In Audit
Sep 2nd, 2019
Lower denial rates are key to turning around large healthcare organization payment issues. When you are a large organization, the number of denied claims can be overwhelming and cost a staggering amount of money. To manage this can be a scary prospect — but fear not, we are here to help. Two things are crucial ...
Learn how to speak the same language as your payer. Every part of the revenue cycle has an impact on reimbursement, as well as on each other. For example, it’s important for the person making the appointment to confirm whether authorization is necessary before services are rendered because the lack of authorization information at the ...
In Billing
Jun 28th, 2018
Effective July 2, CMS-1500 hard copy claims should not list the same ICD-10-CM diagnosis code twice within item 21. Medicare Administrative Contractors (MACs) and Durable Medical Equipment (DME) MACs have been instructed to return these claims as unprocessable. Here’s Why Medicare is implementing systems changes to ensure that all Part B 837 coordination of benefits/Medicare ...
In Billing
Mar 14th, 2018
The Qualified Medicare Beneficiary (QMB) information in the Medicare remittance advice (RA) and Medicare summary  notice is being reintroduced; the issues preventing the processing of QMB cost-sharing claims by states and other secondary payers have been resolved. The simple fix was to include revised “alert” Remittance Advice Remark Codes in RAs for QMB claims without adopting other ...
In Billing
May 14th, 2010
Change Request (CR) 6901 announces the latest update of Remittance Advice Remark Codes (RARCs) and Claim Adjustment Reason Codes (CARCs), effective July 1. The reason and remark code sets must be used to report payment adjustments in Remittance Advice (RA) transactions. The reason codes are also used in some Coordination of Benefits (COB) transactions. Part ...