Posts Tagged ‘Claims’

National Government Services (NGS) will be merging four regions (Connecticut, Upstate New York, Queens County, and Downstate New York) into a single claims processing environment beginning Dec. 12. According to NGS, the Centers for Medicare & Medicaid Services (CMS) has approved a “Dark Day” on Dec. 14 to allow NGS to execute the merge. This will affect all providers who submit claims to the jurisdiction 13 (J13) Part B Medicare Administrative Contractor (MAC).

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Electronic data interchange (EDI) for claims submission is a great thing, but infallible? No. EDI relies on computers, and we all know how reliable computers can be. Let’s just say, the job of a medical biller isn’t done after she clicks the Submit button. To ensure claims are processed correctly and in a timely fashion you need to pay attention to your explanation of benefits (EOB) and communicate with your Medicare Administrative Contractor (MAC), but that’s not all.

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Want to increase the number of claims that successfully complete processing and enhance a positive cash flow? Heed Noridian Administrative Services’ (NAS) advice. The Medicare administrative contractor (B/MAC) has identified its top five denials for the months of July, August, and September and offers solutions and resources. Read more »

Physicians, non-physician practioners (NPPs), and other Part B providers and suppliers submitting claims to carriers or Part B Medicare Administrative Contractors (B/MACs) for ordered or referred items or services can expect further scrutiny during the claims editing process.

Beginning Oct. 5, carriers and B/MACs expanded claims editing to include validation of the ordering/referring provider’s national provider identifier (NPI) and name reported on the claim against Medicare’s provider enrollment records. Read more »

Wondering what you should do if you receive a claim denial due to untimely filing that you believe to be unjust? Request a reconsideration. UnitedHealthcare offers advice on what you should submit as evidence of timely filing.

For electronic claims, include confirmation that UnitedHealthcare or an affiliate received and accepted your claim. Effective Dec. 1, proof of timely filing from an electronic claim submission must include confirmation that UnitedHealthcare accepted the claim. The submission report will no longer be accepted as proof of timely filing.

For paper claims, include a copy of a screen print from your accounting software to show the submission date. The information must show that the claim is for the correct patient and visit. Also include other pertinent information, such as an insurance carrier denial/rejection, explanation of benefits (EOB), a letter indicating terminated coverage, etc.

National Government Services (NGS) posted on its Web site Sept. 30 a notice that the Part A/B Medicare Administrative Contractor (MAC) experienced a claims processing issue impacting Medicare Part B claims submitted from Sept. 16 through Sept. 23. Read more »

Failure to heed an update to the Durable Medical Equipment, Prosthetics, Orthotics and Suppliers (DMEPOS) Fee Schedule could mean lost revenue for your practice.

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Indiana and Ohio physicians want to know why they are being paid late and experiencing payment errors and excessive waiting times for customer service. They say Wellpoint subsidiary Anthem is to blame.

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A recent change to Medicare policy made by the Centers for Medicare & Medicaid Services (CMS) helps ensure claims processing isn’t delayed when the only missing information on the CMS-1490S form is the provider or supplier’s National Provider Identifier (NPI).

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The Office of Inspector General (OIG) identified, Jan. 6, the most significant management and performance challenges facing the U.S. Department of Health and Human Services (HHS) this year. The integrity of the Medicare program is No. 2 on the list.

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