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Pros and Cons of Online Training Programs for Medical Coding and Billing
You can prepare for a career in medical coding and billing through an online program. If you’re self-motivated or if you’re already working in the medical field, online training may be just what you need [more…]
How to Use Medical Billing Modifiers for Government Payers
In medical billing, modifiers may be necessary when you encounter claims with Medicare and other government payers. Knowing what to do in each instance can be a huge time saver. [more…]
When to Use Retired Modifiers in Medical Billing
Because certain payers use older claims processing systems in medical billing, you may encounter retired modifiers. Many of the Medicaid payers and some of the smaller Workers’ Compensation payers still [more…]
How to Avoid Under-Coding in Medical Billing
In medical billing, it is your responsibility as a biller/coder to abstract all billable codes from the medical record. Failing to identify billable codes [more…]
How to Override Published Edits in Medical Billing
As the coder for medical billing, you can override — or bypass — a published edit in the software, if you know how. The most obvious way to bypass a published edit is to assign a modifier to a code. This [more…]
How to Complete the Initial Paperwork for Medical Billing
As a biller and coder, completing the initial paperwork is the first step in the medical billing scenario. When you walk into the office of any healthcare provider, be it a family physician, a testing [more…]
How to Enter the Codes into Billing Software for Medical Billing
As a medical billing professional, you have to enter the codes into the billing software after you have the patient information and the provider documentation of the patient encounter. You now have the [more…]
Medical Billing: How to Decipher Standard Contracts
In the world of medical billing, many payers or networks have standardized contracts that they offer to healthcare providers. It is important that you understand and can decipher these contracts. A well-defined [more…]
How to Deal with Prior Authorization in Medical Billing
As a medical billing professional, dealing with prior authorization is a necessary part of the job. Prior authorization (also known as preauthorization [more…]
How to Track Your Claim from Submission to Payment in Medical Billing
As a medical billing professional, your claim will take a (potentially arduous) journey on the path from submission to payment. The claims process begins when you enter the CPT and ICD-9 codes into the [more…]
What is the Function of the Clearinghouse in Medical Billing?
In medical billing, companies that function as intermediaries who forward claims information from healthcare providers to insurance payers are known as [more…]
How to Get Prompt Processing of Your Medical Billing Claims
When processing claims in medical billing, the payer enters the claim into its processing software. What happens next depends on the claim. Claims that are compliant with the provider contract and patient’s [more…]
How to Negotiate for Full Payment of Your Medical Billing
In medical billing, there are two scenarios once the claim has been processed, receiving payment or negotiation. If the provider and payer have a valid contract on the date the service was rendered, the [more…]
What You Need to Know about Billing Workers’ Comp for Medical Expenses
As a medical billing professional, it’s important to understand that each state has its own guidelines for Workers’ Compensation claim payments. In states that have Workers’ Compensation fee schedules, [more…]
How to File a Medical Billing Appeal with the Payer
In medical billing, you will need to file an appeal if something goes haywire during the claims process and your provider doesn’t get paid or receive the amount contracted. Another point you may have to [more…]
How to Assign CPT Codes and Fee Schedules in Medical Billing
To get your provider paid in medical billing, you’ve got to start somewhere. Look no further than the CPT (procedure) codes and associated fee schedules you submit on each claim. The more accurately you [more…]
Rules Governing Codes to Use in Medical Billing
There are a few things you will need to know about the rules for using codes in medical billing. When you’re coding, you just look at the fee schedule, find the CPT codes you need, and include them all [more…]
How to Link CPT Codes to ICD-9 Codes in Medical Billing
Medical necessity is essential when it comes to procedure codes in medical billing. Every CPT code must be supported by a corresponding ICD-9 diagnosis code that supports medical necessity for the procedure [more…]
How to Make Codes as Specific as Possible in Medical Billing
In addition to choosing the right code in medical billing, you also need to ensure that the assigned code is specific to the procedure. Just as you rely on the physician to be as specific as possible in [more…]
To Bundle or Not to Bundle in Medical Billing
In medical billing, you can link some services together under one code, also known as bundling. This is helpful because a physician may have performed one service as the result of doing another. Other [more…]
How to Use Modifiers Correctly in Medical Billing
As a medical billing professional, you use modifiers to alter the description of a service or supply that has been provided. You can use modifiers in circumstances such as the following: [more…]
How to Use Modifiers for Commercial Payers in Medical Billing
To apply more specific payments to procedures in medical billing, many commercial payers require modifiers. Keep in mind, though, that how the modifiers are used differs from payer to payer. [more…]
How to Resolve Medical Billing Disputes with Contract Payers
In medical billing, most, if not all, disputes arise when the provider, your employer, is underpaid, and these disputes must be dealt with. Ideally, payer contracts clearly define a firm payment structure [more…]
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…]
