DO AND DON'T FOR IMAGING CENTER CLAIMS SUBMISSION

Do 

make sure the beneficiary's name matches their ID card exactly.

Do 

use the right modifiers. Make sure you have used the appropriate modifier (-51 is the most problematic, carriers say).

Do 

list the Medicare identification number (UPIN) for the provider.

Don't 

submit an operative report and a cover letter for claims filed with unlisted CPT codes or CPT codes with modifier 22, Unusual procedural service. Wait until the carrier sends a request for documentation. When the request comes in, then send your documentation to include the operative report and cover letter. Remember, the operative report is the documentation that describes the procedure performed for which there is no appropriate CPT code or explains what was unusual about the service to warrant additional payment to support modifer 22. The cover letter should detail the procedure performed, explain in layman's terms why the procedure was different, took a longer amount of time or why a higher skill level was required, as the clerk who reviews your claim may not have extensive medical knowledge. This is a change due to the mandatory electronic claim submission implemented by Medicare in July 2005.

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