Top 10 Medicare Denials for CPT Codes: What Providers Need to Know

Navigating Medicare’s denial landscape can be challenging for healthcare providers, as denied claims lead to lost revenue and increased administrative costs. Understanding the most frequently denied CPT (Current Procedural Terminology) codes and the reasons behind these denials can help healthcare organizations improve reimbursement rates and avoid costly errors. Here’s an in-depth look at the top 10 Medicare-denied CPT codes, along with best practices for reducing these denials.

1. CPT 99214 - Established Patient Office Visit (Moderate Complexity)

• Common Denial Reasons: Documentation insufficiency, lack of medical necessity, and coding errors.
• Tips to Avoid Denial: Ensure that the complexity level matches the documentation. Include all necessary elements, such as patient history, exam, and medical decision-making, to support the coding level.

2. CPT 99396 - Preventive Medicine Visit (Established Patient, 40-64 Years)

• Common Denial Reasons: Medicare often denies this as “not medically necessary,” as it does not cover preventive services under certain plans.
• Tips to Avoid Denial: Confirm Medicare coverage eligibility and verify if the patient’s plan includes preventive services or if an Advance Beneficiary Notice (ABN) is required.

3. CPT 36415 - Collection of Venous Blood by Venipuncture

• Common Denial Reasons: Service duplication, medical necessity, and bundling issues.
• Tips to Avoid Denial: Confirm that the service is separately payable under the patient’s plan and avoid double-billing when venipuncture is performed with other services.

4. CPT 99203 - New Patient Office Visit (Low Complexity)

• Common Denial Reasons: Incomplete documentation, coding errors, and new patient criteria not met.
• Tips to Avoid Denial: Make sure all required documentation is included, and confirm the patient qualifies as “new” under Medicare guidelines (no professional services provided by the same provider within the last three years).

5. CPT 99308 - Subsequent Nursing Facility Care (Low Complexity)

• Common Denial Reasons: Missing medical necessity and documentation inadequacies.
• Tips to Avoid Denial: Properly document the patient’s condition, services rendered, and reasons for continued nursing facility care to demonstrate medical necessity.

6. CPT 97110 - Therapeutic Exercises (Per 15 Minutes)

• Common Denial Reasons: Lack of documentation to support skilled therapy, exceeding therapy limits, and bundling issues.
• Tips to Avoid Denial: Include detailed notes about therapy goals, progress, and the medical need for ongoing therapy sessions.

7. CPT 99233 - Subsequent Hospital Care (High Complexity)

• Common Denial Reasons: Documentation not supporting complexity, duplication with other codes, and lack of medical necessity.
• Tips to Avoid Denial: Ensure that documentation reflects the high complexity required for this code. Include all elements that substantiate the need for a high-complexity visit.

8. CPT 97010 - Application of a Modality to 1 or More Areas; Hot or Cold Packs

• Common Denial Reasons: Bundling with other services, and Medicare’s non-coverage policy on certain modalities.
• Tips to Avoid Denial: Review Medicare’s bundling policies to determine if the service is covered when provided alongside other therapy services.

9. CPT 80050 - General Health Panel

• Common Denial Reasons: Medicare often does not consider this medically necessary or denies it for exceeding frequency limits.
• Tips to Avoid Denial: Verify if specific components of the panel are covered individually rather than billing the panel as a whole, and confirm the medical necessity before billing.

10. CPT 85025 - Complete Blood Count (CBC) with Automated Differential

• Common Denial Reasons: Medical necessity and frequency limitations.
• Tips to Avoid Denial: Confirm Medicare’s coverage guidelines on frequency and ensure a documented medical reason that justifies ordering the test.

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Key Takeaways for Reducing Medicare Denials

While the reasons for denial vary by code, there are general steps providers can take to minimize the risk:

• Prior Authorization and Coverage Checks: Verify whether the service is covered under the patient’s specific Medicare plan before providing it.
• Proper Documentation: Ensure that medical records comprehensively support the coding level and medical necessity for the service rendered.
• Staff Training: Educate billing and coding staff on Medicare’s policies, including frequent updates to covered services and CPT code guidelines.
• Advance Beneficiary Notices (ABNs): For services with unclear coverage, obtain ABNs from patients to ensure transparency and reduce the likelihood of unexpected denials.

Final Thoughts

By proactively addressing the most commonly denied CPT codes, healthcare providers can reduce administrative burdens, speed up reimbursement, and maintain financial stability. Addressing the underlying causes of denials—whether they involve coding accuracy, documentation, or policy awareness—is essential to a smooth and efficient revenue cycle.

Medical billing (RCM) Process - step by step explained

An efficient RCM process in medical billing can enhance medical practice revenues.
The primary job of any medical practice is to provide the best medical care to ensure positive results. However, bogged down by numerous administrative procedures that include insurance verification, charge entry processing, claim submission process etc, it is becoming increasingly difficult to keep a firm focus on what matters the most, restoring the health of the patient.


Enter medical billing specialists at this stage. These are trained professionals who ensure that billing, coding, claims processing happens smoothly in a process called revenue cycle management (RCM).  Read on to take a closer look at what is the RCM process in medical billing. To understand the RCM process, we will have to begin by telling you what are the steps in medical billing process. Let’s go step by step to understand the process in detail.

Process involved in Medical billing

1. The patient makes an appointment

The RCM process kicks in at the time that a patient himself or his family seeks an appointment at a medical care facility. Upon receiving the call, an employee from the medical care facility provides a confirmation of the appointment, gets the details and makes a record of the demographics and the insurance information of the patient in the RCM software that is installed inhouse, if the medical care facility is small or is outsourced to a revenue cycle management company if it is a larger organisation or a hospital network in question, this job is outsourced to a RCM company.

2 Insurance Verification Process

Once you confirm the appointment and get the patient information. We should validate the patient insurance information either by checking online and calling the insurance directly. Also get copay, deductible and out of pocket information. Only if the insurance is active we could confirm the patient appointment otherwise call patient and inform them what is wrong and get clarified. In this stage we have to get the pre authorization too if the procedure required.

3. The patient’s arrival

Once the patient arrives for the appointment, he undergoes some pre-checkup and updation of medical records according to his specification and prescription drugs, procedures, services and all information has been recorded.  The best practices here is, collect all copay, deductible and previous visit balance billing if any. This would avoid lot of billing process and billing life would be easier. Once these payments are made, they are recorded in the RCM system, under the patient’s account.

