Medicare Compliance & Reimbursement - 2011 Issue 5
Part B Mythbuster: These 7 Deadly Myths Could Damage Your Practice
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Article Overview
This article reviews seven widespread myths related to Part B billing, reimbursement, and compliance in physician practices. It focuses on general billing policy, collection efforts, diagnosis reporting, E/M coding, Medicaid participation, Medicare managed care, and secondary coverage considerations. The piece is aimed at coders, billers, compliance staff, and practice managers who want to understand common risk areas and policy misunderstandings.
Why This Topic Matters
Misunderstanding these topics can lead to billing inconsistency, compliance exposure, claim denials, and avoidable payer or program problems for a practice.
Article Sections
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Myth 1: You have to bill everyone the same amount
Discusses pricing consistency, payer fee schedules, and the need for written billing policies.
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Myth 2: Before you write something off, you have to send three bills
Covers collection efforts, waiver concerns, contractual obligations, and financial hardship considerations.
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Myth 3: You can only bill one diagnosis code per claim
Addresses diagnosis reporting, medical necessity documentation, and the transition to ICD-10-era diagnosis coding.
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Myth 4: E/M codes are assigned solely by the level of medical decision-making (MDM)
Explains that E/M selection involves multiple components and broader visit-level considerations.
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Myth 5: If you're a Medicaid provider, you have to accept all Medicaid patients
Reviews state-level Medicaid participation flexibility and guidance on where to confirm local rules.
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Myth 6: Medicare HMOs have to follow the same rules as Medicare
Compares general Medicare coverage expectations with managed care plan requirements and additional plan rules.
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Myth 7: Secondary insurance always pays what Medicare doesn't
Describes coordination of benefits issues involving secondary and supplemental coverage.
What You Will Learn
- Common compliance myths that affect Part B billing practices
- How collection and write-off misconceptions can create risk
- Why diagnosis reporting and E/M selection are often misunderstood
- How Medicaid and Medicare managed care rules may differ from standard Medicare
- How secondary and supplemental coverage can affect payment expectations
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Physician practice managers
- Revenue cycle staff
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