Claim Submission Billing, Errors and Solutions

Avoiding Denials on Priced Per Invoice Claims - View various procedure codes which require pricing per invoice and must contain specific elements in Item 19 of CMS-1500 claim form or its electronic equivalent for each line item submitted

Claim Submission Error FAQs - View claim submission error related frequently asked questions (FAQs)

Denial Code Resolution - View common claim submission error codes, descriptions of issues, and potential solutions

Incarceration Claim Denials - View solution progression for overpayment recoveries found on previously paid claims that contained a date of service which partially or fully overlaped a period when a beneficiary was incarcerated

Maternity Services - View maternity coverage guidelines and billing instructions

Miscellaneous Services and Charges - View various miscellaneous service topics and related charges

Modifier and HCPCS Changes - View new and deleted National Level II modifiers and HCPCS

Observation and Inpatient Evaluation and Management (E/M) Common Denials and Resolutions - View/search common E/M denials with details about resolutions

Provider Enrollment, Chain, and Ownership System (PECOS) - N264/N265 Denials - Providers who order/refer items or services for Medicare beneficiaries and do not have a Medicare enrollment record must submit a Medicare enrollment application via Internet-based PECOS or CMS-855O. View details

Routine Service Billing - If Medicare denies a service that is generally covered by Medicare as a routine service, providers are allowed to charge patient their normal charged amount. May not exceed amount billed to Medicare on claim for that service

Services Provided Outside the United States - View exceptions to "foreign" exclusion

Services Provided to Relatives - Medicare regulations do not provide payment under Part A or Part B of Medicare for expenses that constitute charges by immediate relatives of the beneficiary or by members of his/her household. View details

Skin Substitute Codes - The invoice price for payment of skin substitute codes in Q41XX range that do not have pricing on CMS quarterly ASP file is required. View submission details

Unlisted Procedure and Not Otherwise Classified Codes - View claim submission requirements when billing unlisted procedure and Not Otherwise Classified Codes (NOC)
 

Last Updated Jul 18, 2019