- 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
Using the IVR to Avoid Eligibility and Entitlement-Related Claim Rejections and RTPs
Some of the top claim submission errors causing Medicare claims to reject or RTP can be easily avoided by taking advantage of the IVR application. Registration staff can quickly and accurately verify information provided by the beneficiary to determine Medicare eligibility and/or entitlement.
These reason codes identify some of the errors that a call to the IVR could avoid:
- Rejection Reason Code C7010: An inpatient, outpatient, or home health claim has service dates overlapping a hospice election period and condition code 07 is not present.
- Rejection Reason Code U5200: CMS records indicate that the beneficiary is not entitled to Medicare coverage for the type of services billed on the claim.
- Rejection Reason Code U5210: The beneficiary's entitlement for Medicare coverage was terminated prior to the first date for services provided on the claim.
- Rejection Reason Code U5233: The admission date on this inpatient PPS claim falls within the enrollment period of a risk HMO. This edit also applies to non-PPS inpatient, SNF inpatient, and all outpatient claims where the statement covered period falls within or overlaps an enrollment period in a risk HMO.
- RTP Reason Code T5052: CMS records indicate the beneficiary is not in file.
- RTP Reason Code N5052: CWF indicates the beneficiary's name and health insurance card number do not match.
The IVR gathers data from the CWF, providing the same information that is available to Customer Care Representatives. By using this self-service tool, providers can verify the following beneficiary eligibility and entitlement information:
- Part A and Part B effective and termination dates
- Date of birth and/or death
- MSP type, insurer name, address, effective and termination dates
- MAO plan number, name, address, telephone number, effective and termination dates
- Last inpatient billing date
- Full and coinsurance hospital, SNF days remaining
- LTR days remaining
- Current and prior year Part B deductible amount met
- Current and prior year physical and occupational therapy limit amount met
- Home health name, address, effective and termination dates
- Hospice name, address, effective and termination dates
- Corrected MBI number
- Remaining psychiatric days
The Medicare Part A IVR Eligibility Checklist allows you to gather information related to your beneficiaries’ Medicare eligibility, enrollment in hospice or MAO programs, available benefit days and so much more!
This self-service tool is useful to have in your Medicare took-kit as you work to avoid these (and other) costly claim submission errors. A full size version of this checklist is available for print/download by clicking the link above.
For more information about the benefits of utilizing the IVR and how to navigate this telephone-based option on our website. Select Contact Us from the in the Resources dropdown, and select Interactive Voice Response System (IVR).
Posted 10/24/2022