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How to Submit Medicare Claims Correctly and Avoid Costly Denials


Medicare denials have become much more frequent of late and can be very costly.  For instance, we at Medical Billing, Inc. been getting an unprecedented amount of denials for “name and ID# do not match.”

And we’re getting these denials on claims for providers who have been seeing and getting paid on claims for these same patients for months or even years.

Why now are these claims denying for name and ID do not match?  Good question. We’ve called Medicare several times and were told the name and ID do not match.  That’s all they would tell us, just as the EOB reflected.

We would explain that we were paid for previous dates but it didn’t matter to the representative.  The name and ID did not match.

Finally we got to the bottom of this challenge!  We spoke with a helpful Medicare representative who gave us the answer.  The error can be owed to a recent change in their processing guidelines.

Any claim now submitted to Medicare must be entered exactly as the ID card shows.  If there is a middle initial, then your claim must have a middle initial.  If there is a hyphenated name, the hyphen must be included. If there is a space, the space must be included.  And of course, if you have misspelled the name, the claim will be denied.

It is now extremely important to get a copy of the patient’s ID card so you can be sure you have it exactly as represented on

the card.  In fact we have had claims denied that did match exactly.   Only after speaking to a representative and proving the claim matched the ID card would Medicare pay.

Furthermore, we have also found Medicare claims denied where the patient name on the denial completely different than the name we submitted.  When we called on this claim and the representative looked at it, we were told they could see that we submitted with the correct name and they weren’t sure what changed it in the system, but they would reprocess.

In short, it seems to us that Medicare is making it harder than ever to get claims correctly processed.  Maybe it is a money saving technique on their part.  If your office is not following up on these denials and running regular aging reports, you are losing lots of money.

Make sure your office is not missing out on payment for these claims.  Take care of the denials using whatever steps are necessary.  Run and work regular aging reports to avoid timely filing issues.

Make sure you quickly remedy these issues.  Ask your patients to present their ID cards and keep copies of them on file.  When you get any denials act on them immediately.  Don’t put them away for when you have time.  These problems need to be dealt with quickly.

How have you dealt with denied Medicare claims? Let us know in the comments section!

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Category: Insurance

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