If you experienced a recent surge of denials for observation visits, a payer error could be at fault.
Four Medicare administrative contractors (MAC) have announced that they improperly denied claims for hospital inpatient and observation care codes and are working on the problem, according to Part B News.
The error affects claims for observation visits performed on or after January 1 and is triggered by the place of service (POS) on the claim.
According to Part B News, First Coast Service Options and Novitas are working on an error that denies claims for initial and subsequent hospital visits reported with the POS for services in the on campus-outpatient hospital setting.
Palmetto GBA and WPS Government Health Administrators identified a similar problem with a wider impact. Their systems denied claims for discharge day management services in addition to initial and subsequent hospital visits, and off campus-outpatient hospital, emergency room, and comprehensive outpatient rehabilitation facility visits.
Donโt resubmit claims for improperly denied observation services to these MACs, Part B News warned. According to the announcements issued to date, the MAC will automatically adjust claims affected by the problem, so no revenue cycle action is necessary.
If your revenue cycle team resubmits the claims, it could trigger duplicate claim denials or improper payments.
HealthLeaders has dubbed 2023 as the year of reducing denials for revenue cycle.
More and more studies are pointing to the growing concern of denials for revenue cycle leaders as more pressure is put on these leaders to help increase their bottom lines.
Revenue cycle leaders must ensure their teams monitor denials of all types. Regularly monitoring denials helps revenue cycle leaders and their teams identify common reasons for rejections, develop solutions to prevent them, and ensure timely reimbursement.
Amanda Norris is the Director of Content for HealthLeaders.