Tip: Patient payment information has to be conveyed to patient during the appointment confirmation stage itself.

4. Creation of superbill.

The doctor examines the patient and specify all diagnosis and treatment information into filling out a superbill on the RCM system. This could be either paper super bill or electronic super bill which doctor enter the CPT and DX in the RCM software itself.

5. Review of the superbill and entering the charges

The medical coding or RCM specialist reviews this super bill at this stage, to ensure that the correct ICD codes, CPT codes and modifiers have been used according to patient visit notes (Medical records). In case any changes are required, the doctor is informed and to make the modifications as necessary. Most of the providers only entering description of the services and Diagnosis. Hence choosing right ICD code matching with CPT code is key element here.

6. Claim submission process

After the superbill has been entered by the RCM team, the billing software kicks into action and sends it to the clearing house for a final review.  If there are any mistakes in codes at this stage, the clearing house sends the claim back as rejection. Only if the claims have been successfully passed through and reach the insurance with acknowledgment report make the claim submission process complete. If all the codes match correctly and patient is active during that time, the bill is sent on further for processing of claims. If the insurance company finds errors or a lapse at this stage, the claim would be denied at this stage. A good RCM company under the supervision of a qualified medical billing specialist has a 98-99% success rate in the first pass claims acceptance ie clean claims.

7. Payment posting and denial management

Once all the approvals are in place, it is time for the insurance company to make the payments. Post claims acceptance and processing, the practice receives that payment. After the receipt of the payments the RCM team reconciles the payment under the patient’s account.  Posting under correct patient and correct DOS is main requirement here. If we choose anything wrong, the system balance would not tallied correctly and that give us indication to choose the right patient and DOS, CPT.

Tip: Choosing the correct denial would reduce the lot of unnecessary work. Educate the team in that manner.

8. AR & RCM process.

This would be most complicated process in RCM process as we don’t have anything to enter or do the quality check-up but need to take the action on non-paying claims. Not all the claim which we submitted to insurance would automatically paid hence we have to run the report of non-paying claims (Aged claims) and do the follow up with insurance is main process here. Unless we call the insurance and ask the status some of the claims will not be paid at all. Hence follow up with insurance is must process.

Tip : The good practice is review of unpaid claim every 15 days. Some action has to be taken on every 15 days in each and every single unpaid claims


Why following medical billing process improve the revenue

Trusting a reputed medical billing service provider who follows the correct process may seem expensive but it is what efficiently streamlines the RCM process for your practice to navigate through the complicated  medical billing procedures. These service providers provide end-to end services right from reviewing patient eligibility and payments, recording, coding, reviewing and final submission for a smooth claim processing.

With an efficient RCM partner at your service you never have to worry about unnecessary financial losses due to lapses in the medical billing process. Further, with 24x7 back end support, you can rely on an expert to guide you through and solve technological glitches if any in the system. In this hyperconnected age, if you are a medical care practitioner it makes financial sense for you to invest in either efficient RCM software or outsource the process to a medical billing services provider at the earliest.

How to change password in Medicare CMS SPOT

Q: How often do I need to change my password, and how do I change it?

A: You must log in to the EIDM portal external link once every 60 days to change your password. You may change your Password as well as personal information associated with your Enterprise
Identity Management (EIDM) account through the My Profile menu on the EIDM website.


Change Password

1. Navigate to CMS’ EIDM portal: https://portal.cms.gov

5. Select My Profile from the My Portal menu
6. The View My Profile page will appear
7. Select Change Password from the Change My Profile left-navigation menu

8. Enter appropriate values in the following fields:

a. Old Password

b. New Password

c. Confirm New Password

9. Click the Next button, and the confirmation page will appear

CMS855R - Medicare reassignment form download and tips to avoid mistakes

When to complete a CMS-855R

CMS-855R is to be used for Reassignment of Medicare Benefits -- Complete this application if you are reassigning your right to bill the Medicare program and receive Medicare payments, or are terminating a reassignment of benefits.

Reassigning your Medicare benefits allows an eligible supplier to submit claims and receive payment for Medicare Part B services that you have provided. Such an eligible supplier may be an individual, a clinic/group practice or other organization.

Things to consider:
• Both the individual practitioner and the eligible supplier must be currently enrolled (or concurrently enrolling via submission of the CMS-855B for the eligible supplier and the CMS-855I for the practitioner) in the Medicare program before the reassignment can take effect.

• Generally, this application is completed by a supplier, signed by the individual practitioner, and submitted by the supplier.

• When terminating a current reassignment, either the supplier or the individual practitioner may submit this application with the appropriate sections completed.

• The individual or authorized/delegated official, by his/her signature, agrees to notify the Medicare fee-for service contractor of any future changes to the reassignment in accordance with 42 C.F.R. 424.516(d)(2).

• An individual will not need to reassign benefits to a corporation, limited liability company, professional association, etc., of which he/she is the sole owner. See the CMS-855I Application for Physicians and Non-Physician Practitioners for more information.

• Physician assistants: This application should not be used to report employment arrangements. Employment arrangements must be reported in Sections 2E through 2G of the CMS-855I

Download CMS-855R external pdf file

• Find step-by-step guidance to completing the CMS-855R form
• View a simulation flash file on how to avoid the No. 1 reason applications are denied

When to use a CMS-855I - Individual provider - tips to avoid error

CMS-855I is to be used by Physicians and non-physician practitioners (including clinical psychologists) -- Complete this application if you are an individual practitioner who plans to bill Medicare and you are:

• An individual practitioner who will provide services in a private setting.

• An individual practitioner who will provide services in a group setting. If you plan to render all of your services in a group setting, you will complete Sections 1-4 and skip to Sections 14 through 17 of this application.

• Currently enrolled with a Medicare fee-for-service contractor but need to enroll in another fee-for- service contractor’s jurisdiction (e.g., you have opened a practice location in a geographic territory serviced by another Medicare fee-for-service contractor).

• Currently enrolled in Medicare and need to make changes to your enrollment information (e.g., you have added or changed a practice location).

• An individual who has formed a professional corporation, professional association, limited liability company, etc., of which you are the sole owner.

