Top 10 Billing Errors ASCs Make

Using CMS's comprehensive error rate testing system, which measures the accuracy of Medicare fee-for-service payments, a Medicare contractor has reviewed Medicare Part B claims from Texas ASCs to determine the top 10 billing errors that lead to denial or rejection of claims.

According to the 11-page document, which also provides discussion of and pointers for remedying each of the errors, these are the most common mistakes ASCs make when submitting Medicare claims:

1. duplicate claim/service

2. missing/incomplete/invalid group practice information

3. treatment rendered in an inappropriate/invalid place of service

4. procedure Inconsistent with provider type/specialty not covered when performed by this provider

5. claim not covered by this payer/contractor

6. medical necessity

7. service not covered unless provider files an electronic media claim

8. procedure inconsistent with modifier used or required modifier missing

9. service covered by another payer per coordination of benefits (working-aged beneficiary)

10. beneficiary eligibility

The guidance was released by Medicare Part A intermediary and Part B carrier TrailBlazer, a wholly owned subsidiary of BlueCross BlueShield of South Carolina.