General Surgery Coding Alert - 2013 Issue 14
Denial Management: Could You Afford to Have 1.85 Percent of Your Claims Denied?
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Article Overview
This article covers Medicare Part B denial management issues related to ordering and referring provider edits, including the transition from informational processing to active denials. It is relevant for practices, billers, coders, and compliance staff who need to understand enrollment and identifier matching requirements, common claim-edit problems, and MAC communications about the change. The discussion focuses on the broad operational impact of PECOS-related edits and how providers are being alerted to correct enrollment and claim-data mismatches before denials begin.
Why This Topic Matters
It matters because claims that previously processed with informational messages may soon be denied if provider enrollment and claim information do not align. The article highlights why practices should review their Medicare enrollment and claim submission data to reduce avoidable payment disruptions.
What You Will Learn
- How Medicare Part B claims are affected by ordering and referring provider edit changes
- Why provider enrollment and claim information alignment matters for denial prevention
- What MACs are communicating to providers about the upcoming denial phase
- Common categories of claim-data problems that can trigger informational messages or denials
- Why specialty information and enrollment status are part of the edit process
Who Should Read This
- Medical billers
- Coding professionals
- Practice managers
- Compliance staff
- Physician practices billing Medicare
Codes Discussed
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