• If you provide services in a group/organization setting, you will also need to complete a separate application, the CMS-855R, to reassign your benefits to each organization. If you terminate your association with an organization, use the CMS-855R to submit that change.

All physicians, as well as all non-physician practitioners listed below, must complete this application to initiate the enrollment process:
• Anesthesiology Assistant
• Audiologist
• Certified nurse midwife
• Certified registered nurse anesthetist
• Clinical nurse specialist
• Clinical social worker
• Mass immunization roster biller
• Occupational therapist in private practice
• Physical therapist in private practice
• Physician assistant
• Psychologist, Clinical
• Psychologist billing independently
• Registered Dietitian or Nutrition Professional
• Speech Language Pathologist

Download CMS-855I external pdf file
Download CMS-855I

• Find step-by-step directions to completing the CMS-855I form.
• View how to avoid the errors flash file that result in the CMS-855I form not being processed, specifically missing signatures or other required information.
how to avoid the errors

When to use a CMS-855B form and tips to avoid error

CMS-855B is to be used by Clinics/group practices and certain other suppliers -- Complete this application if you are an organization/group that plans to bill Medicare and you are:

• A medical practice or clinic that will bill for Medicare Part B services (e.g., group practices, clinics, independent laboratories, portable x-ray suppliers).

• A hospital or other medical practice or clinic that may bill for Medicare Part A services but will also bill for Medicare Part B practitioner services or provide purchased laboratory tests to other entities that bill Medicare Part B.

• Currently enrolled with a Medicare fee-for-service contractor but need to enroll in another fee-for-service contractor’s jurisdiction (e.g., you have opened a practice location in a geographic territory serviced by another Medicare fee-for-service contractor).

• Currently enrolled in Medicare and need to make changes to your enrollment data (e.g., you have added or changed a practice location).

The following suppliers must complete this application to initiate the enrollment process:
• Ambulance Service Supplier
• Ambulatory Surgical Center
• Clinic/Group Practice
• Independent Clinical Laboratory
• Independent Diagnostic Testing Facility (IDTF)
• Intensive Cardiac Rehabilitation Supplier
• Mammography Center
• Mass Immunization (Roster Biller Only)
• Part B Drug Vendor
• Portable X-ray Supplier
• Radiation Therapy Center
• Pharmacy

Note: Are you a supplier looking for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) enrollment? Please visit CGS Medicare external link, the DMEPOS Medicare Administrative Contractor (MAC) for Florida, Puerto Rico, and the U.S. Virgin Islands.

Download CMS-855B external pdf file
http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms855b.pdf


• View how to avoid the errors flash file that result in the CMS-855B form not being processed, specifically missing signatures or dates in Section 15B and Section 16A.
http://medicare.fcso.com/pe_tips_and_tutorials/138139.asp

CMS-855 applications


When to complete a new CMS-855
Q: When do I need to complete a new CMS-855?
A. You need to complete a new CMS-855 when:
• An individual or entity is requesting initial enrollment into the Medicare program.
• Changes are being submitted to update enrollment information and the individual or entity does not have a completed enrollment application (CMS-855) on file.
• An individual or entity is submitting a request for Electronic Funds Transfer (EFT) and an enrollment application is not on file.
Access the Provider Enrollment Application Assistance Tool for more help in determining the appropriate enrollment form for submission.


How to complete a CMS-855 form
Q: How do I complete a CMS-855 form? How can I be sure that I have everything I need?
A: Medicare enrollment applications/forms (CMS-855A, CMS-855B, CMS-855I, and CMS-855R) must be completed with accurate information and include all supporting documentation.
First Coast Service Options Inc. (First Coast) offers several online resources to assist you during the provider enrollment process including:
• CMS-855 tutorials
• Institutional providers: CMS-855A flash file
• Clinics/group practices and certain other suppliers: CMS-855B flash file
• Physicians and non-physician practitioners: CMS-855I flash file
• Reassignment of benefits: CMS-855R flash file
• Provider enrollment tips, terms, and specialty codes:
• Tips to expedite your Medicare enrollment process
• Commonly used provider enrollment terms and their definitions
• Medicare provider/supplier specialty codes
Access the Provider Enrollment Application Assistance Tool for more help in determining the appropriate enrollment form and documentation for submission.


Determining the provider’s legal name

Q: What is the provider’s legal business name that should appear on CMS-855 Medicare enrollment applications?
A: A provider’s legal business name is the name that is registered with the Internal Revenue Service (IRS) and should appear on IRS documents, such as the CP-575, that contains a provider’s employee identification number (EIN) or tax identification number (TIN).
The provider’s legal business name with the IRS should identically match (including any or no punctuation) the business name registered with the National Plan & Provider Enumeration System (NPPES), which issues the national provider identifier (NPI). This is the information that will be loaded into the Provider Enrollment, Chain and Ownership System (PECOS). PECOS and NPPES must match exactly.
To validate that the legal business name the IRS has for you matches the business name registered with NPPES by visiting the NPPES website external link or contacting them at 1-800-465-3203 or 1-800-692-2326 for TTY services.


Certification statement of the CMS-855

Q: Who should sign the certification statement of the CMS-855 provider enrollment application?

A: The following shows the information for the various applications:

CMS-855A and CMS-855B
For initial enrollment and revalidation, the certification statement must be signed and dated (preferably in blue ink) by an authorized official. An authorized official is an appointed official to whom the organization has granted legal authority to enroll it in the Medicare program, make changes or updates to the organization's status, and commit the organization to fully abide by the statutes, regulations, and program instructions of the Medicare program.
The authorized official signature must be original. Faxed, stamped, or photocopied signatures cannot be accepted.
The provider can have an unlimited number of authorized officials. However, each authorized official must be listed in section 6 of the CMS-855. Anyone listed as a "Contracted Managing Employee" in section 6 of the CMS-855 cannot be an authorized official.

CMS-855C
For initial enrollment, updating information and voluntarily withdrawing your registration, the certification statement must be signed and dated (preferably in blue ink) by an authorized official. An authorized official is an appointed official to whom the organization has granted legal authority to enroll it in the Medicare program, make changes or updates to the organization's status, and commit the organization to fully abide by the statutes, regulations, and program instructions of the Medicare program.
The authorized official signature must be original. Faxed, stamped, or photocopied signatures cannot be accepted.

