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    • November 27, 2017

    Claim submissions and redeterminations received by National Government Services indicates a large volume of claims denying for incorrect usage of modifier 59. Modifier 59 is defined as a “distinct procedural service.” Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non... more

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    • October 25, 2017

    As directed by CMS, effective 10/1/2017, NGS Medical Review will transition all lines of business to a Targeted Probe and Educate (TPE) strategy. The purpose of this transition is to reduce costs related to improper payments and appeals, therefore reducing provider burden. In order to avoid claim processing delays it is important that providers... more

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    • September 28, 2017

    National Government Services (NGS) is informing Part B providers of an issue involving claims that did not successfully crossover to the supplemental carrier. Provider remittance advice (RA) indicated in error that claims had automatically crossed over to the supplemental insurance carrier. Letters were later issued advising that claims could not... more

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    • August 29, 2017

    Providers can elect to request Permanent Immediate Recoupment/Offset of their demanded overpayments to avoid making payment by check or avoid the assessment of interest if the immediate recoupment pays the debt in full before day 31. Medicare interest on debt payments accrues monthly rather than daily, debt payments paid on or after day 31 accrues... more

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    • August 29, 2017

    Each quarter, an analysis is performed on a sample of physicians who received HPSA/PSA bonus payments for the prior quarter. If NGS discovers, in their review process, that any claims submitted should not have been paid bonus payments, the claims will be adjusted. It is not necessary to send a check for the HPSA/PSA overpayment amount, as it will... more

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    • August 29, 2017

    National Government Services Provider Contact Center has received calls asking for provider status. The callers are requesting a specific effective date for when a provider became effective. As of 5/15/2017, CMS established specific criteria for the sharing of provider information. NGS has the information available to determine if a provider's... more

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    • August 29, 2017

    Providers and beneficiaries have the right to appeal claim determinations made by NGS. NGS has 60 days to process and complete your first level of appeal. Submitting duplicate appeal requests, either via paper or through NGSConnex, in an effort to speed up this process causes administrative delays and slows down the processing of your appeal.... more

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    • August 29, 2017

    INITIAL Additional Documentation Requests (ADR) letters for CERT are sent to the address on file with the MAC for the provider/supplier that billed/submitted the claim. SUBSEQUENT ADR letters for that claim can be sent to a specific correspondence address designated by the provider. This can be provided to the CERT CSR by calling 888-779-7477 once... more

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