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Common Errors During Urology Claim Submission


Common Errors During Urology Claim Submission

It's quite common for any practice to receive claim rejections and denials even after careful claim submission. It’s difficult to achieve a 100 percent clean claim percentage as payer policies and billing guidelines keep on changing. It's normal to have a clean claim submission rate between 85 to 90 percent. But some practices experience more claim denials and rejections, sometimes up to 40 percent.

Practices lose money and their payments are being delayed due to inaccurate claim submission. While working with multiple urology clients, we realized these common errors and we made a list for reference. In this article, we shared these common errors during urology claim submission and ways how to avoid them. 

Common Errors During Urology Claim Submission

  • Don't submit an operative report and a cover letter for claims filed with unlisted CPT codes or CPT codes with modifier 22 Unusual procedural service. Wait until the insurer sends a request for documentation. When the request comes in send your documentation to include the operative report and cover letter. Remember, the operative report is the documentation that describes the procedure performed for which there is no appropriate CPT code or explains what was unusual about the service to warrant additional payment to support modifier 22. The cover letter should detail the procedure performed, and explain in layman's terms why the procedure was different, took a longer amount of time, or why a higher skill level was required, as the clerk who reviews your claim may not have extensive medical knowledge.
  • Another error is billing for a visit that is included in the global period for surgery or procedure.  This rule only applies to those codes with a global period. Remember, you cannot bill for an evaluation and management service if it is related to the surgical procedure. If the evaluation and management service is performed for a separately identifiable service, then it can be reported on the same day as a procedure. Only if the decision to perform the surgery was made during the visit (and modifier -57, Decision for Surgery, is used) can you bill for both the visit and the procedure.
  • Don't re-submit returned or rejected claim forms. If your claim is returned or rejected for any reason, re-submit a completely new claim. Do not resend the old one and mark it "corrected." This will only result in a second rejection.
  • Don't bill for an unrelated visit during the postoperative period without modifier -24, Unrelated E&M Service by the Same Physician During a Postoperative Period. A visit during the postoperative period must be unrelated to the surgery to be billed and must include modifier -24. The diagnosis code for this visit should be for something completely unrelated.
  • Wait for some time before resubmitting a claim. Remember, it takes roughly 13 days to process an electronic claim and 27 days to process a paper claim. Check the filing date on your original claim before resubmitting.
  • Don't bill Medicare for preventative visits and related services. Medicare does not pay for these services. These charges should be collected from the patient. A signed waiver is not required. Medicare does pay for a welcome to Medicare visit and one annual visit per year.

Billing Tips for Urology Claim Submission

Following are tips that would help to reduce errors while billing for urology claims: 

  • Always check with your insurance carrier for billing guidelines. You can refer to Medicare guidelines as standard ones but every payer has a unique set of billing guidelines and reimbursement policies. 
  • Make sure you have used the appropriate modifier, modifier -51 is the most problematic, wrongly used modifier so far.
  • Check your CPT codes against the NCCI list to determine which CPT® codes can be billed together for the insurance carrier to determine which codes can be reported together and which may require a modifier. Some insurance carriers will follow Medicare's determination of which CPT® codes can be billed together.
  • Use the correct diagnosis code for the service. This is a common problem and frequent reason for denials. Check that you haven't submitted a three-digit code when a fourth- or fifth-digit code exists (remember, you must code to the highest degree of specificity), or made any typographical errors. Make sure the correct 7th digit code is used when there is an injury or trauma.
  • Properly list purchased diagnostic tests. Those diagnostic services with a professional and technical component are subject to the ‘purchased diagnostic’ provision of the Medicare program. Carriers may decide whether or not the physician performed both components (i.e., did not purchase one of the components from an outside source). To signify whether the test was both performed and interpreted in the physician's office, some carriers require the use of locally assigned codes.
  • List your Clinical Laboratory Improvement Amendments (CLIA) identification number for claims containing laboratory tests performed in your office.

In case any help is needed in getting paid for urology services, contact Medical Billers and Coders (MBC). We are a leading revenue cycle company providing complete medical billing services. We can assist you in receiving accurate insurance reimbursement for urology services. To know more about our urology billing and coding services, contact us at info@medicalbillersandcoders.com/ 888-357-3226

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