Feb 21, 2014 | Medical billing basics
000 ERROR: Provider’s specialty code What this means: The rendering provider information is either incomplete or missing from the EDI system, or it doesn’t match what is being sent on the claim. Provider action: Check the rendering...
Feb 12, 2014 | Medical billing basics
Exact duplicate claim/service (DUPLICATE CHARGE PAID ?002XX ON CLAIM ?001XXXXXXXXX) (DUPLICATE CHARGE OF CLAIM ?001XXXXXXXXX NOW BEING PROCESSED) (THIS IS A DUPLICATE OF A CHARGE WE HAVE PROCESSED) (MORE THAN 1 E/M SERVICE BILLED ON THE SAME DAY) Resources/tips for...
Feb 3, 2014 | Medical billing basics
Customer service representatives cannot provide claim status via the toll-free service line Medicare guidelines, specifically, the Internet-only manual (IOM) Publication, 100-09 Chapter 6 Section 50.1 requires that providers call the interactive voice response system...
Jan 13, 2014 | Medical billing basics
As a general rule, where the contractor receives a late filed claim submitted by a provider or supplier with no explanation attached as to the circumstances surrounding the late filing, the contractor should assume that the provider or supplier accepts responsibility...
Jan 8, 2014 | Medical billing basics
Determining End Date of Timely Filing Period—Receipt Date A submission, as defined above, is considered to be a filed claim for purposes of determining timely filing on the date that the submission is received by the appropriate Medicare claims processing...
Dec 31, 2013 | Medical billing basics
Common Working File (CWF) Informational Unsolicited Response (IUR) or Reject for a New Patient Visit Billed by the Same Physician or Physician Group within the Past Three Years Note: This article was revised on June 4, 2013, to reflect the revised CR8165 issued on May...
Dec 26, 2013 | Medical billing basics
Change of Ownership When an organization having a provider agreement undergoes a change of ownership in accordance with the principles articulated in 42 CFR Part 489 and §3210 of the State Operations Manual, the agreement with the existing provider is...
Dec 14, 2013 | Medical billing basics
Medicare E/M claims for new patients As previously announced with MM8165, Medicare implemented a common working file system edit to identify claims where more than one new patient visit was billed for the same patient within three years. Medicare...
Dec 7, 2013 | Medical billing basics
Yes. Effective October 1, 2012, First Coast Service Options Inc. (First Coast) implemented the PWK (paperwork) segment of the X12N version 5010. PWK allows for voluntary submission of supporting documentation with a 5010 version electronic claim. PWK is a segment...
Nov 29, 2013 | Medical billing basics
Claims From Medicare Advantage Organizations Federal regulations require that Medicare fee-for-service contractors maintain payment responsibility for managed care enrollees who elect hospice. These regulations are found that Medicare Fee for Service retains payment...
