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 [...]

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 [...]

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. 

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

39928

Avoiding/Correcting This Error To access the line level reason associated with this reason code providers should go to claim page (2) (MAP 1712) and F11 to MAP171D to see the line level denial codes for each line of the claim. If you disagree [...]

59132

Avoiding/Correcting This Error RHCs should not bill codes G0108 or G0109. Related Content CMS Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 9, Section 70.5 - Diabetes Self-Management Training (DSMT) [...]

39928

Avoiding/Correcting This Error To access the line level reason associated with this reason code providers should go to claim page (2) (MAP 1712) and F11 to MAP171D to see the line level denial codes for each line of the claim. If you disagree [...]

56900

Avoiding/Correcting This Error Regularly access claims in status locations SB6001, SB6098, or SB6099 to obtain a listing of claims for which records have not yet been received by the MAC (Medical Review Department). Look for information on the [...]

56900

Avoiding/Correcting This Error Regularly access claims in status locations SB6001, SB6098, or SB6099 to obtain a listing of claims for which records have not yet been received by the MAC (Medical Review Department). Look for information on the [...]

55B31

Avoiding/Correcting This Error Review coverage guidelines and patient records to determine if all appropriate documentation was sent for review that may have supported medical necessity.  When you receive an ADR from National Government [...]

5WEXC

Avoiding/Correcting This Error Ensure all Medicare coverage and medical necessity requirements are met prior to billing. When the provider determines that Medicare will not cover the services, consider submitting the charges as noncovered. [...]

5WEXC

Avoiding/Correcting This Error Ensure all Medicare coverage and medical necessity requirements are met prior to billing. When the provider determines that Medicare will not cover the services, consider submitting the charges as noncovered. [...]

W7010

Avoiding/Correcting This Error Condition Code 21 is appropriate to use to submit on a “no pay” claim when seeking a denial from Medicare to facilitate payment by subsequent insurers.  This denial allows the subsequent insurer to consider [...]

Illinois, Minnesota, Wisconsin

Member Name Group Email Aldrich, Elizabeth IPW (Independent Physicians of Wisconsin), Allen Family Practice ealdrich@ipw-offices.org Anderson, Benita Aurora Health Care Benita.Anderson@aurora.org [...]

10/28/2024

table, td, th table { border-collapse: collapse; width: 50%; } Self-Service Pulse: What You Need To Know This Week As your MAC, National Government Services wants to provide you with a comprehensive source containing the most [...]

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction K Part B Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Paring or Cutting of Benign Hyperkeratotic Lesion 11055, 11056, 11057 A07 – The [...]

Ambulance Services and Establishing Medical Necessity for Part B Providers

This webinar will help the ambulance community understand the importance of medical necessity as it pertains to Medicare’s coverage guidelines.

Radiopharmaceutical Reimbursement

Radiopharmaceutical Reimbursement National Government Services has reviewed the radiopharmaceutical pricing methodology set forth in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Section 303(h) which states that [...]

Help with Medicare Costs

Help with Medicare Costs Medicare Savings Programs Learn about your options for help with Part B premiums Costs for Medicare Drug Coverage Learn how to get extra help with Part D Revised 11/1/2024

NGS Office of Congressional Affairs Welcome Letter

Dear Members of Congress and Staff: As your work continues in the 118th Congress, National Government Services, Inc. maintains its dedicated role in serving your district/state as a Medicare contractor for Original Medicare. We are your [...]

PECOS Correct and Resubmit Application Instructions

PECOS Correct and Resubmit Application Instructions Login to PECOS and select the following: My Associates View Enrollment for applicable enrollment under Existing Associates Correct and Resubmit for applicable [...]

Supporting Documentation Information

Supporting documentation with the submission of an application is very important. The paper CMS-855A identifies applicable information under section 17. Here’s a list when applicable for initial enrollment, change of information or [...]

NGS RuralServ - Changing the Way We Deliver Education to You!

Our rural health providers face unique challenges in delivering quality of care to Medicare beneficiaries and the associated administrative functions to file claims to Medicare. This session shares the efforts and resources to assist rural [...]

CMS-1500 Claim Form

Medicare Part B 101 Manual CMS-1500 Claim Form Table of Contents General Information Claim Filing Instructions for Paper and Electronic Submission Regulations on Charging for Claim Form Completion OCR System Missing, Incomplete, [...]

Medical Policy Development

Medicare Part B 101 Manual Medical Policy Development Table of Contents Medical Policy Development National Policies National Coverage Determinations National Coverage Provisions in Interpretive Manuals Local Policies [...]

Comprehensive Error Rate Testing

Medicare Part B 101 Manual Comprehensive Error Rate Testing Table of Contents Comprehensive Error Rate Testing What Is CERT? How Long Do Providers Have to Respond to a Request From the CERT Contractor? What Happens if the Provider [...]

Instructions for Unfinished PECOS Enrollment Application(s)

Table of Contents Instructions for Unfinished PECOS Enrollment Application(s) Instructions for Unfinished PECOS Application(s) Instructions for Application Status “Pending E-Signature” Submitted Enrollment Application(s) on Behalf of an [...]

11/4/2024

This is Our Last Self-Service Pulse We sincerely thank you for being a loyal reader of our Self-Service Pulse each week. To continue receiving updates on our latest self-service tools and services, please subscribe to our general Email [...]

