ED Coding & Reimbursement Alert - 2016 Issue 3
Part B Revenue Booster: Boost This Year's Cash Flow with These Expert Pointers
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Article Overview
This article discusses general revenue-cycle and billing practices for medical offices, with emphasis on Medicare Part B and managed care operations. It focuses on why practices should review contract payments, verify patient eligibility, monitor prior authorization requirements, and manage denials and patient collections. The piece is aimed at billing staff, practice managers, and coding/reimbursement professionals who want broad guidance on reducing preventable revenue leakage.
Why This Topic Matters
It highlights common administrative and reimbursement issues that can affect cash flow in physician practices, especially when payer contracts, eligibility, authorizations, and denial follow-up are not monitored closely.
Article Sections
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Ensure You’re Getting Contracted Amounts
Discusses reviewing payer contract payments against expected fee schedules and checking credentialing across practice locations. It also addresses identifying discrepancies in reimbursement processes.
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Pre-Check Eligibility
Covers eligibility verification before visits, use of benefit information, and communicating financial expectations to patients. It also notes the need to stay aware of authorization requirements tied to payer programs.
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Don’t Let Denials Rise Too High
Focuses on monitoring first-pass denial rates, following up on denied claims, and using patient billing calls as an opportunity to resolve balances. It emphasizes general collection and workflow discipline.
What You Will Learn
- How practices can monitor payer reimbursements for consistency with contracted terms
- Why eligibility verification and financial policy communication matter for collections
- How prior authorization awareness can help reduce avoidable billing problems
- Why tracking denial trends is important for revenue-cycle performance
- How patient billing conversations can support collections efforts
Who Should Read This
- Medical billing professionals
- Practice managers
- Revenue cycle staff
- Physician office administrators
- Coding and reimbursement personnel
Codes Discussed
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