1 Billing Tips to Help Providers Avoid Common Billing Problems - Overview Proper Forms and the Fields Causing The Most Problems Proper Forms and the Fields Causing The Most Problems Provider Number Usage Provider Number Usage Top 5 Reasons a Bill Is Returned Top 5 Reasons a Bill Is Returned Common Bill Denial Reasons & What To Do About Them Common Bill Denial Reasons & What To Do About Them How To Request an Adjustment How To Request an Adjustment

2 HCFA 1500 Also called OWCP–1500 and CMS Also called OWCP–1500 and CMS Submitted by: Submitted by:  Physicians  DME Vendors  Therapists  Rural Health Clinics  Chiropractors  Other specialized medical providers, excluding dentists

3 HCFA 1500 Fields that cause the most problems are highlighted.

4 HCFA 1500 Problematic Fields Box 1a or 11 – Claimant Case Number Box 1a or 11 – Claimant Case Number Boxes 12 & 13 – “Signature on File” Boxes 12 & 13 – “Signature on File” Box 21 – ICD-9 Diagnosis Codes Box 21 – ICD-9 Diagnosis Codes Box 24A – Dates of Service Box 24A – Dates of Service Box 24D – CPT/HCPCS Procedure Codes and modifiers if applicable Box 24D – CPT/HCPCS Procedure Codes and modifiers if applicable

5 HCFA 1500 Problematic Fields Box 24E – Diagnosis pointers Box 24E – Diagnosis pointers Box 24F – Line Charges Box 24F – Line Charges Box 24G – Units Box 24G – Units Box 25 – Provider Federal Tax ID # Box 25 – Provider Federal Tax ID # Box 28 – Total Charge Box 28 – Total Charge Box 31 – Signature of physician and bill date Box 31 – Signature of physician and bill date

6 BOX 31 – Treating Provider Appropriate signature Appropriate signature Bill date must be after last date of service Bill date must be after last date of service BOX 32 – Service Address Address where service was rendered Include Zip Code

7 BOX 33 – Billing Address Address where payment is sent Address where payment is sent Provider number (generated by enrollment) Provider number (generated by enrollment) From a provider perspective this is the most important field on a HCFA. This information is vital to pay the correct provider.

8 UB-92 Submitted by: Submitted by: -General Hospitals -Nursing Homes -Hospices -Skilled Nursing Facilities

9 UB-92 Fields that cause the most problems are highlighted.

10 UB-92 Problematic Fields Box 1 – Billing Address Box 1 – Billing Address Box 4 – Type of bill Box 4 – Type of bill Box 5 – Provider Federal Tax ID # Box 5 – Provider Federal Tax ID # Box 6 – Statement covers period Box 6 – Statement covers period Box 17 to 20 – Admission (date/hour/type/source) Box 17 to 20 – Admission (date/hour/type/source) Box 21 & 22 – Discharge hour and Discharge status Box 21 & 22 – Discharge hour and Discharge status

11 UB-92 Problematic Fields Box 42 to 47 – Detail line items (Provide HCPCS for required RCC’s) Box 42 to 47 – Detail line items (Provide HCPCS for required RCC’s) Box 51 – Provider number and Medicare number Box 51 – Provider number and Medicare number Box 60 – Claimant’s case number Box 60 – Claimant’s case number Box 67 to 75 – ICD-9 Diagnosis codes Box 67 to 75 – ICD-9 Diagnosis codes Box 80 to 81 – Appropriate procedure codes Box 80 to 81 – Appropriate procedure codes

12 Provider Number/ID Usage Identifies proper provider for authorizations and payment Identifies proper provider for authorizations and payment Use it when you bill Use it when you bill Use it on the web portal Use it on the web portal Use it when you call in to get information from our call center Use it when you call in to get information from our call center Please Learn it and Use it!

13 Top 5 Reasons A Bill is Returned 1. No signature on file in box 12 and 13 on HCFA Claimant ID missing 3. Tax ID missing 4. Doctors billing for prescriptions dispensed in office MUST to use J8499 and the NDC code 5. Revenue codes missing on UB-92

14 Return letter contains specific information about why the bill was returned.

15 Resubmit Returned Bills for Processing Correct items noted in letter Correct items noted in letter Resubmit the bill for processing Resubmit the bill for processing

16 Common Bill Denial Reasons & What to Do About Them Claimant is ineligible Claimant is ineligible Disagreements with accepted condition Disagreements with accepted condition Treatment Suite Treatment Suite No authorization No authorization Improper CPT codes Improper CPT codes

17 Claimant Eligibility Each claimant must be eligible on date of service Each claimant must be eligible on date of service Claimant case status is determined by DOL Claimant case status is determined by DOL Claimants areresponsible for contacting the district office if there are questions regarding case status Claimants areresponsible for contacting the district office if there are questions regarding case status Resubmit bills for processing once claim is approved or reopened Resubmit bills for processing once claim is approved or reopened

18 Disagreement With Accepted Conditions Claimants are responsible for providing their treating physicians with the accepted condition(s) on the claim Claimants are responsible for providing their treating physicians with the accepted condition(s) on the claim Providers need to acquire this information from the claimant Providers need to acquire this information from the claimant OWCP pays only for services related to the accepted conditions on the claim OWCP pays only for services related to the accepted conditions on the claim Bill with the accepted conditions Bill with the accepted conditions

19 Treatment Suite Services that greatly differ from expected services to treat an injury will deny Services that greatly differ from expected services to treat an injury will deny  Billing for a hand x-ray when the claimant has a cut lip will trigger this denial code

20 No Authorization Certain procedures require prior authorization Certain procedures require prior authorization Submitting a request does not guarantee approval. Submitting a request does not guarantee approval. If an authorization was not previously requested, a retro- authorization may be requested for services already provided If an authorization was not previously requested, a retro- authorization may be requested for services already provided  Follow same guidelines as for requesting an authorization prior to service  Dates MUST be specific for retro-authorizations Once the authorization is approved, resubmit the bill Once the authorization is approved, resubmit the bill

21 Authorization EOB Codes EOB code Case is denied EOB code Case is denied EOB code No authorization on file EOB code No authorization on file EOB Code Authorization for claimant, not for provider EOB Code Authorization for claimant, not for provider EOB Code Authorization for claimant and provider, not for dates of service EOB Code Authorization for claimant and provider, not for dates of service EOB Code Authorization for claimant, provider, and dates of service; not for procedure EOB Code Authorization for claimant, provider, and dates of service; not for procedure

22 How to Request an Adjustment – Two Options 1. Resubmit a corrected bill - At the top of the form write “Corrected Bill” or “Adjustment”. OR 2. Submit your RV a. Block out all information not pertaining to your adjustment. b. Write what you need adjusted.