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How to Protect Yourself in a Medical Coding Audit

For a medical coder, protection from an audit comes only one way. If the documentation is clear, an audit is no problem. In fact, documentation is the [more…]

How to Avoid the Silent PPO Pitfall in Medical Coding and Billing

Medical coders and billers can fall victim to unidentified payers, (Silent PPO’s), which get un-contracted discounts at the expense of the provider. Normally when contracting with a network, providers [more…]

How to Prepare an Out-of-Network Medical Billing Claim

When a patient is being seen out-of-network, the medical coder or biller must verify benefits before any costs are accrued by the provider. To insure that the provider and patient both understand their [more…]

How to Bill Worker’s Compensation for Medical Treatment

Medical coders and billers have another set of guidelines which impact their work, Workers Compensation. Workers’ Compensation carriers underwrite policies that employers carry to cover treatment for injuries [more…]

How to Work with Third Party Administrators as a Medical Coder/Biller

Sooner or later the medical coder and biller will have to deal with a third-party administrator while filing a claim. A third-party administrator (TPA) is an entity hired to handle the administration of [more…]

How to Verify the Patient Coverage so You Can Bill Properly for Medical Treatment

Perhaps it goes without saying, but to do the medical coding and billing of a claim well, you need to verify the patient’s plan and coverage for yourself. Why? You need to know not only the difference [more…]

Medicare LCDs and NCDs in Medical Coding and Billing

Medical coders and billers have two types of coverage determinations within Medicare, local and national. When a contractor or fiscal intermediary makes a ruling as to whether a service or item can be [more…]

How Advance Beneficiary Notices (ABNs) Used in Medicare Medical Coding and Billing

When the provider performs services or provides items that are not reimbursable and for which there is no Medicare coverage, the medical coder can bring the matter to the attention of the office management [more…]

How to Work with Medicare Contractors as a Medical Coding and Billing Specialist

When medical coders and billers think of Medicare, they probably think of the umbrella organization, the Centers for Medicare & Medicaid Services (CMS), but who they [more…]

Medical Coding and Billing: How to Verify Medicare Coverage

The medical coder and biller must know the specific coverage requirements for the various Medicare and Medicaid plans, which must follow federal guidelines. But each policy can have other specified requirements [more…]

How to Obtain Medical Referrals and Prior Authorizations for Medicare Billing

Since the provider’s medical coder and biller are responsible for securing the necessary referrals and authorizations in Medicare and Medicaid, payment will be delayed if procedures aren’t rigidly adhered [more…]

When Medical Referrals or Authorizations are Missing When You are Ready to Bill

As a medical coder or biller, what do you do if the necessary referral or authorization wasn’t secured before the fact? You play nice. Somebody has to do the paperwork for referrals or prior authorizations [more…]

Medical Coding and Billing: How to Deal with Patients Who Can’t Pay

As a medical coder or biller you’ll occasionally need to interface with patients. In these interactions, your diplomacy skills come in handy, especially when they can’t pay their bill to the provider. [more…]

Medical Coding and Billing: How to Deal with Patients on Insurance Payments

Patients with whom you interact with as a medical biller or coder may not fully understand how insurance works, so you may be called upon to explain some insurance basics. These situation often arises [more…]

Basic Body System Terms Used in Medical Coding/Billing

Each vocation has its own specific terms which are widely used and medical coders and billers are no exception. A body system is a group of organs that perform a specific task. For example, the nervous [more…]

The Difference between Illness and Disease in Medical Coding/Billing

As a medical biller or coder, you must know the difference between illness and disease. Just as you may be ill but not be suffering from a disease, you may be suffering from a disease but not feel ill. [more…]

Differences between Acute and Chronic Injury in Medical Coding/Billing

Many physician encounters are due to injury, and the difference between disease and injury can be blurred which can cause problems for medical coders and billers. A patient may suffer bruising due to disease [more…]

Prefixes Used in Medical Coding/Billing

Medical coders and billers use prefixes which are common in the medical field, knowing them is essential. A prefix refers to the beginning segment of the word. The prefix of the word often is the first [more…]

Suffixes Used in Medical Coding/Billing

The terms you encounter in the medical coding/billing world have to end somehow, and that happens with a suffix, which has a special meaning all its own. Knowing their meanings are essential to a medical [more…]

How to Know the Meaning of Medical Codes through Suffixes and Prefixes

After you become familiar with prefixes and suffixes as a medical coder or biller, you’ll be able to make sense of the word as a whole. When you take the parts and assemble them, you have a medical term [more…]

The Importance of Medical Necessity in Medical Coding/Billing

Procedures and the reasons for performing them are at the heart of medical necessity and it’s the medical coder and biller’s job to properly explain them in a claim by selecting the correct codes. Put [more…]

How to Collect Payments from Patients as a Medical Coding and Billing Associate

As a medical biller and coder you may be called upon to contact patients to collect payments due the provider. Yes, your most important job is to fully abstract all billable services and supporting medical [more…]

What are Evaluation and Management Medical Billing Codes

Evaluation and management (E&M) codes are the most commonly billed codes and the medical coder/biller will use them a lot. These are the codes for every office visit and encounter a physician has with [more…]

Hospital Level Codes Used in Medical Coding and Billing

Choosing hospital level codes to report hospital visits by a physician can be a challenge for even the most experienced coders. Over-coding these visits can be an invitation for unwanted attention from [more…]

Medical Inpatient, Outpatient and Observation Billing Codes

The medical coder has to define the patient’s relationship to the hospital, (inpatient, outpatient or under observation), while receiving treatment in the hospital to properly code a claim. [more…]


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