Continuation Blog of PGBA's Top Denial Reason Codes

Pleae find below the most recent posting on PGBA's top denial reason codes

6. 5T099 -Billing Error

Reason for Denial
The service(s) billed (was/were) not covered because, according to the documentation in the medical record, the home health agency made a billing error. Therefore, no Medicare payment was made. The home health agency may not charge the beneficiary for service(s) that (was/were) billed in error.

How to Avoid a Denial
• Check all charges for accuracy/timeliness prior to submitting the final bill to Medicare.

• Check to ensure that all documentation submitted in response to the ADR corresponds to the service(s) rendered and the dates of service(s) billed.


For more information, refer to:
• CMS Manual System, Pub 100-04, Medicare Claims Processing Manual, Chapter 10, Sections 10.1.11 and 10.1.23
• CMS Manual System, Pub 100-04, Medicare Claims Processing Manual, Chapter 1, Section 60.1.1