The CWF or Common Working File is Medicare's application that maintains information regarding coverage for Medicare Beneficiaries. Be sure to always check the CWF in order to review the MSP information to obtain other health insurance coverage.

The CWF also provides information regarding:

• Patient eligibility
• Claim history
• Benefits
• MSP enrollment dates
• Medicare Advantage enrollment dates

Question: What is the #1 reason for denied claims?

Answer: Hoping to avoid the topic won't make the problem go away. Of course, no one wants to discuss claim denials but the only way to prevent them is to be aware of what they are. Understanding the reasons why medical claims deny can help limit the number of denials your office receives. Read the top ten reasons that claims are denied.

The #1 reason for denied claims is:

Incorrect patient identifier information

• Name spelled incorrectly
• Date of birth doesn't match
• Subscriber number missing or invalid
• Insured group number missing or invalid

Read the top ten reasons that claims are denied.

_{Photo courtesy of Joy Hicks}

This week's Medical Office Topics

• Coding Accuracy: Medical coding is a major factor in obtaining insurance reimbursement as well as maintaining patient records. Coding claims accurately lets the insurance payer know the illness or injury of the patient and the method of treatment.
• HCPCS codes are used to describe drugs, supplies, and procedures.
• CPT codes are used to describe outpatient procedures.
• ICD-9 codes are used to describe a patient's diagnosis including symptoms, diseases or disorders.

Question: What is an electronic remit?

Answer: A Remittance Advice (RA) is a document supplied by the insurance payer that provides notice of and explanation reasons for payment, adjustment,denial and/or uncovered charges of a medical claim.

Usually accompanies Medicare and Medicaid payments. Often referred to as an explanation of payment by other insurance payers.

There are two types of RAs:

1. Electronic Remittance Advice (ERA): an RA that is transmitted in an electronic format
2. Standard Remittance Advice (SRA): an RA that is submitted in a paper format

Most insurance payers have implemented the use of the ERA. The benefits include the ability to post payment information automatically and quickly identify denials made during initial billing to make necessary corrections.

The ANSI 835 is the electronic payment and remittance advice standard format for health care claims. HIPAA regulations require the use of 835 as a set of rules to replace paper EOB's when health care providers receive electronic payments.