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Frequently Asked Questions

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What are some of the common errors that affect reimbursement of Part B services by Medicare?

According to Medicare Administrative Contractors (MAC),  the most common errors that impact Part B (services provided by physicians and non-physician practitioners and certain hospital outpatient departments) reimbursement are:
 
    1. Missing or invalid information such as:
      • Incomplete or invalid medical record documentation ( progress notes, discharge summaries, etc.)
      • Orders
      • Dates of service
      • Mismatch between patient name and ID number
      • Practice identifying information
      • Clinical Laboratory Improvement Amendments (CLIA) certification number
    1. Non-compliance with Teaching Physician (TP) requirements
    2. The provider was not eligible or certified to be paid for the service or procedure on a given date of service


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