What are the most common Medicare Part A claims errors we see from working with clients?   We could go on for pages and pages, but we know your time is valuable so we are just dealing with a few of the worst offenders today.

1) Prior claim not processed.

Part A claims are processed in date order and the earlier claim has to process, or the next claim will reject, period.  When billing a series of Medicare Part A claims for a resident, they must be billed in date of service order.  For example, if a resident was admitted in January and discharged in April you will want to bill the January claim first.  If you bill February as a Bill Type 213 claim before January is paid as a Bill Type 212, the  claim will be kicked out and not be processed,  slowing down payment.

We typically see this happen when a facility is behind in billing and tries to get all of their claims in fast for quick payment.  No matter how tempting it is to get the money in, don’t bill out of order!  You will be wasting time and definitely creating some work for yourself.

2) Beneficiary name and number do not match

If the name isn’t an exact match for the name in the Medicare system, the claim won’t process.  All too often we see claims reject because of something as simple and preventable as the name not matching.  This can be remedied with a quick check during the admission process.  Make sure that the name on the Medicare card is the same name entered into your billing software.  If a card is not available, be sure to check the spelling of the name in the Common Working File (CWF).

For example, Jack  Smith may admit to your facility, but in the Medicare system he is known as J.C. Smith.  Make sure the billing matches the name Medicare has listed so your money won’t be tied up.  Also, be sure to take  a copy of the Medicare card for your files as backup.

3) Check the hospital discharge date against the facility admit date

Make sure that no more than 30 days have passed between the hospital discharge date and the admit date into your facility.  Most Medicare admissions will be the same day as the hospital discharge.  We have seen many A/R software packages process these fields incorrectly and pull the wrong dates in.  This usually happens when a resident temporarily discharges from the facility and upon readmit,  the Hospital Stay Dates from the prior stay is pulled in.

This is not always a check that is caught by the software that performs edits on the claims to catch errors.

4) Missing or Inadequate Hospital Stay Dates

It is surprising how many claims reject because there is no Hospital Stay Date on the UB04.  This is often a software and training issue that occurs when the dates are entered in a field other than the one used when creating the UB04.  The admissions person needs to verify the hospital stay dates are correct and in the right field.  A good place to double check the dates is on the hospital face sheet if you have one.

The other issue with Hospital Stay Dates is an inadequate stay.  The hospital stay has to be a minimum of 3 midnights in order for Medicare A to pay for skilled nursing services.  If someone is admitted to the hospital on the 1st and discharged on the 3rd, it is only 2 days and will not qualify for their stay with you.

We will cover more in future postings.  There are definitely enough common mistakes to cover!

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