Medicare Part B Billing: Master Medicare Coding and Billing With These Dos and Don’ts

Why This Topic Matters

Medicare Part B requirements and MAC guidance can affect claim accuracy, denial management, and compliance. This article helps readers understand the major operational areas they should review when updating coding workflows and staff training.

Article Sections

1. Do Check Code Books Often and Update Coding Resources Regularly

   Discusses the importance of keeping coding reference materials current and reviewing claim documentation before submission. The section focuses on general Medicare Part B workflow and annual updates.

2. Don’t Expect MAC Customer Service Reps to Choose Your Codes

   Explains the limits of MAC customer service support and emphasizes reliance on complete records and appropriate reference materials. It addresses who is responsible for coding decisions in the practice setting.

3. Don’t Delay on Appealing Denials

   Covers denial follow-up, appeal timing, and where practices can find MAC appeal procedures. The section highlights the importance of acting promptly when a claim denial occurs.

4. Do Identify Drugs You Inject/Infuse

   Reviews billing considerations for medications associated with injections or infusions. The section addresses general reporting expectations for drug-related claims.

5. Do Educate Staff on the Rules for Telehealth Devices

   Summarizes Medicare telehealth technology expectations and related billing considerations during the public health emergency. It also touches on audio-only telehealth and associated reporting conventions.

6. Don’t Confuse Split/Shared E/M Requirements

   Describes split/shared E/M billing updates for 2022 and the role of physician and nonphysician providers in shared visits. The section addresses reporting conventions for these visits in the Medicare setting.