E/M Coding Alert - 2020 Issue 1
Part B Coding: Avoid Making Part B Errors With Tips Straight From the MACs
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Article Overview
This article reviews frequently encountered Medicare Part B claim problems and the kinds of questions reported by MACs, with a focus on general coding and billing compliance for providers. It is aimed at clinicians, coders, and billing staff who handle Medicare claims and want to understand common denial patterns, claim-form issues, and where to look for official Medicare resources. The discussion covers broad topics such as invalid code usage, modifier placement, missing modifier problems, Medicare Secondary Payer reporting, deductible-related payment questions, postoperative care claims, and duplicate claim handling.
Why This Topic Matters
Understanding the issues highlighted by MACs can help provider organizations reduce avoidable denials and resolve common Medicare Part B claim problems more efficiently.
Article Sections
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Invalid CPT® Codes Are Common
Discusses common Medicare Part B claim issues related to code validity and where providers can review official fee schedule information. It also references broader fee schedule indicators that affect claim review.
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E/M Modifiers Prompt Frequent Errors
Covers recurring problems involving evaluation and management modifier placement and general concerns about reporting modifiers in relation to surgical and E/M services.
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Missing Modifiers Create Issues
Describes denial issues associated with omitted modifiers, bundled code pairs, and the use of official coding resources to identify edits and related claim considerations.
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Medicare Secondary Payer Issues Abound
Summarizes common Medicare Secondary Payer claim problems, including mismatched payer information, missing claim information, and documentation attached to secondary claims.
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Check These Commonly Asked Questions
Reviews additional provider questions about claim payment, deductible application, patient payment routing, postoperative care claims, and duplicate claim submissions.
What You Will Learn
- Common categories of Medicare Part B claim denials and inquiries
- How MACs direct providers to official Medicare resources for claim review
- General areas where modifier reporting problems occur
- Broad Medicare Secondary Payer and claim-form issues
- Common payment and postoperative care claim scenarios
- Why duplicate claims and resubmissions can create problems
Who Should Read This
- Emergency department physicians
- Medical coders
- Billing staff
- Revenue cycle teams
- Provider offices submitting Medicare Part B claims
Modifiers Discussed
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