Radiology Coding Alert

Are you guilty of TrailBlazer's top radiology claim misdeed

Good news: Trailblazer released the top-five reasons for denied radiology claims, and a few quick steps will keep you clear of these common pitfalls. Use this checklist to make sure your claims won't be coming back denied..

1. Beneficiary ineligibility. What to do: Make sure you've entered the correct Medicare number, check on patients' Medicare effective dates, and see whether they're covered by an HMO..

2. Duplicate claims. What to do: Check your claim status before refiling a claim -- the carrier may have already processed it and made a zero payment because of a denial or because the patient hadn't met his deductible. Call your carrier to check on the reason a claim wasn't paid the first time and to verify your claims processing information, Trailblazer says.

3. Medical necessity. What to do: Check national and local coverage determinations, and also make sure your diagnosis codes correspond with your documentation. If necessary, obtain a valid advance beneficiary notice (ABN) before billing. .

4. Filing time limit expired. What to do: Watch your service dates. You have one year to submit Medicare claims, and carriers must accept claims for the current year, the prior year, and at least three months of the year before that. But expect a 10 percent payment reduction if your claim is more than a year after the service date..

5. Medicare secondary payer. What to do: Make sure another payer doesn't cover this patient and keep track of the patient's working/retirement status. Medicare may be the secondary payer for the working aged and for patients covered by liability insurance, workers compensation, or Part A because of disability..


Resource: See the full list on the Web at www.trailblazerhealth.com/partb/downloads/radiologybillingerrors.pdf.