Filing Medicare Claims

Free Health Insurance Claim Form 1500 Download - Filing Medicare Claims

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When submitting professional claims to Medicare part B, there are some things that Medicare requires that differ from other assurance carriers. If you do not result these guidelines or rules, you will find that your claims will be rejected.

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Free Health Insurance Claim Form 1500 Download

First of all, most Medicare carriers are requiring that claims be submitted electronically, even if Medicare is secondary. If you are not capable of submitting your claims electronically you can apply for a waiver. An office with less than 10 full time employees can obtain a waiver granting them permission to file on paper. The Cms requires you to obtain a waiver certificate "demonstrating astonishing circumstances". If proper by Medicare, they can then file claims on paper. If you do not qualify for the waiver then you must find a recipe to submit your claims electronically.

If your software is not capable of electronic billing, which in this day and age would be unusual, or if you just do not want to go through the charge or trouble, you can get a free software from your Medicare carrier. The biggest problem with using the free software is that it many times is cumbersome to use, and it requires double entry of the claims. However, if you do not submit a lot of Medicare claims it can be a viable option.

Another tiny quirk with Medicare is that they need you to enter the word "none" in box 11 (or the equivalent of box 11 if submitting electronically) on the Cms 1500 form. We have had many providers over the years contact us because "Medicare won't pay!" when it was all just because they didn't have the "none" in box 11.

Whenever we train a new worker that is one of the things we try to drill into their head! "Don't forget the 'None'!" There is nothing more annoying to me than getting a rejection to find that the only problem is that 'none' was missing. We are working with a enterprise who is construction a rules machine to forestall problems like this from getting through. The claims scrubber will alert you to the missing word before you submit the claims!

Then of course there are the modifiers required only by Medicare such as the At modifier for chiropractors or the Gp modifier for corporal therapists. These modifiers are not used by any of the other carriers, but without them Medicare will not pay.

Another thing Medicare requires is referring dr name and Npi whole for straightforward in office services such as Ekg's. So if one of my doctors decides to do an Ekg on one of his patients, I have to put His name and Npi whole in as the referring doctor, even though he provided the service. Seems kind of ridiculous to submit a claim for Dr. Smith doing an Ekg where Dr. Smith referred the patient to himself. But if I don't put it in, the Ekg is denied.

Another Medicare quirk is that many Medicare carriers (maybe all) need that you do not put the Npi whole in box 24J if you are filing a claim for an private supplier who bills using just their private Npi number. When the Npi whole is in 24J for an private provider, the claims are rejected. However, if you are filing a claim for a group, the private Npi # must be listed in 24J and the group Npi# must be listed in box 33A.

When a claim is denied by Medicare or any other carrier, it is important to identify why the claim, or service, was denied. If the denial on the eob is not clear, call to get an explanation. If you do not agree with the fancy for the denial ask what the process for captivating the denial is. If the claim was denied for something straightforward that you can fix easily, make the correction and resubmit the claim. If you do not understand the denial even after getting an explanation from a customer aid rep, you can always Google it, or post a query on a good curative billing forum. The important thing is to take care of the denial and not to ignore it.

Most Medicare rules are consistent from carrier to carrier, but some are not. Rules turn and you've got to be ready to turn with them. Stay on top of the requirements, take care of any rejections, and attend any seminars you can. It is important to wholly understand Medicare rules to do a good job at collecting the money due for the services rendered.

Copyright 2009 - Alice Scott

Solutions curative Billing

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