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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)

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

Reason Code Guidance - View most common claim submission error codes, a description of issue and potential solutions

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

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

Last Updated Dec 15, 2017