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How to Resolve Medical Billing Disputes with Non-Contracted Payers

As a medical billing professional, you may sometimes find yourself dealing with a dispute involving a non-contracted payer. Non-contracted payers are those with whom the provider does not have a contract [more…]

When to File an Appeal in Medical Billing

As a medical billing professional, it is good to know some general guidelines for when to file an appeal. After you submit a claim to the payer, you can expect a response within 60 days. Often, larger [more…]

How to Prepare for a Medical Billing Appeal

As a medical billing professional, there are a few things you should know before you begin an appeal. Preparing an appeal to correct an incorrectly processed claim is an art. You have to know enough about [more…]

What to Say during the Medical Billing Appeal Process

During the appeal process in medical billing, it’s important to know what to say to get your desired result. You want to keep to the facts. If a contract exists, refer to the language of the contract. [more…]

How to Start the Medical Billing Appeal Process

In most medical billing disputes, the most efficient first step in the appeals process is to make a phone call to the payer. Ask the representative whether the issue can be resolved; if not, seek direction [more…]

How to Compose a Medical Billing Appeal Letter

In medical billing, sometimes, a phone call just isn’t enough. You may need to compose an appeal letter. The issue may be complicated and easier to document in writing. For example: [more…]

How to Follow Up on a Medical Billing Appeal

As a medical billing professional, if the appealed claim does not bear fruit in the form of a check, you may need to make a follow up call to check on the status of the check. Just as when you compose [more…]

How to Exercise All Possible Medical Billing Appeals

In a perfect world, claims in medical billing always get paid on the first go-round. Because we do not live in a perfect world, you may need to max out your appeals. [more…]

Medical Coding and Billing: How to Avoid Accusations of Fraudulent Billing

When you are executing the bill-collector part of your medical billing job, avoiding the appearance of fraud will forestall any accusations for any reviewing authority. [more…]

Ethics Are Critical to the Billing and Coding Profession

As a medical biller or coder, you must consistently do the right thing at work, especially related to providers, payers, and patients. By virtue of your position, you are privy to sensitive information [more…]

Common Medical Billing and Coding Mistakes and How to Avoid Them

Providers, payers, and patients rely on medical billers and coders to do their jobs accurately and without mistakes. Luckily, that’s pretty easy to do once you’ve had the right training. It also helps [more…]

Tips from Billing and Coding Pros

You’ll find these tips helpful because they come from seasoned medical billing and coding professionals and will keep you sane when you’re knee-deep in coding. [more…]

What to Know About Physician Queries in Medical Billing

As a medical billing professional, if you find you still have money on the table or procedures that were under-coded, you may need to do a physician query. Why? Because if poor documentation is the cause [more…]

How toDouble-Check Your Documentation in Medical Billing

Just as carpenters “measure twice, cut once,” before you send out a claim in medical billing, you need to check and double check your documentation to increase your chances for success [more…]

How to Create a Clean Paper Claim in Medical Billing

Although paper claims can be a nightmare to keep clean in medical billing, they are necessary at times. When you have to submit a claim on paper, follow these guidelines: [more…]

How to Submit a Medical Bill to a Clearinghouse

When you’re ready to submit your claim as a medical billing professional, you upload it to the clearinghouse to be sent to the payer. What, exactly, happens once your claim reaches the clearinghouse? Read [more…]

Relative Value Units in Medical Billing

In medical billing, claims are submitted to generate reimbursement and that reimbursement depends on relative value units. There are several factors that affect the amount that will actually be reimbursed [more…]

Pay Attention to Contract Details in Medical Billing

As a medical billing professional, make sure that you know the contract details and relative value units for each payer, because the differences between payers can be huge. For example, depending upon [more…]

How to Reduce Your Time in Accounts Receivable in Medical Billing

In medical billing, the practice of following up claims after submission can reduce the number of days from submission to payment and thus, accounts receivable. Ideally, the claim should leave your hands [more…]

How to Recover from Medical Billing Claim Errors

In medical billing, claim errors result in either rejections or denials and overcoming these can be challenging. Reimbursement is a direct result of the provider’s tenacity in following up the claim submission [more…]

Medical Billing: What is an Explanation of Benefits?

After a claim processes in medical billing, payment follows. Each payment is accompanied by an explanation of benefits, or EOB. The EOB is sent to the patient and the provider to show how the claim processed [more…]

How to Coordinate Benefits in Medical Billing

As a medical billing professional, knowing your stuff will help with meshing the COB with the EOB. Your explanation of benefits (EOB) may address something known as [more…]

How to Prep Physicians to Transition to ICD-10 for Medical Billing

In medical billing, the ICD-10 transition wheel has many cogs and nothing is more important than prepping the physician who provides the documentation that gets the coding ball rolling. After all, you [more…]

Medical Billing: How to Appeal a Rejected Medicare Claim

The Centers for Medicare & Medicaid Services (CMS) has a defined process for appealing a rejected medical billing claim. This process is easy to follow and quite efficient. You can find all the necessary [more…]

Medical Billing: How to File a Qualified Independent Contractor (QIC) Reconsideration

If your request for Medicare redetermination doesn’t resolve your billing dispute, as a medical billing professional, you may have to initiate a Qualified Independent Contractor [more…]

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