Use the left menu find tips to avoid common denials and claims rejections. Billing Medicare correctly the first time increases your cash flow while reducing provider burden. 

Review claims FAQs and other resources to avoid common denials and claims rejections.

Part A tips

As claims process in the Fiscal Intermediary Standard System (FISS), the Medicare Part A claims processing system, they move through different claim statuses and locations. These claims statuses provide you with information about the claim and may indicate actions you need to take. The status codes are:
• S -- Suspended
• T – Returned to provider (RTP)
• R – Rejected
• D – Denied
• Claim medically denied due to LCD or NCD
• Redetermination is recommended
• P – Paid

In combination with a status code the claim is assigned a reason code. The reason code will provide you with an explanation and help you determine the actions you need to take to correct your claim(s).

Use the Part A reason code lookup

Part B tips

A claim adjustment reason code (CARC) and a group code on your remittance advice describes why a claim or service line was paid differently than it was billed and who is responsible for the adjusted amounts. Visit the Washington Publishing Company for a complete list of the CARC codes and group codes.