Search Results - NGSMEDICARE

Posting Date: 10/25/2024

7K073

Avoiding/Correcting This Error If the beneficiary is entitled to Medicare Part B, an ancillary claim may be submitted to your MAC. Related Content Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) [...]

Posting Date: 10/25/2024

39934

Avoiding/Correcting This Error Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]

Posting Date: 10/25/2024

39934

Avoiding/Correcting This Error Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]

Posting Date: 10/25/2024

39934

Avoiding/Correcting This Error Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]

Posting Date: 10/25/2024

39929

Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]

Posting Date: 10/25/2024

39929

Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]

Posting Date: 10/25/2024

39934

Avoiding/Correcting This Error Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]

Posting Date: 10/25/2024

39929

Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]

Posting Date: 10/25/2024

39929

Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]

Posting Date: 10/25/2024

39721

Avoiding/Correcting This Error To have this claim considered for payment submit a new electronic billing with the requested information.

Posting Date: 10/25/2024

38312

Avoiding/Correcting This Error If appropriate, correct and resubmit a new claim. To prevent this error on future claims: Ensure you have received all charges from all departments and that no claim has been submitted for the same DOS [...]

Posting Date: 10/25/2024

38312

Avoiding/Correcting This Error If appropriate, correct and resubmit a new claim. To prevent this error on future claims: Ensure you have received all charges from all departments and that no claim has been submitted for the same DOS [...]

Posting Date: 10/25/2024

38312

Avoiding/Correcting This Error If appropriate, correct and resubmit a new claim. To prevent this error on future claims: Ensure you have received all charges from all departments and that no claim has been submitted for the same DOS [...]

Posting Date: 10/25/2024

38200

Avoiding/Correcting This Error Always verify the status of a submitted claim before submitting another claim. Verify claim status using the IVR system, FISS/DDE or the NGSConnex online portal. Per CMS mandate, PCC representatives are not [...]

Posting Date: 10/25/2024

38050

Avoiding/Correcting This Error Check your remittance advice or the claims processing system for a previously submitted/processed claim before submitting any new billing.

Posting Date: 10/25/2024

38105

Avoiding/Correcting This Error Verify billing and if appropriate, correct and resubmit the claim. To prevent this error on future claims: Ensure that the correct bill type is submitted once you have received all charges from all [...]

Posting Date: 10/25/2024

U538Q

Avoiding/Correcting This Error Medicare does not pay for medical items/services furnished to an alien beneficiary who was not lawfully present in the United States on the date of service that the items/services were furnished. Related Content [...]

Posting Date: 10/25/2024

34293

Avoiding/Correcting This Error Review your beneficiary’s enrollment in a Medicare HMO/MAO prior to providing services. A beneficiary may drop MAO coverage; review the CWF, IVR, NGSConnex, or HETS to identify a termination date for the MAO [...]

Posting Date: 10/25/2024

U5233

Avoiding/Correcting This Error Verify the admission date, from, and through dates on the claim and compare the dates to the HMO entitlement dates. Outpatient facilities and inpatient noninpatient PPS and IRF hospitals, or LTCH billing [...]

Posting Date: 10/25/2024

U5233

Avoiding/Correcting This Error Verify the admission date, from, and through dates on the claim and compare the dates to the HMO entitlement dates. Outpatient facilities and inpatient noninpatient PPS and IRF hospitals, or LTCH billing [...]

Posting Date: 10/25/2024

U5233

Avoiding/Correcting This Error Verify the admission date, from, and through dates on the claim and compare the dates to the HMO entitlement dates. Outpatient facilities and inpatient noninpatient PPS and IRF hospitals, or LTCH billing [...]

Posting Date: 10/25/2024

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 IVR system, the [...]

Posting Date: 10/25/2024

U5220

Avoiding/Correcting This Error Verify the MBI and date(s) of service. If services were provided prior to the date the beneficiary was entitled to Medicare, no further action is necessary. Otherwise, correct and resubmit.

Posting Date: 10/25/2024

39934

Avoiding/Correcting This Error You can find line level information by accessing MAP171D in the FISS/DDE Provider Online System: Hit <F2>/<PF2> once or <F11>/<PF11> twice from Claim Page 02 of the claim to access [...]

Posting Date: 10/25/2024

38055

Avoiding/Correcting This Error Verify the claim history using the FFS/DDE Provider Online system, your remittance advice and/or the CWF to determine the episode claim that is causing the overlap If there are services that should have been [...]

Posting Date: 10/25/2024

38200

Avoiding/Correcting This Error This reason code may be applied when an NOA and period of care claim are submitted at the same time or when an NOA and one is already in the system. If the NOA and claim were submitted at the same time, and no [...]

Posting Date: 10/25/2024

37364

Avoiding/Correcting This Error There was an issue with NOAs incorrectly editing for U537F. Once the system was fixed, NOAs could be resubmitted and subsequently processed. NOAs submitted late due to this issue may have affected more than one [...]

