Denial code 229 is when Medicare doesn't consider a partial charge due to the claim type. It's used to convey coordination of benefits info in the 837 transaction. (Use with Group Code PR)
Denial code 229 is used when Medicare does not consider a partial charge amount due to the initial claim Type of Bill being 12X. This code is specifically used in the 837 transaction to convey Coordination of Benefits information when the secondary payer's cost avoidance policy allows providers to bypass claim submission to a prior payer. It should only be used with Group Code PR.
Common causes of code 229 are:
- Medicare not considering the partial charge amount due to the initial claim Type of Bill being 12X.
- Incorrect usage of the code in the 837 transaction to convey Coordination of Benefits information.
- Providers bypassing claim submission to a prior payer without following the secondary payer's cost avoidance policy.
- Using the code without the appropriate Group Code PR.
Ways to mitigate code 229 include:
- Ensuring accurate and complete documentation: Make sure that all necessary information is included in the claim, such as the patient's demographic details, medical history, and treatment provided. This will help prevent any potential issues that may arise due to incomplete or inaccurate documentation.
- Verifying patient eligibility: Before submitting a claim, verify the patient's eligibility with Medicare. This will help identify any potential issues or discrepancies that may lead to a denial. It is important to ensure that the patient's Medicare coverage is active and that the services being billed are covered under their plan.
- Submitting claims with the correct Type of Bill: To prevent code 229, ensure that the Type of Bill submitted is appropriate for the services provided. In this case, if the initial claim Type of Bill is 12X, it may be necessary to review the claim and determine if a different Type of Bill should be used to avoid the denial.
- Understanding Coordination of Benefits (COB) rules: Familiarize yourself with the COB rules and regulations set by Medicare. This will help you understand when and how to convey COB information in the claim. By following the correct COB guidelines, you can minimize the chances of a denial due to code 229.
- Regularly reviewing payer policies: Stay updated with the latest payer policies, especially regarding cost avoidance and claim submission to prior payers. By regularly reviewing these policies, you can ensure that you are following the correct procedures and guidelines to prevent denials related to code 229.
- Implementing effective revenue cycle management processes: Establishing efficient revenue cycle management processes can help identify and address potential issues before claims are submitted. This includes conducting regular audits, training staff on proper coding and billing practices, and implementing checks and balances to catch any errors or discrepancies that may lead to denials.
By implementing these strategies, healthcare providers can mitigate code 229 and reduce the risk of denials, ultimately improving their revenue cycle management and financial performance.
The steps to address code 229 are as follows:
- Review the initial claim Type of Bill: Check the Type of Bill used in the initial claim submission. In this case, the Type of Bill should be 12X.
- Verify the charge amount: Ensure that the charge amount being considered by Medicare is accurate and complete. Double-check the partial charge amount that was not considered.
- Determine if Coordination of Benefits (COB) information is required: Confirm if the claim involves secondary insurance coverage and if COB information needs to be conveyed. If there is no secondary payer involved, this code may not be applicable.
- Assess the secondary payer's cost avoidance policy: Understand the secondary payer's cost avoidance policy to determine if it allows providers to bypass claim submission to a prior payer. This information will help determine if the code should be used.
- Use the code appropriately: If the secondary payer's cost avoidance policy allows providers to bypass claim submission to a prior payer, use code 229 in the 837 transaction to convey the COB information. Ensure that the code is used in conjunction with Group Code PR.
- Submit the revised claim: Once the necessary adjustments have been made and the code has been applied correctly, resubmit the claim to Medicare or the appropriate payer for processing.
By following these steps, healthcare providers can effectively address code 229 and ensure that the necessary information is conveyed to the appropriate payer.