Billing Tips to Help Providers Avoid Common Billing Problems - Overview

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1 Billing Tips to Help Providers Avoid Common Billing Problems - Overview Proper Forms and the Fields Proper Forms and the Fields Causing The Most Problems Causing The Most Problems Provider Number Usage Provider Number Usage Top 5 Reasons a Bill Is Returned Top 5 Reasons a Bill Is Returned Common Bill Denial Reasons & Common Bill Denial Reasons & What To Do About Them What To Do About Them How To Request an Adjustment How To Request an Adjustment

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Billing Tips to Help Providers Avoid Common Billing Problems - Overview. Proper Forms and the Fields Causing The Most Problems Provider Number Usage Top 5 Reasons a Bill Is Returned Common Bill Denial Reasons & What To Do About Them How To Request an Adjustment. HCFA 1500. - PowerPoint PPT Presentation

Transcript of Billing Tips to Help Providers Avoid Common Billing Problems - Overview

  • Billing Tips to Help Providers Avoid Common Billing Problems - OverviewProper Forms and the Fields Causing The Most ProblemsProvider Number UsageTop 5 Reasons a Bill Is ReturnedCommon Bill Denial Reasons & What To Do About ThemHow To Request an Adjustment

  • HCFA 1500Also called OWCP1500 and CMS - 1500Submitted by:PhysiciansDME VendorsTherapistsRural Health ClinicsChiropractorsOther specialized medical providers, excluding dentists

  • HCFA 1500Fields that cause the most problems are highlighted.

  • HCFA 1500 Problematic FieldsBox 1a or 11 Claimant Case NumberBoxes 12 & 13 Signature on FileBox 21 ICD-9 Diagnosis CodesBox 24A Dates of ServiceBox 24D CPT/HCPCS Procedure Codes and modifiers if applicable

  • HCFA 1500 Problematic FieldsBox 24E Diagnosis pointersBox 24F Line ChargesBox 24G UnitsBox 25 Provider Federal Tax ID #Box 28 Total ChargeBox 31 Signature of physician and bill date

  • BOX 31 Treating ProviderAppropriate signatureBill date must be after last date of service BOX 32 Service AddressAddress where service was rendered Include Zip Code

  • BOX 33 Billing AddressAddress where payment is sent Provider number (generated by enrollment)

    From a provider perspective this is the most important field on a HCFA. This information is vital to pay the correct provider.

  • UB-92Submitted by:-General Hospitals-Nursing Homes-Hospices-Skilled Nursing Facilities

  • UB-92Fields that cause the most problems are highlighted.

  • UB-92 Problematic FieldsBox 1 Billing AddressBox 4 Type of billBox 5 Provider Federal Tax ID #Box 6 Statement covers periodBox 17 to 20 Admission (date/hour/type/source)Box 21 & 22 Discharge hour and Discharge status

  • UB-92 Problematic FieldsBox 42 to 47 Detail line items (Provide HCPCS for required RCCs)Box 51 Provider number and Medicare numberBox 60 Claimants case numberBox 67 to 75 ICD-9 Diagnosis codesBox 80 to 81 Appropriate procedure codes

  • Provider Number/ID Usage

    Identifies proper provider for authorizations and paymentUse it when you billUse it on the web portalUse it when you call in to get information from our call center

    Please Learn it and Use it!

  • Top 5 Reasons A Bill is Returned No signature on file in box 12 and 13 on HCFA-1500Claimant ID missing Tax ID missingDoctors billing for prescriptions dispensed in office MUST to use J8499 and the NDC codeRevenue codes missing on UB-92

  • Return letter contains specific information about why the bill was returned.

  • Resubmit Returned Bills for ProcessingCorrect items noted in letterResubmit the bill for processing

  • Common Bill Denial Reasons & What to Do About ThemClaimant is ineligibleDisagreements with accepted conditionTreatment SuiteNo authorizationImproper CPT codes

  • Claimant EligibilityEach claimant must be eligible on date of service Claimant case status is determined by DOLClaimants areresponsible for contacting the district office if there are questions regarding case status Resubmit bills for processing once claim is approved or reopened

  • Disagreement With Accepted ConditionsClaimants are responsible for providing their treating physicians with the accepted condition(s) on the claimProviders need to acquire this information from the claimantOWCP pays only for services related to the accepted conditions on the claimBill with the accepted conditions

  • Treatment SuiteServices that greatly differ from expected services to treat an injury will denyBilling for a hand x-ray when the claimant has a cut lip will trigger this denial code

  • No AuthorizationCertain procedures require prior authorizationSubmitting a request does not guarantee approval. If an authorization was not previously requested, a retro-authorization may be requested for services already providedFollow same guidelines as for requesting an authorization prior to serviceDates MUST be specific for retro-authorizationsOnce the authorization is approved, resubmit the bill

  • Authorization EOB CodesEOB code 529 - Case is deniedEOB code 530 - No authorization on fileEOB Code 531 - Authorization for claimant, not for providerEOB Code 532 - Authorization for claimant and provider, not for dates of serviceEOB Code 533 - Authorization for claimant, provider, and dates of service; not for procedure

  • How to Request an Adjustment Two OptionsResubmit a corrected bill - At the top of the form write Corrected Bill or Adjustment. OR

    Submit your RVBlock out all information not pertaining to your adjustment.Write what you need adjusted.