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Billing Tips to Help Providers Avoid Common Billing Problems - Overview

Billing Tips to Help Providers Avoid Common Billing Problems - Overview. Proper Forms and the Fields Causing The Most Problems Provider Number Usage Top 5 Reasons a Bill Is Returned Common Bill Denial Reasons & What To Do About Them How To Request an Adjustment. HCFA 1500.

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Billing Tips to Help Providers Avoid Common Billing Problems - Overview

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  1. Billing Tips to Help Providers Avoid Common Billing Problems - Overview • Proper Forms and the Fields Causing The Most Problems • Provider Number Usage • Top 5 Reasons a Bill Is Returned • Common Bill Denial Reasons & What To Do About Them • How To Request an Adjustment

  2. HCFA 1500 • Also called OWCP–1500 and CMS - 1500 • Submitted by: • Physicians • DME Vendors • Therapists • Rural Health Clinics • Chiropractors • Other specialized medical providers, excluding dentists

  3. HCFA 1500 Fields that cause the most problems are highlighted.

  4. HCFA 1500 Problematic Fields • Box 1a or 11 – Claimant Case Number • Boxes 12 & 13 – “Signature on File” • Box 21 – ICD-9 Diagnosis Codes • Box 24A – Dates of Service • Box 24D – CPT/HCPCS Procedure Codes and modifiers if applicable

  5. HCFA 1500 Problematic Fields • Box 24E – Diagnosis pointers • Box 24F – Line Charges • Box 24G – Units • Box 25 – Provider Federal Tax ID # • Box 28 – Total Charge • Box 31 – Signature of physician and bill date

  6. BOX 31 – Treating Provider • Appropriate signature • Bill date must be after last date of service BOX 32 – Service Address • Address where service was rendered • Include Zip Code

  7. BOX 33 – Billing Address • Address where payment is sent • Provider number (generated by enrollment) From a provider perspective this is the most important field on a HCFA. This information is vital to pay the correct provider.

  8. UB-92 • Submitted by: -General Hospitals -Nursing Homes -Hospices -Skilled Nursing Facilities

  9. UB-92 Fields that cause the most problems are highlighted.

  10. UB-92 Problematic Fields • Box 1 – Billing Address • Box 4 – Type of bill • Box 5 – Provider Federal Tax ID # • Box 6 – Statement covers period • Box 17 to 20 – Admission (date/hour/type/source) • Box 21 & 22 – Discharge hour and Discharge status

  11. UB-92 Problematic Fields • Box 42 to 47 – Detail line items (Provide HCPCS for required RCC’s) • Box 51 – Provider number and Medicare number • Box 60 – Claimant’s case number • Box 67 to 75 – ICD-9 Diagnosis codes • Box 80 to 81 – Appropriate procedure codes

  12. Provider Number/ID Usage • Identifies proper provider for authorizations and payment • Use it when you bill • Use it on the web portal • Use it when you call in to get information from our call center Please Learn it and Use it!

  13. Top 5 Reasons A Bill is Returned • No signature on file in box 12 and 13 on HCFA-1500 • Claimant ID missing • Tax ID missing • Doctors billing for prescriptions dispensed in office MUST to use J8499 and the NDC code • Revenue codes missing on UB-92

  14. Return letter contains specific information about why the bill was returned.

  15. Resubmit Returned Bills for Processing • Correct items noted in letter • Resubmit the bill for processing

  16. Common Bill Denial Reasons & What to Do About Them • Claimant is ineligible • Disagreements with accepted condition • Treatment Suite • No authorization • Improper CPT codes

  17. Claimant Eligibility • Each claimant must be eligible on date of service • Claimant case status is determined by DOL • Claimants are responsible for contacting the district office if there are questions regarding case status • Resubmit bills for processing once claim is approved or reopened

  18. Disagreement With Accepted Conditions • Claimants are responsible for providing their treating physicians with the accepted condition(s) on the claim • Providers need to acquire this information from the claimant • OWCP pays only for services related to the accepted conditions on the claim • Bill with the accepted conditions

  19. Treatment Suite • Services that greatly differ from expected services to treat an injury will deny • Billing for a hand x-ray when the claimant has a cut lip will trigger this denial code

  20. No Authorization • Certain procedures require prior authorization • Submitting a request does not guarantee approval. • If an authorization was not previously requested, a retro-authorization may be requested for services already provided • Follow same guidelines as for requesting an authorization prior to service • Dates MUST be specific for retro-authorizations • Once the authorization is approved, resubmit the bill

  21. Authorization EOB Codes • EOB code 529 - Case is denied • EOB code 530 - No authorization on file • EOB Code 531 - Authorization for claimant, not for provider • EOB Code 532 - Authorization for claimant and provider, not for dates of service • EOB Code 533 - Authorization for claimant, provider, and dates of service; not for procedure

  22. How to Request an Adjustment – Two Options • Resubmit a corrected bill - At the top of the form write “Corrected Bill” or “Adjustment”. OR • Submit your RV • Block out all information not pertaining to your adjustment. • Write what you need adjusted.

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