Compliance: MAC Offers Insight on Top Part B Errors

Why This Topic Matters

Understanding the most common Part B claim errors can help practices recognize where denials and payment delays often arise and where additional review of payer requirements may be needed.

Article Sections

1. Make Sure the CPT® Code Is Valid

   Discusses common issues related to code validity and Medicare fee schedule review. The section also mentions general indicators and related payment-related information available through the fee schedule.

2. Review the Proper Usage of E/M Modifiers

   Covers frequently encountered modifier issues involving evaluation and management services. The discussion focuses on where modifier usage problems can occur in relation to procedures and global periods.

3. Don’t Drop the Modifiers — Append Accordingly

   Explains broader concerns about missing or unbundling-related modifiers and references national coding edit resources. It also addresses the importance of reviewing surgical global periods before submission.

4. Revisit Medicare Secondary Payer Rules and Requirements

   Reviews common Medicare Secondary Payer claim issues, including missing or inconsistent coordination-of-benefits information. The section also discusses primary payer documentation and claim form completeness.

5. Peruse These FAQs

   Summarizes additional frequently asked questions about payment handling, postoperative care billing, and duplicate claim scenarios. The section highlights common claim-processing situations that prompt provider inquiries.