Have you been noticing an increase in denials from Medicare lately? We have been getting an unprecedented amount of denials for “name and ID# do not match”. We are getting these denials on claims for mental health providers who have been seeing and getting paid on claims for these same patients for months or even years. Why now are these claims denying for name and ID do not match? Good question. It is not easy to find the answer. We’ve called Medicare several times and were told that the name and ID do not match. That’s all they would tell us – same thing the eob told us. We would explain that we were paid for previous dates but it didn’t matter to the representative. The name and ID did not match.
Finally we got to the bottom of this challenge! We eventually talked to a helpful representative who gave us the answer. It seems to be due to a change in their processing guidelines. Any claim now submitted to Medicare must be entered exactly as the ID card shows. If there is a middle initial, your claim must have a middle initial. If there is a hyphenated name, the hyphen must be included. If there is a space, the space must be included. If you have misspelled the name, the claim will be denied. It is now extremely important to get a copy of the patient’s ID card so you can be sure you have it exactly as represented on the card. In fact we have had claims denied that did match exactly. Only after speaking to a representative and proving the claim matched the ID card would Medicare pay.
We have also found Medicare claims denied and the patient name on the denial completely different than the name we submitted. When we called on this claim and the representative looked at it we were told that they could see that we submitted with the correct name and they weren’t sure what changed it in the system, but they would reprocess. It seems to us that Medicare is making it harder than ever to get claims correctly processed. Maybe it is a money saving technique on their part. If your office is not following up on these denials and running regular aging reports you are losing lots of money.
Make sure your office is not missing out on payment for these claims. Take care of the denials by whatever steps are necessary. Run and work regular aging reports to avoid timely filing issues. If you run a billing service, this is a great way to stand out above others. Make sure you quickly remedy these issues. Ask your providers for copies of each patient’s ID cards and keep them on file. When you get any denials act on them immediately. Don’t put them away for when you have time. These problems need to be dealt with quickly.