Urology Coding Alert

Take a few simple steps to ensure clean claims and proper payments The Administrative Simplification Compliance Act requires that you electronically submit all initial Medicare claims for reimbursement as of Oct. 16, 2003 (except from small providers with limited exceptions). Of course, what this means in our world is not always simple. Processing the changes and information that come our way on a daily basis is difficult, and claim resubmission can be a constant frustration. But it doesn't have to be difficult if you know where to quickly find the information. CMS has come a long way in instructing our carriers regarding how to process claims and also, unfortunately, when to return them to us for errors. The following is a list of the most common errors encountered by Medicare and some tips on how you can avoid them. You can discover more about these on the CMS Web site (www.cms.gov) in the Medlearn Matters article SE0712.
HICN Is a Must-Have 1. Identify the patient as a Medicare patient. Always use the Health Insurance Claim Number (HICN) and name as it appears on the patient's Medicare card. Tip: CMS carriers receive numerous claims that healthcare providers submit with invalid or incorrect HICNs requiring manual intervention, which could result in beneficiaries receiving incorrect Explanations of Medicare Benefits (EOMB) information. Always be certain you enter the HICNs correctly, and make sure the HICN belongs to the patient you are billing for. HICN format: A correct HICN consists of nine digits immediately followed by an alphabetical suffix. Take particular care when entering the HICN for members of the same family who are Medicare beneficiaries. A husband and wife may have HICNs that share the same Social Security number, but every individual has his or her own alphabetical suffix at the end of the HICN. To ensure proper claim payment, you must append the correct alphabetical suffix to each HICN. And you should never use hyphens or dashes in the number.
Get the Full Address 2. Line item 32 requires that you indicate the place where the provider actually rendered the service to the patient, including the name and address -- and a valid ZIP code -- for all services unless it was in the patient's home. Be aware that any missing, incomplete or invalid information recorded in this required field will result in the claim being returned or rejected in the system as unprocessable. In addition, using the term "same" in these blocks is not allowed. Tip: A deliverable address may contain both a street name and number or a street name with a post office (PO) box number. Similarly, a PO box by itself is acceptable, and a rural route (RR) number [...]