How to Avoid Medicare Denials

Medical billing clerks input information using codes before submitting claims to Medicare. If the clerk enters the wrong code, the claim may get denied. Clerks must also be careful when resubmitting claims so as not to trigger duplicate claim flags.

Instructions

• 1

  Double check medical billing codes and modifiers before submitting them to Medicare. An incorrect code or a code and modifier that do not match can cause Medicare to deny the claim on the grounds that the code was not recognizable. Incorrect codes may also refer to different medical procedures -- including procedures Medicare does not cover -- than the services a patient actually received.

• 2

  Wait 30 days after submitting a claim before submitting additional information or resubmitting the same claim. If you submit the claim again too early, Medicare will interpret it as a duplicate claim and deny the claim to prevent possible fraudulent activity or abuse of the Medicare system.

• 3

  Indicate whether Medicare is the primary or secondary payer when submitting claims to avoid denials based on incomplete information.

• 4

  Verify the reason a claim is denied if you receive a notice that it has been denied. Correct errors and train your staff regarding the errors to minimize the number of denials you get each month.