Problem:

Part I: Avoid claims rejections

A payer may delay or deny payment because of inaccurate or missing information in a submitted claim. Many contracts require payment within a specified period of time, for example, 30 days from submission of a "clean claim."

Required:

How can healthcare service providers avoid claims rejections?

Part II: Ensure payment

The Medicare intermediary has returned a claim to a hospital because of an invalid diagnosis code (OCE-Outpatient Code Edit violation number one). This implies that the procedure performed is not supported by the diagnosis code.

Required:

What action can the provider take to ensure payment?

Provide thorough explanation of each part of the problem.