The Center for Medicare and Medicaid Services (CMS) reported that the number of denied claims had tripled since October of last year. One of the main reasons for increase of denial claims is because CMS made a software change in October of last year. The change in software was a recommendation from the Office of the Inspector General in the Department of Health and Human Services after a review of the Common Working File (CWF), which revealed claims were approved for payment under the wrong beneficiary account number.
The Office of the Inspector General at HHS recommended that CMS implement a modified process for matching the claim information to the beneficiary information on CWF files to eliminate erroneous payments. Provider types affected: All Medicare physicians, providers and suppliers
What you need to do:
Claims submitted to Medicare must match a Medicare beneficiary record on the Health Insurance Claim Number, beneficiary’s last name (surname) and the beneficiary’s first name. The name reported on the claim should always be the name shown on the beneficiary’s Medicare card. If the name submitted does not match the name on Medicare’s files for that claim number, Medicare will deny the claim. Therefore, it is important that billing staff always use the name from the Medicare card when submitting a claim, even if the patient indicates the name on the Medicare card is incorrect.
Providers can avoid denial claims by making sure all records are updated with the correct beneficiary information. When submitting a claim, billing staff should make sure each claim have the correct Health Insurance Claim Number, beneficiary’s last name (surname), and the beneficiary’s first name as it appears on the Medicare card. If the claim is still denied for mismatch information ask the patient to contact their local Social Security Field office to obtain a new Medicare card. For additional information physicians and/or staff may contact 1-877-567-9232.