CMS-855I
The only person who may sign the CMS-855I is the individual practitioner, including solely-owned entities listed in section 4A. This applies to initial enrollments, changes of information, reactivations, etc. An individual practitioner may not delegate authority to any other person to sign the CMS-855I on his/her behalf.

CMS-855POH
For physician-owned hospitals complying with the annual reporting requirement, the certification statement must be signed and dated (preferably in blue ink) by an authorized or delegated official. An authorized or delegated official is an appointed official to whom the organization has granted legal authority to enroll it in the Medicare program, make changes or updates to the organization's status, and commit the organization to fully abide by the statutes, regulations, and program instructions of the Medicare program.

The official’s signature must be original. Faxed, stamped, or photocopied signatures cannot be accepted.

The provider can have an unlimited number of authorized or delegated officials. However, each official must be previously reported and approved on the CMS-855A at the time the physician-owned hospital was enrolled or when a CMS-855A was submitted to report a change in the authorized or delegated official.

CMS-855R

For initial reassignment, both the individual and the group's authorized or delegated official must sign section 6. If either signature is missing, First Coast Service Options Inc. (First Coast) will return the application.
If terminating a reassignment, either party may sign section 6; both signatures are not required. If no signatures are present, First Coast will return the application.
The authorized or delegated official who signs section 6 must be currently on file with First Coast.

All CMS-855 applications

If the application is not signed and dated appropriately, the application will be returned. The application will need to be corrected and resubmitted. Any application resubmission must contain a brand new certification statement page containing a signature and date. The provider cannot simply add a signature to the original certification statement submitted.
Access the Provider Enrollment Application Assistance Tool for more help in determining the appropriate enrollment form for submission.


Delegating authority to sign CMS-855B applications
Q: May an authorized official delegate their authority to sign CMS-855B applications?
A. An authorized official of an organization may delegate authority to make changes to enrollment information and to add physicians/practitioners. The organization must complete the section 16 of the CMS-855B and an authorized official must sign the certification statement. The delegated official must be an individual with an "ownership or control interest" in or be a W-2 managing employee of the supplier. The delegated official must be reported in Section 6.
An individual physician or practitioner cannot delegate authority and must sign the certification statement of the CMS-855I.
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Sole proprietor versus a sole owner
Q: What are the differences in completing Section 4 of a CMS-855I application for a sole proprietor versus a sole owner?

A: Sole Proprietorship - Section 4F of the CMS-855I is completed with the employer identification number (EIN). The instructions in this section state, “if you are a sole proprietor and you want Medicare payments to be reported under your EIN, list it below.” Only one national provider identifier (NPI) number is needed for the provider. Sole proprietors do not complete section 4A.
Sole Ownership - Section 4A of the CMS-855I is completed with the tax identification number (TIN). If anything is listed in section 4A, a separate NPI number must be obtained for the group number that will be assigned and listed in section 4A. The individual’s NPI number and information must be listed in section 4C.

CMS recently made available a document that will assist physicians and non-physician practitioners in completing the CMS-855I form titled Medicare Provider Enrollment of Individuals (Physicians and Non-Physician Practitioners) external pdf file. Scenarios 2a, 2b, 3 & 4 are very helpful in determining if you are a sole proprietor or sole owner.


Section 4 of the CMS-855R
Q: What information should be in Section 4 of the CMS-855R form?
A. The following information is required:

Initial Reassignment
Section 4A on page 6 is signed and dated by the person reassigning their benefits. Section 4B is signed and dated by the group’s authorized official or delegated official. If either signature is missing, First Coast Service Options Inc. (First Coast) will request this information as part of the development process.

Terminating Reassignments
If the individual terminates a reassignment, the individual signs and dates section 4A.
If the organization terminates a reassignment, the group’s authorized official or delegated official signs and dates Section 4B.
For terminations, both signatures are not required. However, if no signatures are present, First Coast will request this information as part of the development process.
Applicable to all CMS-855R applications
The authorized or delegated official who signs section 4B must be currently on file with First Coast. All signatures must be original, preferably in blue ink. Faxed, stamped, or photocopied signatures cannot be accepted.
If the application is not signed and dated appropriately, First Coast will send a developmenMiscellaneous forms and documentation.



Miscellaneous forms and documentation


CMS-460

Q: What is the purpose of the Medicare Participating Physician or Supplier Agreement (CMS-460)?
A: New physicians, practitioners, and suppliers may submit the CMS-460 form  external pdf file at the time of their enrollment. Participants agree to accept assignment for all covered services provided to Medicare patients.

In addition, the CMS-460 may also be used for existing providers during the annual participation open enrollment. The annual physician and supplier participation period begins January 1 of each year, and runs through December 31. The annual participation enrollment is scheduled to begin on November 15 of each year. (Note: The dates listed for release of the participation enrollment/fee disclosure material are subject to publication of the annual Final Rule.)
During the annual enrollment period, for First Coast Service Options Inc. (First Coast), the MAC for jurisdiction N (JN), which includes Florida, Puerto Rico, and the U.S. Virgin Islands, submit your completed CMS-460 form (or disenrollment request) to:
Provider Enrollment
P.O. Box 3409
Mechanicsburg, PA 17055-1849

What is roster billing and downloading the roster form

Roster billing is a quick and convenient way to bill for flu and pneumonia vaccinations. To submit a roster bill, a home health agency must have provided the same type of vaccination to five or more people on the same date of service. Each type of vaccination must be billed on a separate roster bill. You cannot have pneumococcal pneumonia vaccines (PPVs) and flu vaccines on the same roster bill.

Roster billing enables Medicare beneficiaries to participate in mass pneumococcal and influenza virus vaccination programs offered by various entities that give vaccines to a group of beneficiaries. Learn more about this simplified process.

Immunization roster billing

Roster billing may be used when immunizations are offered for large groups of beneficiaries in Public Health Centers (PHCs), shopping malls, grocery stores, senior citizen homes, or health fairs.

• Roster billing is not available for hepatitis B vaccinations.
• Roster billing does apply to influenza and pneumococcal immunizations.

