Top Medical Billing Claim Submission Errors

Top Medical Billing Claim Submission Errors

If you’ve only been doing medical billing for a short period of time or you’re an old hat at it, you know that handling Medicare medical billing claims can be tricky.

A recent study from Medicare identified the top medical billing claim submission errors and addressed them. Most of these are due to medical billing claims being filed in house in the physician’s office direct to Medicare. If a physician outsources their medical billing, they will see their rejection and denial rate drop to less than 1% in most cases.

Homebound patients make up a large part of Medicare claims and the simple lab work, on the medical billing form as : Independent Lab Billing EKG tracing or Specimen Procurement in Place-of-Service “Patient Home” (POS 12). Was the number one erroneous submission for missing the narrative “homebound,” in the extra narrative field. This simple omission resulted in those claims being rejected and having to be refiled with Medicare.

Another big submission error was for procedure code not paid separately (always bundled), non-covered, or not valid for Medicare purposes. The Medicare Physician Fee Schedule Database (MPFSDB) lists status of B, G, I, N, or P for the procedure code billed and if anything other than those exact codes are put on the form, your medical billing runs the risk of being rejected.

Missing provider numbers for both facility (field 32) and the individual was another big reason for submission errors with Medicare medical billing. When the provider or individual number is not entered the claim can not be properly processed.

Codes can change and submitting Medicare medical billing for reimbursement with an Invalid Diagnosis Code was another big reason for rejection of submissions. Keeping up with medical billing coding changes is what your medical billing partner does best. If you are having any of these errors happen with your medical billing filed from your office, now is the time to consider outsourcing your medical billing and eliminate this problem now!

View all Articles by: Melissa Clark, CCS-P