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We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Published Date:04/23/2020
Printed Date: 9/22/2015
URL: http://palmgba.com/marlowe/redesign6/article.html
The Palmetto GBA Denial Resolution tool includes resources for resolving the top claim rejections and denial reasons. Save time and resources by looking here before you pick up the phone.
Following are five of the top reasons that services submitted to Palmetto GBA are denied:
Tip: Review and use the CPT and HCPCS Code Sets (PDF, 3.81 MB) effective for the billed date of service.
Tip: Review the current CPT Coding Manual and CMS coverage guidelines to determine the qualifying service/procedure that must also be submitted to Medicare.
Tip: Review the CMS Medicare Learning Network Items and Services Not Covered Under Medicare Booklet (PDF, 1.15 MB)
Tip: Medicare records indicate the patient has other insurance that may be responsible for the charge(s). Contact the patient or their responsible party for information regarding other insurance that may be liable for the charges related to the care provided.
Tip: Not all screening and preventive services a provider may feel are appropriate for a patient are covered under Medicare. Review the CMS Medicare Learning Network Medicare Preventive Services Publication for a list of Medicare covered screening and preventive services along with any specific coverage and billing guidelines.
Use the Denial Resolution tool to determine whether your denials for these services are correct or whether there are other steps you should take before submitting these claims.
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Last Updated: 04/23/2020