Status of Jurisdiction K Provider Appeal Requests Submitted to NGS

National Government Services (NGS) has recently experienced an increase in the number of claims submitted to Medicare Part B Appeals for review. NGS advises anyone who may have submitted an appeal within the last 60 days to be patient and not resubmit claims as this may cause further delays in processing your appeal request.  Once an initial claim determination is made, providers have the right to appeal the decision of that determination.

If you are a current NGSConnex user, you can check the status of your appeal. However, please do not resubmit the appeal when using NGSConnex.

Click here for more information from NGS.


CMS Instructs Incarcerated Beneficiary Claim Issue

The Centers for Medicare and Medicaid Services (CMS) initiated recoveries from providers and suppliers based on data that indicated that the beneficiary was incarcerated on the date of service (DOS).  Providers receiving demand letters with appeal instructions from CMS for overpayments due to claims paid for incarcerated beneficiaries are being asked not to file appeal requests.

Click here to read more

Check Out Our New Look!

HMS Healthcare Management Solutions is pleased to announce the launch of our new website. Our site has been redesigned with a fresh new look and updated information on all the products and services HMS has to offer.

Learn more about our billing and collections, consulting services, social media strategies and how HMS can help prepare providers for audits and appeals.  Visitors also have access to our resource center for the latest and archived editions of our newsletters as well as case studies highlighting HMS success stories. Links to the HMS blog and our social media sites are conveniently located at the top of our homepage for easy access to HMS on Facebook, Twitter and more!

Visit today to see all of the changes we’ve made!

Tiptastic Tuesday: Turning Denials Into Reimbursement

The appeals process is an important part of ensuring your practice is receiving the reimbursement it is entitled to.  Approaching the process with these simple steps will help increase your chances of winning.

  • Check Your Work:  Double check claims to be sure all the submitted information is correct. Look for common errors and confirm supporting documentation.
  • Research:  Make sure you know what the payor requires for the appeal process before submitting an appeals letter.  Don’t miss important filing deadlines.
  • Make The Case:  State your case in a straightforward manner.  If you aren’t clear as to why your practice deserves to be paid, you have no chance of winning the appeal.
  • Get Proof:  When you submit your appeal, be sure to send it certified mail for proof it was submitted in the time allotted.
  • Internal Appeals:  Never agree on an internal appeal unless it’s made mandatory by the payor.
  • External Appeals:  Requirements for external appeals vary from state to state.  Consult your state department of insurance and banking to learn how to proceed.

HMS Healthcare Management Solutions can assist your practice with our billing solutions.  We quickly bill for all claims and ensure accurate coding greatly reducing the need for appeals.  In fact, 99% of our claims are paid on the 1st pass resulting in improved cash flow for your busy practice.  Contact us today for a free consultation.