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Primary Care Coding Alert

Reader Question:

Get the Scoop on Medicare's Reasons for Denials

Published on Sun May 01, 2005

Question: Do you have a list of Medicare's "Top 10" reasons for denying practices' claims?

Georgia Subscriber Answer: Yes. Here's Medicare's "Top 10":

1. no documentation of service
2. no signature or authentication
3. always assign the same level of service (LOS)
4. consult versus outpatient/office visit
5. invalid codes due to old resources
6. unbundling of procedure codes
7. misinterpreted abbreviations
8. no chief complaint listed/reflected
9. global fee service billed separately
10. inappropriate or no modifier used.
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