ED Coding & Reimbursement Alert - 2013 Issue 1
Revenue Booster: Are Your Overlooking These 5 Opportunities To Collect Reimbursement?
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Article Overview
This article is a practice-management and medical coding discussion aimed at helping physician offices identify areas where reimbursement may be leaking. It covers patient collection processes, timing of follow-up, undercoding concerns, modifier use in bundled or separately identifiable services, and billing considerations when an annual wellness visit overlaps with another evaluation. The piece is useful for billing staff, coders, auditors, and practice managers who want to understand broad reimbursement risks and related CMS/CPT guidance.
Why This Topic Matters
The article addresses common operational and coding issues that can delay or reduce payment in a medical practice. Understanding the topics it covers can help readers determine whether the full article is relevant to revenue integrity, coding compliance, and reimbursement workflow improvement.
Article Sections
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Not Collecting Coinsurance and Copays
Discusses patient financial responsibility collection before or at the time of service and the general impact on practice cash flow.
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Waiting Too Long to Collect
Covers follow-up timing for patient balances, statement cycles, and general collection workflow considerations.
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Consistently Undercoding
Addresses underreporting of services, compliance concerns, and the revenue impact of reporting lower-level services than documentation supports.
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Failing to Append Modifiers
Reviews modifier-related reimbursement issues in the context of bundled services and linked diagnosis coding, with reference to CPT and ICD-9-CM.
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Failing to Bill A Sick Visit With an AWV When Indicated
Covers annual wellness visit billing overlap, E/M service reporting, and documentation considerations related to separate service reporting.
What You Will Learn
- How common collection and follow-up practices can affect reimbursement flow
- Why underreporting services can create revenue loss and compliance risk
- How modifier use can affect payment for bundled services
- What broad documentation considerations matter when billing overlapping E/M and preventive visits
- Which general reimbursement opportunities practices may overlook
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Revenue cycle staff
- Physician office administrators
- Compliance staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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