help Your Patients Quit Smoking Smoking is one of the leading causes of heart disease and stroke. At least 70% of cigarette smokers see a clinician annually and many want to quit. Each [...]

Part B Claims Denied with Error 524B

An error in CWF processing has not yet been fully corrected. The error is occurring when Demo Codes A5 (Making Care Primary-MCP) or A6 (Guiding an Improved Dementia Experience-GUIDE) are on the claim and the HIC on the claim has an active MSP [...]

IVR Conversion Table

Conversion Chart for Patient Names Conversion Chart for Beneficiary HICN/MBI/PTAN/DCN Letter Conversion Letter Conversion A 2 A *21 B 2 B *22 C 2 C *23 [...]

Using the IVR

Table of Contents MBI Phonetic Alphabet Now Available Tips MBI Phonetic Alphabet IVR Conversion Tool [Return to Top] MBI Phonetic Alphabet Now Available To assist you when speaking the MBI, we have implemented the MBI phonetic [...]

When to Use the Provider Contact Center Versus Self-Service Tools

When to Use the Provider Contact Center Versus Self-Service Tools The CMS requires contractors to provide self-service and electronic communication technologies as efficient, cost effective means of disseminating Medicare provider information, [...]

Prothrombin Time

Prothrombin Time 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 that caused improper [...]

Diagnostic Mammography

Diagnostic Mammography 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 [...]

Prolonged Services

Prolonged 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 [...]

Annual Wellness Visit

Annual Wellness Visit 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 an [...]

Hyperbaric Oxygen Therapy Treatment

Hyperbaric Oxygen Therapy Treatment Insufficient documentation is documentation that was incomplete, inaccurate or was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient [...]

Surgery Services

Surgery Services 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 [...]

Medication Administration

Medication Administration Insufficient documentation means 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 [...]

Ambulance Services

Ambulance Services 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 [...]

Stereotactic Body Radiation Therapy

Stereotactic Body Radiation Therapy Insufficient documentation means that something was missing from the medical records. Below are the most common reasons CERT determined there was insufficient documentation that caused improper payments for [...]

Anesthesia Services

Anesthesia Services Insufficient documentation means 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 [...]

Diagnostic Testing Services

Diagnostic Testing Services Insufficient documentation means 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 [...]

Transcatheter Aortic Valve Replacement

Transcatheter Aortic Valve Replacement The CMS CERT program produces a national Medicare FFS error rate, as required by the Improper Payments Information Act. CMS strives to eliminate improper payments in the Medicare Program to maintain the [...]

Part A to Part B Claims (Rebilling) Submissions

Submitting Part A to Part B Claims (Rebilling) Submissions Administrator’s Ruling CMS 1455-R The Administrator’s Ruling CMS 1455-R, issued on 3/13/2013 established an interim process for hospitals to use to submit claims for Part B [...]

Inpatient Hospital Surgery

Inpatient Hospital Surgery National Government Services would like to alert providers on one of the highest dollar and most avoidable denials from the CERT contractor: submitting documentation relating to inpatient hospital surgeries.  [...]

Redetermination/Reopening Requests Online with NGSConnex

Redetermination/Reopening Requests Online with NGSConnex The NGSConnex web application allows providers/suppliers the ability to electronically submit and check the status of all redeterminations and/or reopenings requests online with no costs [...]

Selecting the Appropriate Principal Diagnosis for Inpatient Services

Selecting the Appropriate Principal Diagnosis for Inpatient Services CERT analysis indicates providers are not coding the principal diagnosis to the highest level of specificity and/or selecting the most appropriate code for the inpatient [...]

Complete Blood Count with Differential CPT Code 85025

Complete Blood Count with Differential CPT Code 85025 Error code 31 services incorrectly coded have been increasing in relation to CPT code 85025 - Complete blood count with differential (CBC w/Diff). Review of the CERT data shows that the [...]

Evaluation and Management Codes

Evaluation and Management Codes E/M services are the most common CERT errors found with Medicare Part B claims. The medical records that were provided either do not support the level of service billed or do not indicate the service was [...]

Diagnosis-Related Group Claims Reviewed for IPPS Providers

Diagnosis-Related Group Claims Reviewed for IPPS Providers This notice is intended to educate IPPS providers on the CERT program findings for DRG claims reviewed. Trending analysis disclose that the top errors are related to medical necessity [...]

Therapy Checklist

Therapy Checklist National Government Services would like to thank all providers for their cooperation in providing requested medical records to the CDC. We at NGS appreciate your effort and encourage your continued assistance in the program. [...]

Urgent: Beginning Monday 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR

Urgent: Beginning Monday 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR As we’ve communicated, beginning Monday 11/18/2024, beneficiary eligibility information will not be offered on the IVR. This includes all [...]

Urgent: Starting Today 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR

Urgent: Starting Today 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR As we’ve communicated, starting today, 11/18/2024, you won’t have access to beneficiary eligibility information on the IVR. This includes all [...]

Hospital

Hospital Billing for Beneficiaries Enrolled in Option Code C Medicare Advantage Organization Plans

Hospital Billing for Beneficiaries Enrolled in Option Code C Medicare Advantage Organization Plans  A Medicare beneficiary can choose to enroll in an option code C MAO plan. If they do, that plan replaces their original Medicare. Original [...]

Medicare Coverage at Rural Health Clinics for Primary Health Care Services for Medicare Patients

Medicare Coverage at Federally Qualified Health Centers for Primary Health Care Services for Medicare Patients

About PA RSNAT Model

  About PA RSNAT Model Table of Contents About PA RSNAT Model Background How it Works Ambulance HCPCS Codes [Return to Top] About PA RSNAT Model The Centers for Medicare & Medicaid Services implemented a prior [...]

2020 Changes Driven by You – National Government Services Self-Service Tools

2020 Changes Driven by You – National Government Services Self-Service Tools We are committed to improving your experience while using our secure self-service tools which includes our NGSConnex portal, our NGSMedicare.com website and our IVR [...]

Hospice Certification and Recertification

Hospice Certification and Recertification We have experienced an increasing number of CERT errors due to documentation requirements not being met. Below is the documentation required for hospice certification and recertification. The hospice [...]

Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated and Advance Payments for Part A Providers and Part B Suppliers Frequently Asked Questions

Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated and Advance Payments for Part A Providers and Part B Suppliers Frequently Asked Questions Please see the below for the latest FAQs related to the CHOPD Accelerated and Advance [...]

Top Tobacco Counseling Claim Errors - Tips to Avoid and Correct Claim Errors

Top Tobacco Counseling Claim Errors - Tips to Avoid and Correct Claim Errors National Government Services is committed to reducing provider burden associated with Medicare claim denials and claim submission errors. Don’t wait until you receive [...]

The Medicare Hospice Benefit: Effects on Other Provider Types

The Medicare Hospice Benefit: Effects on Other Provider Types Table of Contents The Medicare Hospice Benefit: Effects on Other Provider Types What is Hospice Care Providing Services Related to the Terminal Condition Providing Services [...]

Main Menu Options

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 provider numbers, Medicare numbers, PTAN, NPI, TIN, dates of service, [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]