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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…]

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…]

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