tci Medicare Compliance & Reimbursement - 2018 Issue 13

Industry Note: Avoid Diagnosis Code Debacles on the CMS-1500 or Risk Denials

Make sure you double-check line 21 on your CMS-1500 before you send Medicare your claims, new guidance suggests. The agency will automatically deny submissions that list duplicate diagnosis codes for line 21 on paper claims. “CMS-1500 hard copy claims should not list the same diagnosis code twice within item 21, or your Medicare Administrative Contractor will return these claims as unprocessable with Claim Adjustment Reason Code 16, Remittance Advice Remark Code (RARC) M76, and alert RARC N211,” said the MLN Connects June 28 release. Review the Medicare claims guidance at www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Provider-Partnership-Email-Archive-Items/2018-06-28-eNews.html?DLPage=1&DLEntries=10&DLSort=0&...

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