Railroad Medicare Denials: Top Reasons and Procedures
The Palmetto GBA Denial Resolution tool includes resources for resolving the top claim rejections and denial reasons. Save time and resources by looking here before you pick up the phone.•Access denial...
View ArticleMedicare ADR - how to send Medical record
Exciting New Way to Send Medical Documentation to the RRB SMAC: esMD live for Appeals and Medical Review ADR ResponsesThe Railroad Retirement Board Specialty Medicare Administrative Contractor (RRB...
View ArticleDenial code PR 49, CO 236 how to prevent the denial
Avoiding denial reason code PR 49 FAQQ: We received a denial with claim adjustment reason code (CARC) PR 49. What steps can we take to avoid this denial?Routine examinations and related services are...
View ArticleHow and when multiple procedure payment reducation calculated.
Learn More about Multiple Procedure Payment Reduction (MPPR)Effective Sept. 13, 2014, Humana plans apply multiple procedure payment reduction (MPPR) for diagnostic cardiovascular services, diagnostic...
View ArticleHow to file a cost report appeal with First Coast Medicare
Once a provider receives a notice of program reimbursement (NPR) from a cost report settlement, it has a right to redress audited adjustment related issuesthrough the cost report appeals process either...
View ArticleAction for these Denials - PR B9, CO236, PR 49
How to Avoiding denial reason code PR 49 Q: We received a denial with claim adjustment reason code (CARC) PR 49. What steps can we take to avoid this denial?Routine examinations and related services...
View ArticlePreventing duplicate claim denials
Claim system edits search for duplicate and repeat services within paid, finalized, pending and same claim details in history. Therefore, unless applicable modifiers are included on your claim, the...
View Articlewhat is demanded debt - immediate offset
Q. Can I request early or immediate offset of a demanded debt?A. Yes. When you receive an overpayment demand letter indicating a refund is due, you can request immediate offset of the debt in...
View ArticleOverpayment FAQs
Q. What do I do if I have been overpaid because of a duplicate primary payment?A. Medicare Secondary Payer (MSP) overpayments are processed differently than non-MSP overpayments and require a refund to...
View ArticleRailroad Medicare Denials: Top Reasons and Procedures
The Palmetto GBA Denial Resolution tool includes resources for resolving the top claim rejections and denial reasons. Save time and resources by looking here before you pick up the phone.• Access...
View ArticleE/M Service: Similar Services from Multiple Providers in the Same Group denial
Denial Reason, Reason/Remark Code(s) • M86: Service denied because payment already made for same/similar service(s) within set time frame • B14 (CO): Only one visit or consultation per physician...
View ArticleHospice: Non-Attending Physician Denials PR - B9
Denial Reason, Reason/Remark Code(s) • PR-B9: Patient is enrolled in a Hospice• Procedures: All, especially CPT code 99308, 99309 and 99232 Resources/Resolution • Determine whether the patient...
View ArticleReason code 80, 81 and 82 - covered days not equal. - Hospital part B denial
We received an RTP with reason code 12206. What steps can we take to avoid this RTP?A: You received this RTP, because the total number of covered and non-covered days on the claim is not equal to the...
View ArticleRTP reason codes 153XX to 154XX, 30912, 30949 FAQ
Q: What steps can we take to avoid return to provider (RTP) reason code(s) 153XX-154XX?A: Claims that RTP with reason codes 153XX-154XX indicate that the total charges revenue line 0001 contains a...
View ArticleHospital part A Denial reason code 31816, 37544 and N5252 - what should we do ?
Q: We are receiving a return to provider (RTP) reason code 31816, so what steps can we take to avoid this reason code?A: You are receiving this reason code when the claim contains any of the following...
View ArticleHospital claim - Duplicate reject/return to provider (RTP) reason code FAQ...
Q: My claim rejected, or was returned to provider, as a duplicate of another claim. Can I resubmit the claim? What steps can I take to avoid duplicate claims?A: Claim system edits are in place to...
View ArticleEstablished Patient Office Visits: NCCI Bundling Denials
Denial Reason, Reason/Remark Code(s) • M-80: Not covered when performed during the same session/date as a previously processed service for the patient • CO-B15: Payment adjusted because this...
View ArticleEye Refraction: Statutory Denials PR 204
Denial Reason, Reason/Remark Code(s) • PR-204: This service/equipment/drug is not covered under the patient's current benefit plan • CPT code: 92015 Resolution/Resources • Eye refraction is...
View ArticleE/M Service: Global Surgery Denials co 97
Denial Reason, Reason/Remark Code(s)• CO-97 - Global Surgery Denials: Services submitted for the same patient by the same doctor on the same day as or within the post-op period of a major/minor...
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Medicare denial claim reopen from SPOT
Claim reopening: Request types What types of changes may I include in a claim reopening request? May I change more than one field on each line item? Can I add or remove line items?The only form of...
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