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Wiki COB20 denial

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jhutchens

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Has anyone else received this denial from Medicare...COB20 service was partially or full furnished by another provider...? I have seen several denials with this reason code and to my knowledge there is no other provider involved in services....any idea? thank you
 
one denial I have received is for 52648 dx 600.01 outpt...and I have received this same denial for office visits.

thank you
 
denial

These codes include preop, the service, and post op, is it possible that another physician billed for part of the service? On the E&M's, could they be within the global of a procedure?
LeeAnn
 
COB20 denials

We are now getting these denials on x-ray films. Pt was transferred from another hospital and films taken at that hospital didn't come with the patient. We are billing the professional component of a X-ray that was taken at our hospital and are getting denials. Should we just add the 77 modifier? That is what Medicare is telling us to. Just not comfortable with that when we dont' know what films were taken at the other hospital.
 
We are experiencing ongoing denials for critical care billing using CPT code 99291, despite multiple appeals. Medicare representatives have been unhelpful, often advising us to simply continue appealing without providing meaningful guidance. In one instance, a representative mentioned that one of our diagnosis codes (pointer 4) was considered primary on a claim submitted by another specialist, which we resolved by removing the code and rebilling. However, this type of information is not consistently disclosed, making it difficult to identify similar issues proactively.

This is a significant problem because if Medicare is implementing these practices, other insurers like Oscar are likely to follow suit. We need a clear strategy for addressing these denials and navigating future claims to prevent further complications.
 
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