Medicare Compliance & Reimbursement

Medicare is just as eager to pay your claims as you are to collect them. That was the takeaway from CMS’ Angela James during a “CMS Provider Minute” compliance video released on Jan. 20. “When you submit a claim, Medicare pays the first submission of an approved claim, and the good news is that if you submit a clean, payable claim, you only have to do it once. In fact, we pay 90 percent of clean, payable claims within 30 days.”

If you don’t collect within a month, don’t resubmit just yet. “If the claim is an exact duplicate, we will deny it,” James said. “Instead of submitting a duplicate, you can easily check the status of a claim by going through your MAC’s electronic claims status inquiry tool, or by calling your MAC. You can get the contact information for your MAC from www.cms.gov.”

Exact duplicate claims are those that have the same health insurance claim number, provider number, service dates, type of service, procedure code, place of service and billed amount, she said.