decisionhealth Newsletters, Part B News - 2010 Issue 1 (January)
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Article Overview
This article discusses a billing and documentation question about discontinued procedures and the type of supporting information some payers may request before processing a claim. It is aimed at coders, billers, and practice staff who handle Medicare and carrier claims, and it highlights payer documentation practices, claim form handling, and the need to support reduced-service reporting with appropriate records.
Why This Topic Matters
Understanding what general documentation a payer may expect can help practices avoid claim delays and respond appropriately when additional information is requested for a discontinued procedure.
Article Sections
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Question from a reader
Introduces the billing scenario and the concern about claim processing delays when a discontinued procedure is reported.
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Expert response
Summarizes the general types of supporting information that some payers may accept and notes that requirements can vary by payer.
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Example payer policy: National Government Services, Inc. (NGS)
Describes how one Medicare Administrative Contractor handles additional documentation requests and claim review for this situation.
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On the Internet
Provides a referenced website source for further payer information.
What You Will Learn
- How some payers handle claims involving discontinued procedures
- What kinds of supporting documentation may be requested
- How payer-specific requirements can affect claim processing
- Where to find a referenced payer information source
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Practice managers
- Healthcare compliance staff
Modifiers Discussed
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