Novitas Solutions, the Medicare administrative contractor for Texas, has cautioned physicians to be aware of the top 10 most common claim submission errors made in 2023.
If left uncorrected, these common errors will lead to denied claims and prevent payment from Medicare:
- Filing duplicate claims or services;
- Not including insurance information that may cover care per a patient’s coordination of benefits;
- Billing for procedures not deemed medically necessary by payers;
- Billing for non-covered charges;
- Billing a patient separately for a procedure performed during the same session and date as another service;
- Billing a patient separately for a service related to a surgery and conducted during the post-op period;
- Filing a claim not covered by a patient’s payer or contractor;
- Billing for a procedure that a physician is not eligible to perform; and
- Billing for a service performed during the same session or date as a previous procedure.
Novitas’ website provides tips on how to avoid such problems, for example by checking a claim’s status, ensuring a service is covered under Medicare prior to performing or billing for it, or by asking patients to provide the nine-digit payer identification number of their primary insurance plan or program.
Robert Bennett, the Texas Medical Association’s vice president of medical economics, also reminds physicians that they can meet with TMA experts, who work to untangle billing and coding issues within practices and who work directly with Medicare, Medicaid, and large insurers.
“These frequent coding errors can occur for a variety of reasons, but TMA is here to help physicians and their practices navigate them,” he said.
For more billing help, check out TMA’s free Reimbursement, Review, and Resolution Service, where TMA experts advocate for members by helping them resolve issues related to insurance payments.
Last Updated On
January 17, 2024
Originally Published On
January 17, 2024