Medicare billing does not necessarily mean denials and rejections. An individual needs to do his homework and follow the guidelines laid down by the government. Read on to learn about Medicare billing compliance.
The list of do’s and don’ts is very long, but if they are kept in mind, they will help ensure that the individual who is filing for Medicare will get the benefits he deserves without any hassle.
We have outlined the things you need to do and don’t need to in detail, have a look –
1. You must fill in the codes correctly. They should correspond with the procedures, tests and services they are assigned to.
2. When the medical record is submitted, it should have up to date and precise descriptions of all tests, procedures and services that were performed and availed. Details of symptoms, injuries, and other conditions should not be omitted.
3. The CPT and HCPXS codes should match perfectly with the medical record. If an accurate code is not available, the applicant should look for one that goes well with the documentation.
4. When repotting the codes, the precise modifier should be used in order to justify the claim appropriately.
5. When filling in details of the treatment, exact mention should be made of the duration as well as the details of the medical unit.
6. While reporting the ICD-9 diagnosis codes, it is absolutely necessary that the exact specification is used. The complaints, symptoms and other injuries related to the patient must be mentioned in the documentation.
7. The claims should be filed within a year of the last date of service. Delays can hardly be justified.
8. Units of service should be reported using the NCCI and MUE’s to prevent any duplication in the procedures and the services. Separate codes are given for the reason to avoid overlap of the services performed on a single day.
9. An Advance Beneficiary Notice is a must in order to report services that are not covered in the modifier. This will clarify the services that can be billed or not billed to the patient.
10. The claim will be null and void in case the patient has not signed on it. A signature is a must in order to authorize the care details in the claim.
11. Finally, it is fundamentally important to verify whether the patient is actually eligible for the claim or not. This can be checked through the Common Working File or CWF. The details of the patient on the form should be identical to that on the file.
12. It is obvious from the above list that a carefully filled form will be approved on all compliance criterions. It will make the life of the patient stress free and smooth.
Remember that a form that is filled incorrectly or has false claims in it, will only create hassles for the medical unit and the patient.