Capturing Reimbursement - The Importance of Triple Checking Part B Claims




Why triple check Part B claims?

Historically, the month-end triple check process has focused on Part A claims, incorporating a random spot check of Part B claims, if any. Such practice places projected reimbursement at risk due to edits by Medicare Administrative Contractors (MACs) that can result in multiple line item denials, requiring costly labor hours to resolve. Claim areas that are essential to verify:

  • Sequencing of diagnoses provided by rehab. Many MACs require a supporting diagnosis on the bill to reimburse specific procedure codes (procedure to diagnosis edit).

  • Billing of add on codes (AOC), procedure codes that describe a service that is performed in conjunction with another primary service; such codes must be listed sequentially (e.g., 97129 must precede billing of 97130, with 97129 representing the first 15 minutes of treatment and 97130 in conjunction with 97129 for each additional 15 minutes of therapy)

  • Validation of key modifiers

  • Validation of certifications necessary for billing

Let's Get to the Point:

Please take time to evaluate the effectiveness of your triple check process, refining to capture vital Part B reimbursement. QRM is here to provide support; please contact us for guidance surrounding your triple check process.

Submitted by QRM VP of Medical Review and Clinical Compliance, Ashley Duggan, OTR, RAC-CTA.