Handling Denials Due to Limitations of Service

Getting a medical billing claim denied is one of the biggest problems you can have with your billing. One tricky medical billing claim that many practices get denied for is the service for counseling patients that smoke or seeking to quit smoking and received counseling for doing so.

Many payers outright reject any claim that has anything to do with tobacco, including counseling for the stoppage of its use. The patients either have zero coverage for this service or they get a limited number of counseling visits and those are normally less than full reimbursements. If the patient has already seen another physician regarding these services, you will have just performed a counseling session for free. The Centers for Medicare & Medicaid Services have come up with a medical billing solution to let you know how many sessions a patient has already used.

As of April 1, 2006 you will be able to check a database that will show how many counseling sessions the patient has had with you or any other physician for the cessation of tobacco usage. The name of the database is the CWF (Common Working File). This database will show how many visits the patient has had and how many are left towards the limit. If you choose to service the patient that has used up all of their allotted counseling visits, your medical billing claim will probably be denied under the service limitation criteria.

The CWF database may help your practice improve medical billing reimbursement. If you see that a patient has used up all counseling sessions, you may deny service. The Common Working File is one effort CMS has made to create simpler medical billing and insure proper reimbursements for all services rendered.

View all Articles by: Melissa Clark, CCS-P