Question

A billing and coding specialist is reviewing a remittance advice from Medicare and notices that the amount paid for a procedure is less than the contracted amount. Which of the following is a potential reason for the reduced amount of payment?

The claim indicated an incorrect place of service.
The claim is missing demographic information.
The coordination of benefits was not updated.
The claim was for a work-related injury.

Answer 1

The claim was for a work-related injury.

Explanation: Workers' compensation is the primary payer for work-related injuries, so Medicare will pay secondary (or not at all), resulting in a reduced Medicare payment on the remittance advice.