Roster billing for Part A providers

Part A providers who use direct data entry (DDE) pdf file can submit roster bills by following the steps below:
• To access the roster bill entry page, choose option "2" claims/attachments) and then select option "87" (roster bill entry).
• The page allows providers to enter pneumococcal and influenza vaccinations in a roster bill form. When completing the roster bill, providers should observe the following points:

• Only one date of service per roster page
• A maximum of 10 patients per roster page may be reported on a DDE roster page
• Press F9 to transmit the claim

Roster billing for Part B providers
To enable Medicare beneficiaries to participate in mass pneumococcal and influenza virus vaccination programs offered by PHCs and other individuals and entities that give vaccines to a group of beneficiaries, the simplified roster billing process was developed.

• Influenza virus vaccine: Roster sheet pdf file
http://medicare.fcso.com/Forms/137489.pdf

• Pneumococcal pneumonia virus vaccine: Roster sheet
http://medicare.fcso.com/Forms/138380.pdf

New or modified Remittance Advice Remark and Claims Adjustment Reason Code

New Codes – RARC Code Modified Narrative         Effective Date

N753  Missing/Incomplete/Invalid Attachment Control Number. 07/01/2015
N754 Missing/Incomplete/Invalid Referring Provider or Other Source Qualifier on the 1500 Claim Form. 07/01/2015
N755 Missing/Incomplete/Invalid ICD Indicator on the 1500 Claim Form. 07/01/2015
N756 Missing/Incomplete/Invalid point of drop-off address, 07/01/2015
N757 Adjusted based on the Federal Indian Fees schedule (MLR). 07/01/2015
N758 Adjusted based on the prior authorization decision. 07/01/2015
N759 Payment adjusted based on the National Electrical Manufacturers Association (NEMA) Standard XR-29-2013. 07/01/2015
M47 Missing/Incomplete/Invalid Payer Claim Control Number. Other terms exist for this element including, but not limited to, Internal Control Number (ICN), Claim Control Number (CCN), Document Control Number (DCN). 07/01/2015
MA74 ALERT: This payment replaces an earlier payment for this claim that was either lost, damaged or returned. 07/01/2015
N432 ALERT: Adjustment based on a Recovery Audit. 07/01/2015
N22 ALERT: This procedure code was added/changed because it more accurately describes the services rendered. 07/01/2015
M39 ALERT: The patient is not liable for payment of this service as the advance notice of non-coverage you provided the patient did not comply with program requirements. 07/01/2015
M109 ALERT: This claim/service was chosen for complex review. 07/01/2015
M38 ALERT: The patient is liable for the charges for this service as they were informed in writing before the service was furnished that we would not pay for it and the patient agreed to be responsible for the charges. 07/01/2015
N381 ALERT: Consult our contractual agreement for restrictions/billing/payment information related to these charges. 07/01/2015
MA91 ALERT: This determination is the result of the appeal you filed. 07/01/2015
270 Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient’s dental plan for further consideration. 07/01/2015
45 Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Note: This must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability.) 11/01/15

Retroactive Medicare Entitlement - Medicare timely filing denial

The time for filing a claim will be extended if CMS or one of its contractors determines that a failure to meet the filing deadline is caused by all of the following conditions:
(a) At the time the service was furnished the beneficiary was not entitled to Medicare.

(b) The beneficiary subsequently received notification of Medicare entitlement effective retroactively to or before the date of the furnished service.

Thus, a provider or supplier may have furnished services to an individual who was not entitled to Medicare. More than a year later, the individual receives notification from SSA that he or she is entitled to Medicare benefits retroactive to or before the date he or she received services from the provider or supplier. In this situation, the provider or supplier may submit a request for a filing extension to the appropriate Medicare claims processing contractor, as long as the provider or supplier submits supporting documentation that verifies that the conditions above are met.

If the beneficiary and the provider or supplier is notified on different days about the beneficiary’s retroactive Medicare entitlement, there will be two extensions of time triggers. One extension of time trigger is when the beneficiary is first notified about the beneficiary’s retroactive Medicare entitlement and the other extension of time trigger is when the provider or supplier is the first party notified of the beneficiary’s retroactive Medicare entitlement. If the beneficiary is submitting the claim, the time to file the claim is based on the day the beneficiary is first notified of the retroactive Medicare entitlement. If the provider or supplier is submitting the claim, the time to file the claim is based on the day the provider or supplier is first notified of the retroactive Medicare entitlement.
Where retroactive Medicare entitlement is alleged, the provider, supplier, or beneficiary will need to provide the contractor with the following information:

• an official Social Security Administration (SSA) letter notifying the beneficiary of Medicare entitlement and the effective date of the entitlement; and,

• documentation describing the service/s furnished to the beneficiary and the date of the furnished service/s.

If the provider, supplier, or beneficiary is unable to provide the contractor with an official SSA letter, the Medicare contractor shall check the Common Working File (CWF) database and may interpret the CWF date of accretion and the CWF Medicare entitlement date for a beneficiary in order to verify a beneficiary’s retroactive entitlement. For example, if the CWF indicates a Medicare entitlement date of March 1, 2008 and a date of accretion of December 14, 2010, then the contractor may interpret the CWF data to mean that the beneficiary was retroactively entitled to Medicare as of March 1, 2008 and that this data was added to the CWF database on December 14, 2010. If the contractor has any problems or concerns with respect to interpreting the CWF data, then the contractor should consult with the appropriate CMS regional office.

If the contractor determines that both of the conditions for meeting this exception described above are met, the time to file a claim will be extended through the last day of the 6th calendar month following the month in which either the beneficiary or the provider or supplier received notification of Medicare entitlement effective retroactively to or before the date of the furnished service.

Medicare part A & part B premium and coinsurance rates

What are the Medicare premiums and coinsurance rates for 2011

The following is a listing of the Medicare premium, deductible, and coinsurance rates that will be in effect in 2011:

Medicare Premiums for 2011:

Part A: (Hospital Insurance) Premium

• Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.

• The Part A premium is $248.00 per month for people having 30-39 quarters of Medicare-covered
employment.

• The Part A premium is $450.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

Part B: (Medical Insurance) Premium

Most beneficiaries will continue to pay the same $96.40 or $110.50 premium amount in 2011. Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium in 2011.

For additional details, see our FAQ titled: "Will my Medicare Part B premium increase in 2011?"

