Medicare Claim Errors: The Easy and the Common

Filing your Medicare claims correctly the right way every time saves time and money. Fortunately, correcting a simple mistake on a Medicare claim is easy.

However, if your practice is among those making the common errors Medicare administrator Novitas Solutions has identified that result in rejected claims, you might need to invest in some staff training to avoid the resulting headaches. 

The Easy

If you need to correct a minor error on a claim, such as adding a modifier, you can do it online through the Novitas portal, Novitasphere. This is the best way to change such elements as:

  • The number of services or units,
  • Diagnosis,
  • Certain modifiers (or add or delete them),
  • Procedure code,
  • Date of service, and
  • Place of service.

You also can correct an unlimited number of claims by calling Novitas’ interactive phone line at (855) 252-8782 (M-F, 8 am-4 pm CT). To get to the claims correction line, press 1 or say “claims” when prompted; at the next prompt, press 2 or say “claim correction.” Review the information you’ll need to correct your claim. In three weeks or less, you will receive either a remittance notice reporting the corrected payment information or a letter explaining why no payment is forthcoming.

The Most Common

Novitas identified the six top claim submission errors for Texas for January 2021. They are as follows (explanation of Medicare benefits message numbers are in parentheses), with tips on how to avoid them.

  1. “Noncovered charge(s).” (96) When you are not sure if a service is covered, refer to the Centers for Medicare & Medicaid Services (CMS) Internet Only Manual, 100-02, Chapter 16, General Exclusions from Coverage.
  2. “Claim not covered by this payer/contractor.” (109) Another Medicare contractor processes or pays this service (e.g., a durable medical equipment, hospice-related, or Medicare Advantage service). You must send the claim to the correct payer/contractor.
  3. “Duplicate claim/service.” (18) To prevent duplicate denials, allow Novitas sufficient time to process a claim before resubmitting. You can check claim status through Novitasphere or the interactive phone line, (855) 252-8782, to see if a claim was paid or is being processed.
  4. “Claim/service lacks information which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation.” (16) Before submitting a claim, ensure you have reported all required information. To verify the required claim information, refer to Completion of CMS-1500 (02-12) Claim Form on the Novitas website.
  5. “Services not covered because the patient is enrolled in a hospice.” (B9) For hospice patients, check patient eligibility before filing a claim.
  6. “The benefit for this service is included in the payment or allowance for another service or procedure that has already been adjudicated.” (97) Medicare doesn’t pay for a service when it is considered part of another service under the CMS National Correct Coding Initiative. Check the NCCI edits to identify which codes should not be submitted together. 

Need help with coding and documentation in your practice? TMA Practice Consulting can bring a two-hour Coding and Documentation Training session to you. The session covers medical necessity, evaluation and management documentation guidelines, modifiers, and more. The training offers up to 2 AMA PRA Category 1 CreditsTM per physician in the practice. For more information, email TMA Practice Consulting or call (800) 523-8776.


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Last Updated On

March 31, 2021

Originally Published On

March 12, 2013

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