Medicare Compliance & Reimbursement

Run down this quick checklist to pinpoint the reason for a denial

When you get a denial for a claim you know Medicare should pay, use this action plan to decipher exactly what you need to do next.

If you receive a denied or underpaid claim, you first have to make sure that the denial isn't a result of the way you filed the claim. To do so, follow these steps as outlined by Barbara Cobuzzi, director of outreach programs for the American Academy of Professional Coders, based in Salt Lake City:

1. Read denial codes on explanation of benefits (EOB) to determine the payor's reason for denial or underpayment.
2. Audit and review coding documentation.
3. Make sure the documentation supports what was billed.
4. Determine whether the payor made an error.

If you determine that Medicare made an error, you can write a letter expressing why you think your carrier should pay the claim.

If you find you've made a mistake, remember that you don't have to appeal, according to CMS. Just ask your carrier to reopen the claim so you can correct the error.