ACCURATE INFORMATION IS KEY:
•Put the beneficiary’s name and Medicare number on each piece of documentation submitted. Always use the beneficiary’s name exactly as it appears on the beneficiary’s Medicare card.
• Include all applicable NPIs on the claim, including the NPI for the referring provider.
• Indicate the correct address, including a valid ZIP code, where the service was rendered to the beneficiary. Any missing, incomplete, or invalid information in the Service Facility Location Information field will cause the claim to be unprocessable. Any claims received with the word “SAME” in fields indicating that the information is the same as in another field are unacceptable. A post office box address is unacceptable in the field for the location where the service was rendered.
• Include special certification numbers for services such as mammography (FDA number) and clinical laboratory (CLIA number).
• Ensure that the number of units/days and the date of service range are not contradictory.
• Ensure that the number of units/days and the quantity indicated in the procedure code’s description are not contradictory.
CODING TIPS:
•Use current valid diagnosis codes and code them to the highest level of specificity (maximum number of digits) available. Also make sure that the diagnosis codes used are appropriate for the gender of the beneficiary.
•Use current valid diagnosis codes and code them to the highest level of specificity (maximum number of digits) available. Also make sure that the diagnosis codes used are appropriate for the gender of the beneficiary.
• Use current valid procedure codes as described in the Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) manuals.
• Use only Level II HCPCS codes, not local codes.
• Use current valid modifiers when necessary.
