Last Modified: 3/8/2010
Location: FL, PR, USVI
Business: Part A
Below are the most frequent RTP reason codes and descriptions for claims processed by Medicare Part A during January 2010, as well as tips and resources to help you avoid many of these issues.
Please share this information with all who need to know, such as your IT staff, billing service, vendor, or clearinghouse. Remember, billing Medicare correctly the first time saves everyone time and money.
• Remember: Questions about claim status, patient eligibility (Medicare, MSP and Medicare Advantage [formerly Medicare HMO]), deductible information, and your financial information (last three checks, month/year to date dollar amounts) can be answered via
direct data entry (DDE) 
or must go through the Interactive Voice Response unit or IVR. Contact the Part A IVR by calling 1-877-602-8816. Refer to the
Part A Quick Reference Guide for instructions.
Note: Under current guidelines, any reference to "UPIN" within the definitions of codes should be interpreted as "NPI." The Centers for Medicare & Medicaid Services (CMS) are not responsible for updating denial codes, so some definitions may reflect outdated verbiage.
The Provider Data Summary (PDS) is a comprehensive billing report designed to be utilized along with Medicare Remittance Notices (MRNs) and other provider-accessible billing resources. You may use this report to help identify potential Medicare billing issues through a detailed analysis of personal billing patterns in comparison with those of similar providers.
On this Web site, navigate to the “Home” link on the Part A page. Select “More” within the Provider Data Summary section. It is here you will find all PDS resources, including a guide, helpful FAQs, and the PDS Portal. Select the link titled “
PDS Portal.” From there, you will be given the option to login, get help with a misplaced password, or create an account.
Source: FCSO Education Action Team
