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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…]

Medical Billing: How to Request a Hearing with an Administrative Law Judge (ALJ)

In medical billing, you may find yourself faced with a difficult Medicare situation and need an ALJ hearing. If you have tried a request for redetermination and a QIC reconsideration and are still unsatisfied [more…]

Medical Billing: How to Appeal to the Medicare Appeals Council (MAC)

As a medical billing professional, you may find yourself facing a stalemate in the Medicare Appeals Process. The Medicare Appeals Council (MAC) is part of the Departmental Appeals Board of the Department [more…]

How to Appeal a Workers’ Comp Medical Billing Claim

In medical billing, appealing a workers’ comp claim can sometimes be tricky. Often an out-of-network payer is responsible for paying a Workers’ Compensation claim. Many states have legislation in place [more…]

Medical Coding and Billing: Who (or What) is WHO?

As a medical biller/coder, the information you communicate from the provider to the payer is submitted to the information gathering organization known as the World Health Organization [more…]

Types of ICD Codes Used in Medical Billing

As a medical billing professional, you will need to become familiar with the ICD coding system. The international classification of diseases (most commonly known as ICD) classifies any disease or health [more…]

Differences between ICD-9 and ICD-10 Medical Billing and Coding Systems

As a medical billing professional, it is essential that you understand the differences between ICD-9 and ICD-10. Repeat after me: ICD-9 is to ICD-10 as VCR is to DVR. In other words, ICD-9 is the old school [more…]

Medical Billing and Coding: Get Prepared for the Move from ICD-9 to ICD-10

As a medical billing professional, you will need to know about the move from ICD-9 to ICD-10. The ninth edition of the ICD classification is ICD-9, which the U.S. has used since 1979. But ICD-10 IS [more…]

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