For all others, the standard Medicare Part B monthly premium will be $115.40 in 2011, which is a 4.4% increase over the 2010 premium. The Medicare Part B premium is increasing in 2011 due to possible increases in Part B costs. If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $115.40 per month. For additional details, see our FAQ titled: "2011 Part B Premium Amounts for Persons with Higher Income Levels".

Medicare Deductible and Coinsurance Amounts for 2010:

Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period  Medicare pays all covered costs except the Medicare Part A deductible (2011 = $1,132) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.

For each benefit period you pay:

• A total of $1,132 for a hospital stay of 1-60 days.
• $283 per day for days 61-90 of a hospital stay.
• $566 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
• All costs for each day beyond 150 days

Skilled Nursing Facility Coinsurance

• $141.50 per day for days 21 through 100 each benefit period.

Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)

• $162.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $162.00 deductible.)

what is Medicare - Part A , part B - basics

Federal Benefit Program: Medicare

Description:

Medicare is a health insurance program for people 65 years of age or older, some disabled people under 65 years, and people with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant). Medicare coverage is comprised of two parts: Hospital Insurance (Part A) and Medical Insurance (Part B).

Eligibility Criteria:

You must be 65 years of age or older and a citizen or permanent resident of the United States. You might also qualify for coverage if you are a younger person with a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant) or Lou Gehrig's Disease.

Hospital Insurance (Part A):

You can get Part A at age 65 without having to pay premiums if:
•  You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
•  You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
•  You or your spouse had Medicare-covered government employment.

Medical Insurance (Part B):

If you are under 65, you can get Part B without having to pay premiums if:
•  You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
•  You are a kidney dialysis or kidney transplant patient.

how to bill preventive medicine service during screening service

PREVENTIVE MEDICINE SERVICE PROVIDED AT THE TIME OF COVERED SCREENING SERVICE

A preventive medicine exam includes a comprehensive age and gender appropriate history, examination, counseling/anticipatory guidance/risk-factor reduction interventions, and the ordering of appropriate immunization(s) and laboratory/diagnostic procedures. Sometimes these other elements are performed during the same visit as the Medicare covered services, particularly G0101 and Q0091. The following pie chart illustrates this circumstance.

Medicare will reimburse for the shaded parts of the pie (the collection of the Pap smear and the pelvic exam). The remaining portions of the preventive service are billed to the patient. The amount paid by Medicare is subtracted from the physician’s usual fee for a preventive service. The remaining amount is the patient’s fee. This is referred to as a “carve out,” meaning that Medicare’s covered portion of the preventive service is carved out of the total preventive service. The amount reimbursed by Medicare and the amount reimbursed by the patient will equal the physician’s usual fee.

Example : The “carve out” method for reporting the screening pelvic examination (G0101) with other preventive medicine care:

Bill to:	CPT/HCPCS Code(s)	ICD-9 Codes	Charge
Medicare	G0101-GA	V72.31 or V15.89	$34.60
Patient	99397-GY	V72.31	$65.40
Total amount billed			$100.00

The physician’s usual charge for the preventive visit (99397) is $100. The total billed to the patient and to Medicare equals the physician’s usual charge for the preventive service.

The GA modifier indicates that an ABN has been signed. Modifier GY is reported for a service that is not a Medicare covered benefit. The service is being reported to Medicare to receive a denial. The patient is responsible for the preventive service less the Medicare carve out amount.

Example 2: Preventive visit reported with screening pelvic examination (G0101) and collection of a screening Pap smear specimen (Q0091):

Bill to:	CPT/HCPCS Code(s)	ICD-9 Codes	Charge
Medicare	G0101-GA	V72.31 or V15.89	$34.60
	Q0091-GA	V72.31 or V15.89	$40.00
Patient	99397-GY	V72.31	$25.40
Total amount billed			$100.00

The physician’s usual charge for the preventive visit (99397) is $100. The total billed to the patient and to Medicare equal the physician’s usual charge.

The GA modifier indicates that an ABN has been signed. Modifier GY is reported for a service that is not a Medicare covered benefit. The service is being reported to Medicare to receive a denial. The patient is responsible for the preventive service less the Medicare carve out amount.

Once Medicare has processed the claim, the patient is billed for her portion of G0101 and Q0091. However, the patient can be billed at the time of service for the portion not covered by Medicare.

ABN notice -does patient need to sign every visit ? GA, GZ, GY modifier -

Does a beneficiary need to sign an Advance Beneficiary of Noncoverage (ABN) for every visit?

Answer:  

Notifiers are required to issue ABNs when an item or service is expected to be denied based on one of the provisions in the Medicare Claims Processing Manual Chapter 30 §50.5. This may occur at any one of three points during a course of treatment which are initiation, reduction, and termination, also known as 'triggering events.'

Initiations

An initiation is the beginning of a new patient encounter, start of a plan of care, or beginning of treatment. If a notifier believes that certain otherwise covered items or services will be non-covered (e.g., not reasonable and necessary) at initiation, an ABN must be issued prior to the beneficiary receiving the non-covered care.

Example: Mrs. S. asks her physician for an EKG because her sister was recently diagnosed with atrial fibrillation. Mrs. S. has no diagnosis that warrants medical necessity of an EKG but insists on having an EKG even if she has to pay out of pocket for it. The physician’s office personnel issue an ABN to Mrs. S. before the EKG is done.

Reductions

A reduction occurs when there is a decrease in a component of care (i.e., frequency, duration, etc.). The ABN is not issued every time an item or service is reduced. But, if a reduction occurs and the beneficiary wants to receive care that is no longer considered medically reasonable and necessary, the ABN must be issued prior to delivery of this non-covered care.

Example: Mr. T, is receiving outpatient physical therapy five days a week, and after meeting several goals, therapy is reduced to three days per week. Mr. T wants to achieve a higher level of proficiency in performing goal related activities and wants to continue with therapy five days a week. He is willing to take financial responsibility for the costs of the two days of therapy per week that are no longer medically reasonable and necessary. An ABN would be issued prior to providing the additional days of therapy weekly.

Terminations

A termination is the discontinuation of certain items or services. The ABN is only issued at termination if the beneficiary wants to continue receiving care that is no longer medically reasonable and necessary.

