decisionhealth Newsletters, Answer Books - 2009 Issue 9 (September)
Answer_Book / Claims_Filing / Watch for denials when you treat patients in custody
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Article Overview
This article is for billing, coding, and claims staff who work with Medicare claims and may encounter denials tied to patient custody status. It discusses how custody is viewed for payment purposes, how Medicare and the MAC may verify status, the general exception framework for certain custodial situations, and where modifier QJ comes into play. The focus is on understanding the policy topic and spotting when this type of denial may need review or appeal.
Why This Topic Matters
Custody status can change how a claim is processed and paid, so knowing the policy topic helps organizations recognize avoidable denials and evaluate appeals appropriately. It is especially relevant for providers that treat patients who may be under correctional or similar custodial arrangements.
What You Will Learn
- How Medicare considers custody status in the claims process
- Why claims may be denied when a patient is in custody
- What general factors are checked to verify custody status
- When an exception to the usual payment assumption may be relevant
- What modifier is associated with custodial prisoner services under Medicare policy
Who Should Read This
- Medical coders
- Billing specialists
- Revenue cycle staff
- Claims processors
- Compliance staff
Modifiers Discussed
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