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 [...]

Bill Inpatient or Outpatient Services

Bill Inpatient or Outpatient Services To help avoid denials, National Government Services has compiled information regarding references that will aid in determining whether to bill inpatient or outpatient services. CMS Medicare Learning [...]

Hospital Discharge Summary: Insufficient Documentation Causes Most Improper Payments

Hospital Discharge Summary: 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 [...]

Psychiatry and Psychology Services

Psychiatry and Psychology Services CERT has determined that insufficient documentation caused improper payments for psychiatry and psychotherapy; insufficient documentation means that information was missing from the medical [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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. [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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. [...]

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 [...]

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. [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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.  [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

Hospital

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, [...]

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

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 [...]

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 [...]

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 [...]

Hospice Top Claim Errors

Do you see the same rejections and return to providers (RTPs) over and over? Do you know how to correct the most common errors and more importantly how to avoid them in the future? In this session we’ll review the most common reason codes [...]