Wiki Medicare denying claim due to referring physician

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CatchTheWind

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Has anyone had an issue with Medicare denying payment for pathology charges, stating that they do not cover this service when referred by the particular referring provider, and you know for a fact that the referring provider is an active Medicare provider with a clean record and an active PECOS enrollment?
 
CO-183 "The referring provider is not eligible to refer the service billed." But we know that the provider is eligible to refer, because we get paid on 99% of the claims for services referred by him.
 
I receive these as well and was told that Medicare did an update of the physician files. I did find that a few of the ones I had the wrong NPI number so check that out. Also, my referring providers who were DC used to get paid but now do not.

Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management
 
We recently got some of those denials as well. We're working on updating the information for one of our doctors. The other doc here is covered. It's such a pain.
 
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