AMA CPT® Assistant - 1992 Issue 3 (Fall)
How to Report Physician Services to Third Party Payors (Fall 1992)
Fall 1992 page 36-end Coding Tip How to Report Physician Services to Third Party Payors 1) Request to see the current insurance card(s) from each patient at each encounter. Make a copy of the card(s) for your file. 2) Identify the third party payor and select the appropriate claim form for that payor. 3) Fill out the patient identification reformation on the claim form according to the instructions provided by that payor. (Make sure all information being requested is provided: do not assume the payor has the reformation on file.) 4) >Include the appropriate billing identification numbers...
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Article Overview
This article explains general claim-submission workflow for physician services and highlights the importance of using current payor instructions, proper patient and billing information, timely reporting, and careful review of documentation. It also discusses broad coding considerations involving CPT, ICD-9-CM, and CPT modifiers, making it relevant to practices handling physician claims and administrative coding compliance.
Why This Topic Matters
It helps billing and coding staff understand the administrative steps and documentation checks needed before submitting physician claims, reducing avoidable claim problems and improving consistency with payor requirements.
What You Will Learn
- How physician services are generally prepared for submission to third-party payors.
- Why documentation review matters when assigning procedure and diagnosis codes.
- What kinds of administrative information should be checked on claims before submission.
- How payor communications and publications can affect billing workflows.
Who Should Read This
- Physician coders
- Medical billers
- Practice managers
- Revenue cycle staff
- Compliance staff
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