Skilled Nursing Facility Billing Basics

This session will focus on the basics of skilled nursing facility (SNF) inpatient and outpatient billing, including consolidated billing guidelines. Learn about the required fields on SNF claims, timeframes for claim submission and how proper [...]

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 [...]

Connecticut

Connecticut Member Name Professional Title Association Business Name/Address Email Fitzgerald, Elizabeth Audit and Education Specialist Hartford Healthcare 181 Patricia Genova Drive Newington, CT [...]

National Government Services Guide for New Providers

National Government Services Guide for New Providers

National Government Services Guide for New Providers

National Government Services Guide for New Providers

Two Weeks to Prepare to use NGSConnex for Beneficiary Eligibility Information

Two Weeks to Prepare to use NGSConnex for Beneficiary Eligibility Information As we’ve communicated, beginning 11/18/2024, Beneficiary Eligibility information will not be offered on the IVR. This includes all beneficiary eligibility [...]

How to Avoid Duplicate Claims

Duplicate denials continue to be one of the top billing errors. Unnecessary duplicate filing of Medicare claims cost the provider's office valuable time and resources, as well as Medicare's time and money to process them. Please join us for [...]

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction 6 Part B Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or [...]

Getting Access to PECOS

During this webinar, we’ll discuss how to obtain access to the Internet-based Provider Enrollment Chain & Ownership System (PECOS) and gain connection to provider enrollment record as well as understand other Centers for Mediacre & Medicaid [...]

Provider Enrollment: Completing the CMS-855B Paper Application

During this webinar, we'll provide an understanding of how to complete the CMS-855B provider enrollment paper application for a clinic, group, or supplier.

Anesthesia Billing Codes

Anesthesia Billing Codes Table of Contents Anesthesia Not Otherwise Classified Codes Add-On Codes for Anesthesia Related Content [Return to Top] Anesthesia Body Area CPT Codes Head 00100‒00222 [...]

Monitoring Anesthesia Services

Monitoring Anesthesia Services Monitored Anesthesia Monitored anesthesia care involves intraoperative monitoring by a physician or qualified individual under the medical direction of a physician or of the patient’s vital physiological signs [...]

Daily Management and Pain Management

Daily Management and Pain Management Table of Contents Daily Management of Continuous Pain Control Techniques Pain Management Consultations Postoperative Pain Control Procedures [Return to Top] Daily Management of Continuous [...]

Provider Qualifications

Provider Qualifications Table of Contents General State Licensing Physician – Anesthesiologist (Specialty 05) Medical and Surgical Services Performed with Anesthesia by an Anesthesiologist Qualified Nonphysician Anesthetists [...]

Payment and Reimbursement

Payment and Reimbursement Table of Contents Anesthesia Claim Billing Instructions Multiple Anesthesia Procedures Multiple CRNAs Same Procedure Payment at Personally Performed Rate Payment at Medically Directed Rate Payment at [...]

Provider Enrollment: Completing the CMS-855I Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855I provider enrollment paper application for a group member, sole proprietor or sole owner and we’ll also focus on reassigning Medicare benefits.

Cervical Fusion with Disc Removal Best Practices

Cervical Fusion with Disc Removal Best Practices Table of Contents Introduction Coverage General Documentation Requirements Medical Necessity Criteria for Each Indication Limitations and Exceptions to Conservative Therapy [Return to [...]

Frequently Asked Questions Have Been Reviewed and Updated

Frequently Asked Questions Have Been Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Please take time to review these FAQs for answers to [...]

Top Claim Errors Reviewed and Updated

Top Claim Errors Reviewed and Updated Using data analysis, we review and update the Top Claim Errors on a quarterly basis and provide: the error reason code; a description of the error; the error type; details that include steps you [...]

Home Health Billing

Avoiding Reason Code 38200

CR 9189 Transmittal 602: Medical Review of Home Health Services

Contractor Advisory Committee

Assist National Government Services in the Development of Local Coverage Determinations Background CMS released Change Request 10901 and the companion MLN® Matters MM10901: Local Coverage Determinations (LCDs) article to expand the parameters [...]

Medicare Overpayments Process

Ensure that you are compliant and avoid financial penalties by understanding the Medicare overpayment regulations. This session will focus on identifying overpayments, using the proper forms and procedures, the timelines for repayment and the [...]

Proper Medicare Part B Claim Submissions

This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments or denials. We will guide you through the CMS-1500 claim form and the electronic equivalent loops [...]

Proper Medicare Part B Claim Submissions

This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments or denials. We will guide you through the CMS-1500 claim form and the electronic equivalent loops [...]

PECOS: View and Manage Reassignments through Group Enrollment

During this webinar, we’ll provide an understanding of how to view and manage reassignments through the group enrollment in Provider Enrollment, Chain and Ownership System (PECOS), including to add or terminate reassignments. Individual [...]

Medicare Part B Secondary Payer Post-Pay Overpayments

This session is intended to educate providers and office staff on the Medicare Secondary Payer (MSP) post-pay overpayment process. During this webinar, providers and office staff members will learn about the Medicare Part B overpayments process [...]

A/B DME MAC Collaborative Lower Limb Orthoses Webinar

A/B DME MAC Collaborative Lower Limb Orthoses Webinar This is your opportunity to hear directly from the Medicare contractors regarding Medicare’s criteria necessary for the coverage of lower limb orthoses. Representatives from all four DME [...]

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 [...]