ED Coding & Reimbursement Alert - 2015 Issue 8
Revenue Boosting Quiz Answers: Are You Collecting Every Billable Dollar? Check Your Quiz Answers Here
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Article Overview
This article reviews several billing and coding scenarios that can affect reimbursement under Medicare and other payer policies. It is aimed at coders, billers, and revenue cycle staff who want to identify missed-charge opportunities, reduce write-offs, and better understand modifier use, denial follow-up, no-show fees, and screening-related claim handling. The discussion is framed as quiz answers with examples of general claim situations and the types of documentation or billing issues involved.
Why This Topic Matters
The article focuses on everyday billing situations where small underpayments or missed charges can add up over time. It is useful for organizations looking to improve charge capture, support denials work, and understand when claims may need special modifiers or policy-based handling.
Article Sections
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Introductory tip
A brief opening note introduces the overall theme of capturing billable services that might otherwise be written off.
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Answer 1: Unrelated post-surgical E/M visits
Discusses postoperative evaluation and management scenarios in which the visit is not related to the prior surgery and a modifier may be relevant.
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Answer 2: Low-dollar denials and appeals
Covers the importance of reviewing small denied charges, identifying patterns of write-offs, and considering appeal follow-up when appropriate documentation exists.
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Answer 3: No-show fees and patient policies
Explains general considerations for charging patients for missed appointments and the need for consistent office policy application.
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Answer 4: Screening that becomes diagnostic during colonoscopy
Addresses a colorectal screening encounter that changes during the procedure and the associated distinction between screening and diagnostic billing pathways.
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Answer 5: Pap test coverage and ABN use
Reviews a Medicare coverage scenario involving Pap testing, beneficiary liability notice handling, and claim submission considerations.
What You Will Learn
- How common billing oversights can affect revenue recovery
- How postoperative claim handling may differ when services are unrelated to surgery
- How appeal review can identify cumulative value in low-dollar denials
- How office policies can support billing for missed appointments
- How a screening procedure may become diagnostic during the encounter
- How patient liability notices relate to certain Medicare-covered preventive services
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Practice managers
- Compliance staff
- Healthcare administrators
Codes Discussed
Modifiers Discussed
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