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Claim Submission Billing, Errors and Solutions

Topic

Brief Description

Incarceration Claim Denials

Medicare will generally not pay for medical items and services furnished to a beneficiary who was incarcerated or in custody under a penal statute or rule at time items and services were furnished

Outpatient Coding Questions

Providers may address Healthcare Common Procedure Coding System (HCPCS) related inquiries to "Central Office on HCPCS." Mail or fax

Provider Enrollment, Chain, and Ownership System (PECOS)

If you order or refer items or services for Medicare beneficiaries and you do not have a Medicare enrollment record, you must submit an enrollment application to Medicare. You can do this using Internet-based PECOS or by completing paper enrollment application (CMS-855O)

Quick Reference Billing Guide

View compilation of most commonly used coding and billing processes for Medicare Part A claims

Reason Code Guidance

View most common claim submission error codes, a description of issue and potential solutions

Returned to Provider (RTP) Help

List of common reason codes why claims are Returned to Provider (RTP) for correction

Services Provided Outside the United States

View exceptions to "foreign" exclusion

 

Last Updated Jan 11, 2017