Example: Ms. X has been receiving covered outpatient speech therapy services, has met her treatment goals, and has been given speech exercises to do at home that do not require therapist intervention. Ms. X wants her speech therapist to continue to work with her even though continued therapy is not medically reasonable or necessary. Ms. X is issued an ABN prior to her speech therapist resuming therapy that is no longer considered medically reasonable and necessary.
Period of Effectiveness/ Repetitive or Continuous Noncovered Care

An ABN can remain effective for up to one year. Notifiers may give a beneficiary a single ABN describing an extended or repetitive course of noncovered treatment provided that the ABN lists all items and services that the notifier believes Medicare will not cover. If applicable, the ABN must also specify the duration of the period of treatment. If there is any change in care from what is described on the ABN within the one-year period, a new ABN must be given. If during the course of treatment additional noncovered items or services are needed, the notifier must give the beneficiary another ABN. The limit for use of a single ABN for an extended course of treatment is one year. A new ABN is required when the specified treatment extends beyond one year.


If a beneficiary is receiving repetitive non-covered care, but the provider or supplier failed to issue an ABN before the first or the first few episodes of care were provided, the ABN may be issued at any time during the course of treatment. However, if the ABN is issued after repetitive treatment has been initiated; the ABN cannot be retroactively dated or used to shift liability to the beneficiary for care that had been provided before ABN issuance.

ADVANCED BENEFICIARY NOTIFICATION

Medicare screening services are limited to a specific frequency (e.g., once every 2 years, once every year). A physician may not know whether a patient is eligible for this service in a given year. If she is not eligible, the service will be denied. Therefore, the physician should ask the patient to sign an advance beneficiary notice of noncoverage (ABN) using the form provided by Medicare. For more information on Medicare’s ABN form, visit http://www.cms.hhs.gov/BNI/02_ABN.asp. Claims for
Medicare patients should be submitted with the appropriate HCPCS modifier.

• GA modifier indicates that an ABN form has been signed.

• GZ modifier indicates that an ABN form has not been signed. (Item or service expected to be denied as not reasonable and necessary)

• GY modifier indicates that the service provided is not a covered Medicare benefit. The service is being reported to Medicare in order to receive a denial.

Using the appropriate modifier ensures that the patient will receive the correct information on her Explanation of Benefits (EOB). For example, when a service is reported with a GY modifier, the EOB will state that it is not covered and therefore is the patient’s responsibility.

Medicare covered Screening Services

Medicare Screening Services

Physicians are often confused about how to document and report preventive services provided to their Medicare patients. This document is designed to assist physicians in documenting, reporting and receiving reimbursement for these services.
Medicare does not cover comprehensive preventive visits (99381-99397). However, Medicare does cover certain screening services which are often performed during preventive visits such as:

• Screening pelvic exam
• Collection of screening Pap smear specimen
• Interpretation of the Pap smear test (reported by the laboratory)
• Screening hemoccult
• Screening mammography
• Screening bone mass measurement
• Initial preventive physical examination (Welcome to Medicare examination)
• Diabetes screening
• Cardiovascular blood test
• Tobacco use cessation counseling

The table at the end of this document provides an overview of Medicare screening services. The Centers for Medicare and Medicaid (CMS) have published several educational products that describe covered screening services available to Medicare patients.

Limitations for bone mass measurement

Limitations for bone mass measurement (BMM)

1. Tests not ordered by the physician/qualified non-physician practitioner, who is treating the individual, are not reasonable and necessary.
2. Oxford's reimbursement for an initial bone mass measurement may be allowed only once, regardless of sites studied (e.g., if the spine and hip are studied, CPT code 77080 should be billed only once).
3. It is not medically necessary to perform more than one type of BMM test in any individual, unless a DXA confirmatory test is performed as a baseline for future monitoring (see Indications #7 and #8).
4. It is not medically necessary to have both peripheral and axial BMM tests performed on the same day.
5. Oxford will not reimburse BMM tests performed by a second provider, when a test has already been performed within the defined coverage period, as stated above, unless as confirmatory testing for future monitoring. Individuals must authorize providers to obtain prior test results. If unsuccessful efforts to obtain prior test results from another provider are documented, new tests may be considered for reimbursement.
6. Single and dual photon absorptiometry, CPT code 78350 and 78351, are non-covered services.
7. Bone mass measurement is not covered and will be denied when performed by a portable x-ray supplier. Transportation charges for BMM testing will be denied
8. Bone mass measurement tests provided without an accompanying interpretation and report, as part of the test, will be denied as not medically necessary.
10. Bone mass measurement tests will be denied as not medically necessary if performed by a non-physician practitioner. 
12. CPT code 77082 is considered by Medicare to represent vertebral fracture assessment only. Because code 77082 does not represent a bone density study, it should NOT be billed for screening. This code may be billed when medically necessary (i.e. when a vertebral fracture assessment is required). Symptoms should be present and documented, and it should be anticipated that the results of the test will be used in the management of the patient.

E & M code billed with surgical code - Medicare guidelines

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The Centers for Medicare & Medicaid Services (CMS) guidelines for:

    * Same Day and
    * Follow Up Day edits.

Same Day edits may be edited in the Correct Code Editor or in a separate Same Day edit depending on the claims processing system.

The following codes will be denied when billed on the same date of service as a surgical code:

99211 99212 99213 99214 99215 99217 99218 99219 99220 99221 99222 99223 99231 99232 99233 99234 99235 99236 99238 99239 99241 99242 99243 99244 99245 99251 99252 99253 99254 99255 99291 99292 99304 99305 99306 99307 99308 99309 99310 99315 99316 99334 99335 99336 99337 99347 99348 99349 99350 99466 99467 99468 99469 99471 99472 99475 99476 99478 99479 99480

CPT code 20550 - Injection CPT

Injection Code 20550

  When I submit CPT code 20550, "Injections; tendon sheath, ligament" for different sites injected on the same date, should I attach modifier -51, "Multiple procedures," so that a multiple procedure rate reduction may apply to the second, third or any additional sites injected?


According to CPT, 20550 is not exempt from modifier -51. Likewise, the Medicare Fee Schedule database indicates that this code is subject to the standard payment adjustment rules for multiple procedures. To make it clear that injections were done at different sites, submit 20550 for the first site injected and 20550 with modifier -59 (to show that a different site was injected) and modifier -51 (to indicate multiple procedures were performed) for subsequent injection sites. Linking appropriate diagnosis codes to each instance of 20550 may also make it clear that the injections were done at different sites.


