ED Coding & Reimbursement Alert - 2010 Issue 40
Reimbursement: 5 Tips Help You Keep the Money Flowing Into Your Practice
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Article Overview
This article discusses general reimbursement and practice revenue topics for physician offices and other medical practices. It focuses on Medicare-related payment changes, incident-to billing considerations for mid-level providers, cautious use of modifier 22, practice management software planning, collecting patient balances when out of network, and handling no-show fees under payer policy requirements. It is useful for coders, billers, office managers, and reimbursement staff who want a broad overview of cash-flow and compliance-related issues.
Why This Topic Matters
Changes in reimbursement policy and everyday billing processes can affect practice revenue, audit risk, and patient collections. The article helps readers identify common operational areas where practices may lose money or create avoidable billing problems.
Article Sections
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Take Incident-To Seriously
Discusses Medicare incident-to billing in the context of physician offices and mid-level providers, along with general participation and supervision considerations.
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Don't Ignore Modifier 22
Reviews cautious use of a CPT modifier in surgical billing and highlights the importance of limiting overuse while recognizing when it may be considered.
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Don't Invest in Practice Management Software Just Yet
Covers practice management software planning and the relationship between electronic health records and integrated billing workflows.
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If You Are Non-Par with the Patient's Insurer, Always Collect At Time of Service
Addresses patient collection policies for practices that do not participate with a payer, including communication of fees and payment expectations.
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Bill for No-Shows
Summarizes no-show charge policies, with attention to Medicare and non-Medicare billing consistency and patient-level collection requirements.
What You Will Learn
- How reimbursement changes can affect practice cash flow
- General considerations for incident-to billing in a physician office
- When a CPT modifier may be relevant in surgical reporting
- How EHR and practice management systems can affect billing operations
- How out-of-network practices may structure time-of-service collections
- How no-show policies intersect with Medicare and other payer requirements
Who Should Read This
- Physician practices
- Medical billers
- Certified professional coders
- Practice managers
- Reimbursement staff
Codes Discussed
Modifiers Discussed
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