Outpatient Facility Coding Alert - 2015 Issue 3
Billing: This MAC's Top 5 Most Common Denial Reasons May Surprise You
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Article Overview
This article is a Medicare billing overview for providers and coders that highlights common Part B denial reasons reported by a Medicare administrative contractor. It covers hospice-related billing, noncovered services, National Correct Coding Initiative edit issues, primary-versus-secondary payer questions, and global surgery packaging, along with references to CMS tools and Medicare guidance used to research these topics. The piece is useful for staff who want to understand where denials often arise and what general categories of claim review may be involved.
Why This Topic Matters
Knowing the most common denial categories can help billing teams review claims more efficiently, reduce avoidable denials, and better understand where Medicare and other payer rules intersect.
Article Sections
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Introduction
An overview of the denial theme and the Medicare Part B context for the article.
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Top denial reason categories
A numbered discussion of common denial categories reported by the MAC, including hospice-related claims, noncovered services, NCCI edit issues, payer order questions, and global surgery packaging.
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Resources and references
Pointers to CMS and MAC resources mentioned for reviewing coverage, edits, and fee schedule information.
What You Will Learn
- The general categories of Medicare Part B denials discussed by the MAC
- How hospice, coverage, bundling, payer order, and global surgery issues can affect claims
- Which CMS and MAC resources are referenced for investigating denial patterns
- Why some claims may be denied even when the service seems familiar or routine
Who Should Read This
- Medical coders
- Billing specialists
- Revenue cycle staff
- Practice managers
- Compliance teams
- Medicare providers
Codes Discussed
Modifiers Discussed
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