BC Advantage - 2010 Issue 3
Being Smart Billers
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Article Overview
This article discusses practical billing and coding workflow guidance for medical billers, with an emphasis on early verification, follow-up on unpaid or denied claims, and resolving missing information before problems grow. It is aimed at billers, coders, and reimbursement staff who work with claim submission, payer communication, and account follow-up in medical practice settings. The discussion uses general billing scenarios, workers’ compensation-related verification, and diagnostic coding context to illustrate why front-end review matters.
Why This Topic Matters
The article highlights process improvements that can reduce denials, speed reimbursement, and improve account resolution by verifying information early rather than handling problems after submission. It also underscores the importance of documentation, follow-up, and coordination with employers and payers when claims involve complicated circumstances.
What You Will Learn
- Why early verification is emphasized in billing workflows
- How follow-up on unpaid or denied accounts supports revenue cycle management
- Why documentation review matters when claims need additional context
- How payer and employer coordination can affect claim resolution
- General reasons claims may require additional investigation after submission
Who Should Read This
- Medical billers
- Medical coders
- Revenue cycle staff
- Emergency medicine billing staff
- Practice administrators
Codes Discussed
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