Guidance on Invoices

Palmetto GBA uses invoices to determine payment amounts for some contractor priced codes. Providers should be aware of what is expected on invoices to avoid unnecessary claim rejections or denials.

An invoice is a document issued by a seller to a buyer. It outlines the products being provided, the quantity of the products, and the agreed upon prices for the products. Invoices are clearly marked as an invoice. Invoices are issued by the entity from which the product was purchased by the provider. Packing lists and bills of lading will not be accepted as invoices.
  
Invoices at a minimum should identify:

• The seller
• The buyer
• The date of the sale
• An itemized list of goods or services
• The prices for the goods or services
• The quantity of the goods or services
• The total amount due
• Payment terms

Discounts, rebates and/or additional pricing adjustments should be clearly indicated on the invoice when they exist. Please review CMS Medicare Fraud & Abuse: Prevent, Detect, Report (PDF).

Handwriting or marked out items/elements on invoices may result in the invoice being rejected.

Note: It is critical that the items on the invoice can be matched to what is being billed on the claim. Invoices will be rejected if we cannot confirm the invoice submitted is for the item(s) that appear on the claim. It is also important to note that some codes may have additional requirements due to the nature of the product. Separate guidance will be provided for those situations.

Please see our Submitting Additional Documentation (Jurisdiction J Part B) article or the Electronic Claims and Additional Documentation (Jurisdiction M Part B) article for more information on how to submit invoices with your claim.