- Outpatient Services for Registered Inpatients
- Using the IVR to Avoid Eligibility and Entitlement-Related Claim Rejections and RTPs
- Allergen Immunotherapy Preparation (95144-95165)
- Ambulatory Surgical Center Approved HCPCS Codes and Payment Rates
- Annual Wellness Visits ‑ Billing Tips for Physicians
- Billing for FQHC MAO Plan Supplemental Payment (PPS Providers)
- Billing for Services Not Included in the FQHC Benefit
- Attention all OPPS Providers: Provider-Based Department Edits Being Implemented on/after 8/1/2023
- Billing Medicare for a Denial - Condition Code 21
- URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations
- Billing Medicare Part A When VA-Eligible Medicare Beneficiaries Receive Services in Non VA Facilities
- Condition Code G0 Reminder
- CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy
- Electronically Submitted Claims that Exceed $99,999.99
- ESRD Facilities: Clarification for Providing Dialysis Services to Patients Acute Kidney Injury
- Federally Qualified Health Centers Behavioral Health Claims Job Aid
- Federally Qualified Health Centers Contracting with Medicare Advantage Plans
- Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid
- Answers to Common Fee-for-Time Compensation Arrangements Questions
- FQHC and Group Therapy Services Job Aid
- Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities
- Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate
- Inhalation Treatment CPT 94640 – Billing Errors
- Immunization Roster Billing
- JK: Medicare Paid Hospital Providers Twice for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient IPPS Hospital Stays
- Nonphysician Practitioners Billing for Surgical Procedures
- Professional Services During a Patient Hospice Election
- Professional Services During a Patient Hospice Election
- Proper Billing for Finger and Toe Procedures
- Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements
- Proper Use of Taxonomy Codes
- A/B Rebilling Facts
- Common Reciprocal Billing Questions and Answers
- Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans
- Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System
- Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims
- Reporting Multiple Qualifying Visits on the Same Date of Service for FQHC Reimbursement
- Unlisted and Not Otherwise Classified Procedure Codes
- What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy
- Fiscal Year/Calendar Year Claim Split
- Hospitals Must Correctly Assign Severe Malnutrition Diagnosis Codes to Inpatient Claims
Electronically Submitted Claims that Exceed $99,999.99
Electronically submitted claims containing a dollar amount in excess of 99,999.99 will be rejected as a front-end EDI edit.
The Standard Companion Guide for Health Care Claim: Professional (837P) clarifies and specifies data content when exchanging transactions electronically with Medicare. The instructions given pertaining to the maximum number of characters submitted in any dollar amount field is seven characters. Therefore, claims that exceed this amount will need to be submitted on separate claims as the following:
Scenario # 1: Billing One Line of Service
1st Claim:
- Submit the service with an acceptable billed amount (< $99,999.99).
- In the documentation field, identify this as, "Claim 1 of 2; Dollar amount exceeds charge line amount."
2nd Claim:
- Submit the service with CPT modifier 59.
- Enter the billed amount as the remaining dollar amount.
- In the documentation field, identify this as, "Claim 2 of 2; Remaining dollar amount from Claim 1 amount exceeds charge line amount."
For example, if the billed amount is $100,000.00, submit the billed amount on the first claim as $51,000.00; on the second claim submit the billed amount as $49,000.00.
Scenario # 2: Billing Multiple Lines of Service
1st Claim:
- Split the lines of service with an acceptable billed amount(s) (< $99,999.99).
- In the documentation field, identify this as, "Claim 1 of 2; Dollar amount exceeds allowable claim amount."
2nd Claim:
- Enter the remaining lines of service and remaining billed amount(s).
- In the documentation field, identify this as, "Claim 2 of 2; Remaining dollar amount from Claim 1 amount exceeds allowable claim amount."
For example, if the claim billed amount is $100,000.00, split the lines to ensure that each claim total is less than $99,999.99. After splitting the claim, if the first claim total is now $51,000 then the second claim would be submitted with the additional lines of service and the remaining billed amount of $49,000.00.
Keep in mind:
- If you do not note in the documentation field the reason the claim is split this way, it will be denied as a duplicate.
- When splitting the billed amount, be sure the dollar amounts are slightly different, as this will prevent the system from assuming the two claims are an exact duplicate.
Reviewed 11/3/2023