Novitas Solutions, the Medicare administrative contractor for Texas, has released a top 10 list of errors made between January and March 2024 physicians should be aware of to mitigate billing problems in their practices.
If left uncorrected, these common errors will lead to denied claims and prevent payment from Medicare:
- Filing duplicate claims or services;
- Not including insurance information that may cover care per a patient’s coordination of benefits;
- Billing for a procedure provided prior to coverage;
- Billing for non-covered charges;
- Billing for procedures not deemed medically necessary by payers;
- Billing a patient separately for a procedure performed during the same session and date as another service;
- Billing for evaluation and management (E/M) services related to a surgery and conducted during the post-op period;
- Filing a claim not covered by a patient’s payer or contractor;
- Billing for a procedure that a physician is not eligible to perform; and
- Billing for a service performed during the same session or date as a previous procedure.
Novitas’ website provides instructions on how to avoid these errors. For example, physicians can review all services billed on the date of service by a rendering physician, verify patient eligibility, ensure a service is covered under Medicare prior to performing or billing for it, or ask patients to provide the nine-digit payer identification number of their primary insurance plan or program, among other helpful practices.
Carra Benson, the Texas Medical Association’s director of reimbursement services, says the list gives physicians the opportunity to avoid common mistakes that could lead to payment delays.
“Being proactive is a major factor in being successful. This list can help better prepare staff for billing across all health plans,” she said.
She also reminds physicians that TMA experts are here to help untangle billing and coding issues within practices as they work directly with Medicare, Medicaid, and large insurers on behalf of physician’s best interests.
For more billing help, check out TMA’s free Payment Resource Center, whose experts advocate for members by helping them resolve issues related to insurance payments.
Last Updated On
April 15, 2024
Originally Published On
April 15, 2024
Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469