Duplicate Claims and Other Common Billing Errors

Texas Medicare carrier TrailBlazer Health Enterprises has identified the top 10 billing errors for the fourth quarter of 2005. Be on the lookout for these billing errors in your practice:

  1. Duplicates.  This continues to be the top billing error by far. Remember, always call TrailBlazer's Interactive Voice Response (IVR) system at (877) 392-9865 to check claim status before refiling a new claim. If you are questioning the reason for nonpayment of a claim, call Provider Inquiries at (866) 211-5708; don't refile the claim until you know it is necessary.
  2. Nonconvered services.  Be aware of services that Medicare excludes, such as personal comfort items; pills and other medications not administered by injection; routine immunizations, physicals, and dental care; and lab tests and X-rays performed for screening purposes (except screening mammograms).
  3. Medical necessity.  Check the Medicare newsletters and the Local Coverage Determination for lists of covered diagnoses for a particular service. Links to both are on the TrailBlazer Part B Texas main page .
  4. Bundled services.  Payment for B status code services is always bundled into payment for other services. These codes have no relative value units or established payment amount, and no separate payment is ever made. Go to the Medicare page  on the TMA Web site, and click on "National Physician Fee Schedule Relative Value File" under Related Files to find out if the procedure codes you are billing are B status codes.
  5. Beneficiary eligibility.  Verify the Medicare number as well as the patient's effective date for Medicare Part B on the patient's Medicare card. File the claim with the number exactly as it is printed on the card. To obtain Medicare eligibility, call the IVR at (877) 392-9865.
  6. Incorrect carrier. Check the patient's Medicare card and verify the Health Insurance Claim (HIC) number on the card. Patients with traditional Medicare Part B coverage will have HICs that are nine digits followed by an alphanumeric suffix.
  7. Medicare secondary payer. The care of a Medicare patient may be covered by another payer such as workers' compensation, an employer health plan, auto insurance, the U.S. Department of Veterans Affairs, or Medicare Part A. Obtain routine information concerning working/retirement status of each Medicare patient with each visit.
  8. Provider eligibility. Verify if the correct date of service appears on the remittance notice (RN), and follow procedures for having an error corrected, if necessary. If the RN has the correct date, there may be an issue with the effective date and/or termination date of your Medicare billing number; contact TrailBlazer's Provider Enrollment Helpline at (866) 528-1602 for information.
  9. CLIA. You must submit a Clinical Laboratory Improvement Act of 1988 (CLIA) number on each claim for lab services. Report the CLIA number of the laboratory that performed the testing in Item 23 of the CMS-1500 claim form, along with the name and address of the performing lab in Item 32. If the claim is not for a referral service, enter the CLIA number in Item 23, or if billing electronically, in 2-180-REF02 (X4) loop 2300.
  10. Place of service.  Make sure the place of service code you use is valid for the procedure you are billing by checking the Medicare Place of Service Codes database  [PDF]. For example, TrailBlazer will reject place of service code 11 (office) billed with an inpatient hospital evaluation and management service code.


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