 |
 |
TIPS, TRICKS AND TACTICS: MASTERING COMPLEX SECONDARY FILING REQUIREMENTS “Confusing” is the word most often used by billing managers to describe the process required for filing secondary claims with Medicare. And their frustration is understandable. Previously, practices were required to simply take an EOB or paper Form 1500 and pop it into the mail. Now they have to transfer data from one document to another, confirm that calculations and adjustments appear in the correct field, and ensure the claim is transferred securely across cyberspace. At Navicure, we’re trying to make the process as painless as possible. Here’s a look at several of the most common coordination of benefit (COB) problems practices encounter while filing secondary claims – and how to solve them. “Adjustment” must appear on service line. Identifying where discrete pieces of information belong on the electronic form leaves many practices scratching their heads. Specific data belong on the service level, while other information can be displayed on the claim level – and some can appear in both places. But if particular combinations occur, the claim will hit a calculation edit and be rejected. Here’s a rule of thumb: Information like paid amount, date claim paid and patient responsibility can appear on the service or claim level, or even both. But adjustments calculated on the primary claim must be entered only on the service level of the secondary form. If it appears on the claim level, or in both places, it will trigger the calculation edit. All “paid” amounts must appear on secondary claim. Another stumbling block involves claims that the primary insurer paid in full. Perhaps a practice submitted a claim reflecting a series of procedures and the payer fully reimbursed one CPT code. Billing staff prepares a secondary claim, but excludes that paid service – after all, the practice has already been reimbursed for total charges billed. However, the absence of that payment from the overall calculation on the secondary claim will trigger an edit and cause the secondary claim to be bounced back to be reworked. Definitions for reason codes required Secondary claims must also display the definitions of reason codes explaining adjustments applied by the primary payers. Indicating the code itself is not adequate. Secondary claims must include the full definition (e.g., Reason Code 42 – Charges exceed our fee schedule or maximum allowable amount) and must display only active reason codes. Navicure supports secondary filing Navicure can assist clients, even if claims were submitted through another clearinghouse or billing service. Claims data can be electronically forwarded to Navicure (via 835 transaction sets) through the practice management system. Practices need to enter additional data only if complete COB detail is not available. If the primary claim was generated through Navicure, the secondary claim can be similarly filed, provided all remittance and COB information is available. Although challenging now, electronic secondary claims submission represents an easier approach for optimizing revenue. Increasing numbers of payers are following Medicare’s lead and requiring electronic filing. Navicure stands ready to help with the transition. Contact our Client Services team at 770-342-0800 or clientservices@navicure.com. In addition, a Webinar has been developed specifically to explain the intricacies of secondary billing. Email seminars@navicure.com for a schedule and further details.
|
|
|
|
 |