Editor's note: While this department attempts to provide accurate information and useful advice, third-party payers may not accept the coding and documentation recommended. You should refer to the current CPT and ICD-9 manuals and the "Documentation Guidelines for Evaluation and Management Services" for the most detailed and up-to-date information.

CMS Final Rule Announces a 21.2% Medicare Physician Payment Cut

CMS Final Rule Announces a 21.2% Medicare Physician Payment Cut for 2010 

Medicare’s final 2010 payment rule confirms that in 60 days physicians face steep cuts of 21.2% — the largest payment cut since Congress adopted the Medicare physician payment formula.

The difference is due to the use of the most recently available data on CMS spending for physicians’ services.


Medicare’s payment rule also includes refinements that will increase payment rates for primary care services.

Taking all changes in the final rule-with-comment period into account, the CMS projects that payments to general practitioners, family physicians, internists and geriatric specialists will increase by between 5% and 8%, prior to application of the negative update required by the SGR.

The final rule with comment will appear in the Nov. 25, 2009 Federal Register.  CMS will accept comments on designated provisions of the final rule with comment period until Dec. 29, 2009, and will respond to all comments at a later date.  Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after Jan. 1, 2010.

Jonathan Blum, Director of CMS, Center for Medicare Management, indicated the Administration tried to avert the pending fee schedule cut in the FY 2010 budget proposal that it submitted to Congress, and remains committed to repealing the SGR (Sustainable Growth Rate).


CMS is currently finalizing its proposal to remove physician-administered drugs from the definition of ‘physicians’ services’ for purposes of computing the physician fee schedule update. While this decision will not affect payments for services during CY 2010, the CMS projects it will have a positive effect on future payment updates.

While the CMS had proposed to use information about physician practice costs from the Physician Practice Information Survey (PPIS), the agency will now phase in the information during a 4-year period.

In addition, the CMS will continue to uses specialty supplemental survey data — not information from the PPIS — to determine practice expenses for medical oncology.

Other provisions in the rule make changes to the Physician Quality Reporting Initiative and the Electronic Prescribing Incentive Program. These changes include providing participants with more reporting options and implementing a new method for practices to be considered successful e-prescribers.

Claims Data for PHRs - Blue Button Initiative

In January 2010 the Centers for Medicaid & Medicare Services (CMS) and the Department of Veterans Affairs (VA) were invited to attend a meeting with the Markle Consumer Engagement Workgroup. Discussion at the face-to-face meeting focused on how best to provide consumers with electronic access to data and to incent market innovators to create health information technology solutions using the data, to expand its usefulness for individuals. The workgroup expressed a strong desire for CMS and VA as "data holders" to participate in follow up discussions on the breakthrough idea of a download button (i.e. a "blue button" in the portal) that would enable individuals to download their electronic health data. Subsequent discussions on the potential for a demonstration project included a request for the creation and public availability of sample data sets from CMS and VA as a way to 1) advance understanding of the available data and 2) to begin to enable the identification and development of applications using the data to support consumer engagement.

Currently, Medicare beneficiaries can access their claims data on MyMedicare.gov, and can add personal information into that site as well. They can then create and print a report called the "On-the-Go report" to share with their caregivers and providers. At this time, beneficiaries cannot download their own data into their own computers. CMS is interested in enabling beneficiaries to use their data with other health management tools, and may be conducting a project called "the BlueButton" through which beneficiaries can test their computer's ability to download their claims information in a simple file format, which can then be uploaded into a unique Personal Health Record application of their choice.
Today Veterans can create and maintain a web-based Personal Health Record (PHR) with VA's My HealtheVet. My HealtheVet is intended to improve the delivery of health care services to Veterans, to promote health and wellness, and to engage Veterans as more active participants in their health care. The My HealtheVet portal enables Veterans to create and maintain a web-based PHR that provides access to patient health education information and resources, a comprehensive personal health journal, and electronic services such as online VA prescription refill requests and secure messaging.  Veterans can visit the My HealtheVet website and self-register to create an account, although registration is not required to view the professionally-sponsored health education resources, including topics of special interest to the Veteran population. Once registered, Veterans can create a customized PHR that is accessible from any computer with Internet access.

On May 10, 2010, CMS and VA co-hosted a web-based meeting on increasing consumer access to data through the use of Personal Health Record (PHR) applications. CMS and VA are working together because of our mutual interest in improving services to constituents, including PHR-related services. This meeting was intended as a dialogue and exchange of ideas to foster innovation, not just for CMS and VA beneficiaries, but also as an exercise for the PHR industry to gain experience in using data from external entities. We hope this meeting will support industry innovation and enable industry stakeholders to provide feedback for future initiatives to better serve citizens. Interested parties learned about the sample data sets available to test PHR functionality and related health information technology applications and services.  To access the sample data files, go to the Related Links Inside CMS section below.  This is part of the government's ongoing efforts to support ehealth initiatives and open government principles.

AARP Medicare Rx Plan Enrollment Information

AARP Medicare Rx Plan Enrollment Information

Open enrollment is between November 15th and December 31st of each year.
You will need to compare plans to see which will meet your individual needs. If you are currently an AARP Medicare Plan beneficiary, your membership will be renewed automatically; however, you may use the open enrollment period to make any needed changes to your plan.


How Do I Prepare for Enrollment?

First, you need to check to see if you qualify for financial assistance. Based on your income and resources, you may be eligible for assistance to help offset or completely pay additional out-of pocket expenses (costs not covered by your insurance plan). Pre-planning is important, and it may take up to eight weeks for financial assistance to be processed and approved. Don't delay. You don't want to miss the enrollment period (Nov 15 - Dec 31).

Next, you will need to gather all your information on health care or drug coverage you may have. You will also need to make a complete list of the names, dosage, and refill information for any prescription drugs you currently take. This information will help you to compare plans and make the best choice.

The final step is to compare several Medicare Part D Plans in your area. There are several things you should consider in order to accurately compare plans. You will need to find out what the monthly premiums are, and if there is a deductible. Also, ask the following questions: What is the company's reputation? What drugs are covered? Is there a co-pay amount?

Once you have completed these steps, it is time to select the option that will provide you with the coverage you require, and enroll in the plan you have chosen. With the costs of prescription drugs on the rise, this program can help you get the medications you need when you need them.