Question: Our dermatology practice has been receiving numerous Medicare claim denials recently, and there doesn't seem to be any correlation between the rejections and certain types of billed services. Any idea what's going on?
Virginia Subscriber
Answer: The Medicare beneficiary information you're submitting for each patient may be to blame.
Since Medicare implemented an October 2004 edit requiring an exact match between claim data and a beneficiary's card information, denials have tripled, according to the Medlearn Matters article SE0516 issued on Feb. 14. Here's how you can avoid rejections:
Solution: Check patients' Medicare cards - or you're setting your claims up for failure. Verify that the name on the record matches the name on the beneficiary's Medicare card. Sometimes the denial-causing mismatch can be as simple as a different spelling of the patient's name or a missing middle initial.
If the patient indicates that the name is incorrect, you should still report the "card" information, then advise the individual to contact his local Social Security Field Office to obtain a new Medicare card.