Posting Date: 10/25/2024

U5211

Avoiding/Correcting This Error Verify the MBI and dates of service. If appropriate, correct the information and submit a new claim or update returned claim. If the actual date of death was reported in error to the Social Security office, [...]

Posting Date: 10/25/2024

U5600

Avoiding/Correcting This Error Providers should develop and implement a process to ensure that duplicate claims are not being submitted. If the claim is truly a duplicate, no action is necessary If this is not a duplicate and the provider [...]

Posting Date: 10/25/2024

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: 10/25/2024

U5200

Avoiding/Correcting This Error Verify that the MBI on the claim is for the correct beneficiary. If the MBI is correct, verify the beneficiary’s entitlement information, correct, and resubmit if appropriate. If the MBI is incorrect, submit [...]

Posting Date: 10/25/2024

39934

Avoiding/Correcting This Error You can find line level information by accessing MAP171D in the FISS/DDE Provider Online System: Hit <F2>/<PF2> once or <F11>/<PF11> twice from Claim Page 02 of the claim to access [...]

Posting Date: 10/25/2024

39929

Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Providers can see line details in NGSConnex and hover over the line item reason code(s) for [...]

Posting Date: 10/25/2024

38200

Avoiding/Correcting This Error This reason code may be applied when an NOA and period of care claim are submitted at the same time or when an NOA and one is already in the system. If the NOA and claim were submitted at the same time, and no [...]

Posting Date: 10/25/2024

38055

Avoiding/Correcting This Error Verify the claim history using the FFS/DDE Provider Online system, your remittance advice and/or the CWF to determine the episode claim that is causing the overlap If there are services that should have been [...]

Posting Date: 10/25/2024

38054

Avoiding/Correcting This Error Verify the claim history to determine the period of care claim that is causing the overlap If there are services that should have been included on a processed/paid claim, you must submit an adjustment (3X7 [...]

Posting Date: 10/25/2024

38037

Avoiding/Correcting This Error Providers should develop and implement a process to ensure that duplicate claims are not being submitted. Verify the ‘from’ and ‘through’ dates, provider number, revenue codes, HCPCS codes and diagnosis codes [...]

Posting Date: 10/25/2024

34538

Avoiding/Correcting This Error To avoid this error: When submitting your Medicare primary claim, report the reason Medicare is primary using claim coding in Prevent an MSP Rejection on a Medicare Primary Claim. To correct this [...]

Posting Date: 10/25/2024

38032

Avoiding/Correcting This Error If duplicate claim was submitted in error, no additional provider action is necessary. If it is determined that the claim was due to additional charges for a patient for a specific date of service, wait for the [...]

Posting Date: 10/25/2024

38032

Avoiding/Correcting This Error If duplicate claim was submitted in error, no additional provider action is necessary. If it is determined that the claim was due to additional charges for a patient for a specific date of service, wait for the [...]

Posting Date: 10/25/2024

34538

Avoiding/Correcting This Error To avoid this error: When submitting your Medicare primary claim, report the reason Medicare is primary using claim coding in Prevent an MSP Rejection on a Medicare Primary Claim. To correct this [...]

Posting Date: 10/25/2024

34538

Avoiding/Correcting This Error To avoid this error: When submitting your Medicare primary claim, report the reason Medicare is primary using claim coding in Prevent an MSP Rejection on a Medicare Primary Claim. To correct this [...]

Posting Date: 10/25/2024

34538

Avoiding/Correcting This Error If this is correct: Follow MSP billing guidelines and submit the claim accordingly. If this is incorrect: As part of a provider’s eligibility verification process for Medicare beneficiaries, which is required to [...]

Posting Date: 10/25/2024

The National Correct Coding Initiative and Medically Unlikely Edits for Part B Providers

This webinar will assist Part B providers with navigating tables for the National Correct Coding Initiative and the medically unlikely edits. We'll also review proper modifiers to use to avoid denials. There will be time for your questions [...]

Posting Date: 10/25/2024

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 [...]

Posting Date: 10/25/2024

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 [...]

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

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

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

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

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

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

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

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

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

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: 08/04/2022

Assistants at Surgery at Teaching Hospitals

Assistants at Surgery at Teaching Hospitals CMS instructs providers to use specific modifiers on claims representing assistance during a surgical procedure: Modifier 80 denotes service by an assistant surgeon Modifier 82 denotes service by [...]

Posting Date: 08/04/2022

Bundled Services Missing Appropriate Modifiers at Time of Initial Claim Submission

Bundled Services Missing Appropriate Modifiers at Time of Initial Claim Submission Accurate coding and reporting of services are critical aspects of proper billing. Services denied based on the NCCI code pair edits or MUEs may not be billed to [...]