Medicare Compliance & Reimbursement
One Phone Call May Solve A Simple Mistake
When you get a denial for a claim you know Medicare should pay, use this action plan to decipher exactly what you need to do next.
If you receive a denied or underpaid claim, you first have to make sure that the denial isn't a result of the way you filed the claim. To do so, follow these steps as outlined by Barbara Cobuzzi, director of outreach programs for the American Academy of Professional Coders, based in Salt Lake City:
1. Read denial codes on explanation of benefits (EOB) to determine the payor's reason for denial or underpayment.
2. Audit and review coding documentation.
3. Make sure the documentation supports what was billed.
4. Determine whether the payor made an error.
If you determine that Medicare made an error, you can write a letter expressing why you think your carrier should pay the claim.
If you find you've made a mistake, remember that you don't have to appeal, according to CMS. Just ask your carrier to reopen the claim so you can correct the error.
Medicare Compliance & Reimbursement
- PART D:
Dodging The Donut Hole Gets Trickier Next Year
Watch for these Part D traps in 2008
For Part D prescription drug plans, the race [...] - BENEFITS:
Insurers Keep Big Picture Of 2008 Benefits Top Of Mind
Drug benefits are trending upward
Community pharmacists and consumer advocates are watching carefully as Medicare Part [...] - DOCUMENTATION:
Are Your Nurses' History Notes Becoming Audit Bait?
Nurses can document chief complaint, but history should be in doctor's handwriting
Warning: Don't let your [...] - CODING COACH:
Apply These 5 Appeal-Winning Steps To Your Next Claim
It works: Empire Medicare covers rhinometry thanks to this coder's digging
If you shudder at the [...] - OIG ALERT:
Look For A Crackdown On Diagnostic Imaging
OIG also looking into incident-to billing, polysomnography
Heads up: If your practice owns an MRI or [...] - BILLING:
One Phone Call May Solve A Simple Mistake
Run down this quick checklist to pinpoint the reason for a denial
When you get a [...] - REIMBURSEMENT:
Don't Treat A Second-Hand Problem Like A New Development
Don't bill Medicare for routine pre-operative chest X-ray
A problem may be new to your doctor, [...] - INDUSTRY NOTES:
January Is Drop-Dead NPI Deadline, CMS Says
Plus: Prepare to fight a powerful insurance lobby to stop 10 percent pay cut
You can [...]
