How to Work with Medicare Contractors as a Medical Coding and Billing Specialist - dummies

How to Work with Medicare Contractors as a Medical Coding and Billing Specialist

When medical coders and billers think of Medicare, they probably think of the umbrella organization, the Centers for Medicare & Medicaid Services (CMS), but who they should be thinking about are the local Medicare contractors or fiscal intermediaries, because these are the people providers deal directly with.

Submit your medical billing claims

You submit your claims to the local carrier, who processes them. Each carrier is required to follow Medicare processing guidelines, which help contractors provide the same Medicare level of service to all providers. Each Medicare contractor must do the following:

  • Accept electronic claim submissions

  • Maintain an interactive voice response (IVR) provider phone line

  • Follow the same timely filing requirements set by Medicare

  • Make payment according to Medicare fee schedules and timely payment rules

  • Operate the same way when it comes to the Health Insurance Portability and Accountability Act (HIPAA) communications and observe all HIPAA regulations

Regardless of which contractor you call, you can always expect the process to follow these steps:

  1. At the contract’s request, you supply the provider’s PTAN (provider transaction access number), the provider’s NPI (national provider identification number), and the last five digits of the TIN (tax identification number).

  2. You will be asked for the patient’s Medicare number, name, and date of birth before any privileged information will be shared.

  3. You may then make claim or member-specific inquiries.

By following the same protocols for every single phone call, the contractors allow Medicare to operate with more expedience and efficiency for the large number of claims that are submitted daily.

Regardless of which government program you’re dealing with, you work with a regional, or possibly a local, company. Each of these administrators has its own contact information (phone number, electronic payer identification number, and physical address).