Medicare Remittance Advice and solutions ( Denials and action)


Medicare remittance codes and its explantion


M1
X-ray not taken within the past 12 months or near enough to the start of treatment.
M2
Not paid separately when the patient is an inpatient.
M3
Equipment is the same or similar to equipment already being used.
M4
Alert: This is the last monthly installment payment for this durable medical equipment.Note: (Modified 4/1/07)
M5
Monthly rental payments can continue until the earlier of the 15th month from the first rental month, or the month when the equipment is no longer needed.
M6
Alert: You must furnish and service this item for as long as the patient continues to need it. We can pay for maintenance and/or servicing for every 6 month period after the end of the 15th paid rental month or the end of the warranty period.Note: (Modified 4/1/07)
M7
No rental payments after the item is purchased, or after the total of issued rental payments equals the
purchase price.
M8
We do not accept blood gas tests results when the test was conducted by a medical supplier or taken while the patient is on oxygen.
M9
Alert: This is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement.Note: (Modified 4/1/07)
M10
Equipment purchases are limited to the first or the tenth month of medical necessity.
M11
DME, orthotics and prosthetics must be billed to the DME carrier who services the patient's zip code.
M12
Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim.
M13
Only one initial visit is covered per specialty per medical group.Note: (Modified 6/30/03)
M14
No separate payment for an injection administered during an office visit, and no payment for a full office visit if the patient only received an injection.
M15
Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.

All the above denials are only to hospital billing and not for professional billing. As far as i know hospital billing is not outsourcing anywhere so i dont have any idea about this. If any of you doing the hospital billing. Please mail me to billingatchennai@gmail.com.

Links are simillar denials and solutions


http://billingatchennai.blogspot.com/2009/06/denial-and-actions-co-b16.html
http://billingatchennai.blogspot.com/2009/02/medicare-remittance-review-part-4.html
http://billingatchennai.blogspot.com/2009/02/medicare-remittance-advice-part-3.html
http://billingatchennai.blogspot.com/2008/10/denials-and-action-lacks-of-information.html
http://billingatchennai.blogspot.com/2008/09/medicare-denial-and-action-enrolled-in.html

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