Common Medicare billing errors per EOBs

Medicare Benefits Message #96 Non-covered charge/s.  Prior to performing or billing a service, ensure that the service is covered under Medicare. Please refer to the Centers for Medicare & Medicaid Services Internet Only Manual, 100-02, Chapter 16.  

Medicare Benefits Message #18 Duplicate claim/service.  Please check claim status through the IVR to see if another claim was paid or is currently being processed. To prevent duplicate denials, allow us sufficient time to process a claim before submitting a second.

Medicare Benefits Message #46 Charges exceeds fee schedule/maximum allowable amount or contracted/registered fee arrangement.  Please check your Medicare Summary Notice for the additional remark codes as to why your claim has been adjusted.

Medicare Benefits Message #109 Claim not covered by this payer/contractor.  This denial indicates that the service is one that is processed or paid by another contractor. Examples of these types of services are: Durable Medical Equipment, hospice related services or Medicare Advantage. You must send the claim to the correct payer/contractor.

Medicare Benefits Message #B7 This provider was not covered by Medicare when you received this service.  This provider was not certified/eligible to be paid for this procedure/service on the date of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110) Service Payment Information REF), if present.

Medicare Benefits Message #183 The referring provider is not eligible to refer the service billed. Note: Refer to the 834 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.  This item or service is not covered when performed, referred or ordered by this provider.

Medicare Benefits Message #246 This non-payable code is for required reporting only.  This code is for information/reporting purposes only.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.