ED Coding & Reimbursement Alert - 2014 Issue 9
Billing: Check Your Billing Expertise With 3 FAQs
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Article Overview
This article covers common billing compliance and workflow questions faced by Part B practices. It focuses on evaluating outside billing vendors, organizing denial follow-up, and understanding how payer contracts and explanations of benefits affect patient billing and collections. The piece is aimed at billing staff, physicians, compliance personnel, and practice managers who want to assess whether their current processes are up to date.
Why This Topic Matters
Billing mistakes, weak denial management, and incomplete vendor oversight can lead to compliance risk, delayed reimbursement, and avoidable revenue loss. The article helps readers identify the broad areas where billing operations and payer-facing processes need review.
Article Sections
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Screen Your Third Party Billers
Discusses how practices can evaluate outside billing companies, including compliance, privacy, training, references, and specialty fit. It also covers office visits and documentation review as part of vendor assessment.
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Tackle Denials in a Timely Manner
Reviews ways to organize denial management, track frequent denial patterns, and structure follow-up responsibilities within a billing team. It also addresses appeal workflow and payer communication.
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Know Your Contracts
Explains general considerations related to insurance contracts, patient billing, and the role of payer determinations in collecting amounts due. It addresses how contract status affects billing workflow and patient responsibility.
What You Will Learn
- How to evaluate a third-party billing company at a broad operational level
- How denial tracking and appeal workflows can be organized
- How payer contracts and benefit determinations affect billing and collections
- What broad compliance and privacy areas should be reviewed in billing operations
Who Should Read This
- Part B practices
- Physicians
- Billing staff
- Practice managers
- Compliance personnel
Modifiers Discussed
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