To maintain sound cash flow, it is essential that the amount of rejected or denied claims be as close to zero as possible.Following are some errors that could kick your claim out of a smooth reimbursement process:
- Lack of special services certification numbers like the FDA number for a mammography or a CLIA (clinical laboratory) number.
- Lack of beneficiary name and Medicare number (if applicable), on every piece of documentation.
- Failure to include all applicable NPIs on the claim.
- Using the word "same" in a field where the information is also accessible in a different part of the form.
- Filing an incorrect address, zip code and service facility location. Post office boxes are unacceptable.
- Lack of consistency of the number of days and the dates of the service range.
Regarding coding, keep the following in mind:
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Apply current, legitimate diagnosis codes.
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Code the procedures to the highest level of specificity.
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Code to the proper gender.
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Use the codes as specified in the Current Procedural Terminology (CPT) or the Healthcare Common Procedure Coding System (HCPCS) manuals.
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When necessary, use only the most current valid modifiers.
Nothing works as well as accurate documentation to ensure a smooth payment cycle. Conversely, nothing derails it like inaccurate data.