# Medicare Denial Management & IPA Billing Guidelines
> Learn to manage Medicare claim denials, understand coding compliance, and resolve IPA/Medical Group billing errors for accurate reimbursement.

Tags: medicare, denial-management, revenue-cycle-management, medical-billing, ipa-billing, healthcare-compliance, rcm
## Medicare Overview & RCM Strategy
- **Target Population**: Focuses on individuals 65+, disabled individuals, and ESRD patients.
- **Core Components**: Breaks down Medicare Parts A (Hospital), B (Medical), C (Advantage), and D (Drugs).

## RCM Importance in Medicare
- **Eligibility Verification**: Reducing front-end errors by confirming coverage.
- **Coding Compliance**: Utilizing ICD-10 and procedure codes accurately.
- **Regulatory Standards**: Adhering to National (NCD) and Local Coverage Determinations (LCD).

## Denial Management: IPA/Medical Group Billing
- **Scenario**: Claims incorrectly billed to health plans instead of delegated IPAs.
- **Root Cause**: Capitation agreements and incorrect routing where the insurance payer denies liability.
- **Key Codes**: 
  - **CARC 24**: Charges covered under capitation.
  - **CARC 96**: Non-covered charge.
  - **RARC N95**: Requirement to bill the IPA/Medical Group.

## Resolution & Prevention
- **Action Steps**: Check eligibility responses for IPA info, verify contracts, and re-bill to the correct Payer ID.
- **Final Takeaway**: Always identify the delegated authority (Risk/Capitation) before submission to prevent recurring denials.
---
This presentation was created with [Bobr AI](https://bobr.ai) — an AI presentation generator.