What is Denial Reason Code CO 24 and CO 22? How to Resolve Them?

Did you know how often your claims were denied by Medicare with the following reasons? “CO24 – Charges are covered under a capitation agreement/Managed Care Plan” or “CO22 – This care may be covered by another payer per coordination of benefits. Root cause of this denial and how to eradicate this coverage related denials?

Medicare is an essential insurance program that ensures proper medical treatment for those at or above 65 years of age or any younger people with a special problem in desperate need of medical care.

The program typically is divided into three sub-parts:

1. Part A covers hospital insurance covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care.
2. Part B covers health care providers’ services and outpatient care; it also covers durable medical equipment, home health care, and some preventive services.
3. Part C covers the Medicare advantage plan

While this is a popular program in the US, sometimes Medicare is denied attributing the denial to-

“Denial Code CO 22 – The care may be covered by another payer per coordination of benefits, and hence the denial” and

“Denial Code CO 24 – The charges are covered under a capitation agreement or managed care plan”

What is Denial Reason Code CO 24 and CO 22? How to Resolve Them?

What is the CO 22 Denial Code?

In case the patient has more than 1 payer then COB (Coordination of Benefit) has the utmost responsibility to determine which payer is primary, secondary, and tertiary to ensure the payment isn’t done twice and the correct payer pays the correct amount. CO(Contractual Obligation) 22 denial code related denials happen when the secondary payment isn’t fulfilled without information from the first.

The most common reasons for such denials are:

1. Patient is insured by another program other than medicare
2. Patient’s COB itself is not up to the mark

How to resolve the CO 22 and prevent it from coming up in the future?

To resolve the denial issue follow the steps below:

1. Understand from the patient to verify whether Medicare is primary or secondary insurance
2. Keep all the insurance information on the files up to date once the verification is complete
3. Contact the patient or the COB itself to verify
4. If you find that the denial happened because Medicare was the secondary payer, you may choose to submit the claim to the primary payer, to address revenue loss if any.

However, you can prevent the CO 22 denial if you exercise the following caution:

1. Understand if the patient even eligible for Medicare
2. Verify with the patient if Medicare is primary or secondary
3. Alert the front desk to inform the patient in advance to make the payment for the service

What is “CO 24”?

If the patient is already covered under the Medicare Advantage Plan (Medicare Part C) but instead the claims are submitted to the insurance, then the claims are denied as CO24.

How to resolve CO 24 and prevent it from coming up in the future?

Fortunately, you can work around a denial to find a favorable solution

1. Query the Medicare department to get the detailed information including the Medicare ID
2. Call the insurance company to check on the patient’s eligibility and if the patient is covered under the Medicare care plan
3. Submit the claims to that correct beneficiary

You can take the following steps to prevent CO 24 denials:

1. Before delivering the service, check if the patient has the coverage under the care plan
2. Get detailed information like the member ID from the patient or the Medicare
3. Claims can then be submitted to the correct beneficiary managing the care plan

Professional medical billing services firms have the desired knowledge and resources to help you navigate through claim submissions and re-submissions in case of denials.

Atlantic RCM is one of the leading multi-specialty medical billing companies in USA that serves 25+ major medical billing specialties. Our experts work across your practice in billing, collections and account receivables management, to help you succeed.

Get in touch with the leading medical billing outsourcing company to learn more. Call us at (469) 501-1500 or write to us Info@atlanticrcm.com