When it comes to Medicare billing, there can be no mistakes or confusion. Medicare claims require accuracy and reimbursement expertise.
Given that 15% of the U.S. population is enrolled in Medicare, there are lots of people who are receiving treatment and billing it to this social system.
However, the system is imperfect, and there are lots of spaces for Medicare billing errors that can cause both providers and patients undue stress. One of the best ways to avoid this stress is to know what the common mistakes are and how to handle them.
Here’s a guide to some of the most common billing errors and what you can do about them.
Make Sure Treatment’s Covered
Medicare billing is complicated, and billing is prone to inaccuracies. One of the more common reasons for this is that the care that’s being given isn’t actually covered.
Before performing a service or billing for anything, it’s smart to ensure that Medicare covers the care that you’re planning to give. Make sure that all the staff in your facility have been properly trained to recognize which services are covered.
If you’re in a facility that deals with a lot of patients on Medicare or with an older population, have a system in place to discuss these charges. Some patients may request that a charge is billed to cross over to their secondary insurance. Make sure to append a “GY” or another modifier to let them know.
Covered By Another Contractor
There are lots of claims that aren’t covered by every payer or contractor. When this notification is sent, it means that the service is going to be denied.
Durable medical equipment, Medicare Advantage, or hospice related services are often accompanied by this type of denial.
If you want to keep these kinds of rejections to a minimum, you need help from your front desk. They need to request a current insurance card every time your patients come in for service. Run eligibility checks each time just to be safe.
Your patients may change insurance coverage frequently. While some beneficiaries might think their new card as “additional coverage,” it may only be replacement coverage. Save everyone a headache by intercepting these kinds of issues.
The Service or Claim Is Duplicated
Some services are only available to patients once. While some treatments might require regular weekly, monthly, or quarterly applications, Medicare might not realize it and reject the bill. This error can get in the way of the treatment plan that you’ve laid out for your patients.
Checking a claim status via the Medicare IVR unit allows you to see if another claim was paid or is being processed. One of the most surefire ways to avoid this issue is to allow 2-4 weeks for them to process the claim before you resubmit one. Duplicate claims can put the brakes on important treatment.
This rejection sometimes indicates that there was a claim previously paid for which the payment just hasn’t been received yet. It might also apply to a previously denied claim where the remittance is pending.
Wrong Type of Provider
It’s become common that some payments get denied when they’re performed by some providers. It’s important to know the limits of the services that Medicare will support when you’re the provider. If ordered, referred, or performed by some providers, Medicare isn’t willing to step in.
Refer to the guidelines written by Medicare that indicate the requirements for this kind of treatment. The physician or non-physician practicing some treatments needs to be a specialist in some cases. This allows them to order and refer treatments, let alone perform them.
Medicare only reimburses doctors for x-rays if they’re a certain type of doctor. Osteopaths and doctors of medicine can bill for x-rays while others may not. Chiropractors are one case where x-rays aren’t reimbursed by medicare even when they’re necessary.
Educating patients will play a positive role in eliminating the stress of these situations.
Services Aren’t a Medical Necessity
While some doctors or providers think a treatment is medically necessary, only Medicare defines those limits to coverage. Just because it seems necessary doesn’t mean that it’s going to be paid. This is a common cause of denial.
Check out the local and the national coverage determinations that are laid out by Medicare. All procedures need to be performed to ensure that the patients have the diagnosis codes necessary for the procedure. The frequency should also be noted to stay within the appropriate limits.
Review claims before you submit them. This can go a long way to ensuring that the right codes are linked to the procedures performed.
Is Your Coding Specific?
One issue that providers see again and again is that their coding isn’t specific. There are degrees for each code and a maximum number of digits related to each code. Use as many digits as possible to ensure that you’re using the code that applies most specifically to the treatment.
Some issues come up with a code, followed by a period, and a number that specifies the category it falls under. Someone with high blood pressure and someone with severe hypertension could be put under the same category if your coding is wrong. However, it’s important to bill carefully to thread this needle.
Sometimes the code is not enough in its truncated form, and you need several digits after the ICD-10 number. While it’s extra work and research, it will seriously eliminate small but costly errors.
Medicare Billing Requires Patience
It takes years to navigate the complex and convoluted system of Medicare billing and coding. However, once you do, you can make patients comfortable knowing that their care is covered. You also eliminate stress for your office that comes with chasing down your beloved patients for payment.
If you’re considering outsourcing your billing, check out our guide for some useful tips.