ED Coding & Reimbursement Alert - 2015 Issue 5
Part B Revenue Booster: 5 Services You Shouldn't Offer for Free--And 3 That You Should
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Article Overview
This practice-management article reviews everyday office and outpatient scenarios that affect Part B revenue, compliance, and patient billing. It focuses on broad categories of services that may be billable, situations that must be offered without charge, and the documentation and payer-policy considerations that influence whether a claim can be submitted. It is relevant to physicians, coders, billers, and compliance staff who handle Medicare and other payer claims.
Why This Topic Matters
Understanding which encounters and supplies can be reported versus which are included in routine care can help practices avoid missed reimbursement and reduce compliance risk. The article also highlights where payer policy, documentation, and office procedures affect billing decisions.
Article Sections
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Collect for These Five
This section reviews five common practice scenarios that may affect billing and reimbursement, including payer collection issues, supplies, documentation-heavy services, and missed appointments. It also references Medicare, CPT, HCPCS, and compliance considerations.
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Make Sure You Offer These at No Charge
This section outlines several office activities that are generally treated as included in other services rather than separately billed. It discusses routine patient interactions, record review, and follow-up-related care in a general reimbursement context.
What You Will Learn
- Which everyday office situations may affect Part B reimbursement
- How payer policies and documentation can influence whether services are billed
- Which types of routine patient activities are generally treated as included care
- What compliance themes are associated with waiving patient cost-sharing or charging for missed visits
Who Should Read This
- Physician practices
- Medical coders
- Medical billers
- Compliance staff
- Practice managers
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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