Wiki Help with a denial

I work in a primary care office and one of my doctors is an Infectious Disease specialist who sees patients at our hospital for consults. The last couple of weeks we have been getting denial code B20 (Payment adjusted because procedure/service was partially or fully furnished by another provider.) from our Medicare claims for procedure code 99232.

I have called NHIC to get clarification on the denial, but have gotten no resolution other that i was told to contact the billing department at the hospital. I called the hospital's billing department, but they are a couple of weeks behind on submitting claims.

Has anyone dealt with thie denial?

Should I be using a modifier on there denials, and if so which one?

thanks

Medicare is denying the claim? If needed it's modifier 25

I am also getting this denial for an office visit. The patient was seen by a specialist in the same physcian group but has a different specialty and used completely different diagnosis.

I disagree with the -25 modifier as that is for E/M only and not hospital care.

I look at this as just something else to use to delay payment.

i've seen this.

when I get this denial it's because 2 providers with our tax ID (we're a multispecialty practice) have seen the patient in the hospital on the same day. Or the patient requested a second opinion and now Medicare has claims from 2 untrelated providers with the same specialty on the same day. Usually we get paid on appeal for the 1st issue, and for the 2nd issue the first provider to bill gets paid and the second is SOL. Sorry

Despite multiple appeals, we are experiencing ongoing denials for the same reason: critical care billing using CPT code 99291. Medicare representatives have been unhelpful, often advising us to simply continue appealing without providing meaningful guidance. In one instance, a representative mentioned that one of our diagnosis codes (pointer 4) was primary on a claim submitted by another specialist, which we resolved by removing the code and rebilling. However, this type of information is not consistently disclosed, making it difficult to identify similar issues proactively.

This is a significant problem because if Medicare is implementing these practices, other insurances like Oscar are likely to follow suit. We need a clear strategy for addressing these denials and navigating future claims to prevent further complications.