Outpatient Facility Coding Alert - 2012 Issue 16
Reader Question: Payer Contract Trumps ABN
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Article Overview
This short reader question and answer discusses the relationship between a contracted payer agreement, reimbursement expectations, and patient billing for a supply item. It is aimed at coders, billers, and practice staff who need a general understanding of how contract terms can affect payment handling and contract review. The article focuses on the business and compliance implications of payer agreements rather than coding mechanics or clinical documentation.
Why This Topic Matters
It helps practices recognize that contract terms can affect whether a charge can be shifted to the patient and why fee schedule review matters during contract renewal.
What You Will Learn
- How payer contracts can affect billing choices for covered supplies
- Why fee schedule review is important in contract management
- Why contract renewal may prompt discussion of reimbursement levels
- The general compliance and business considerations involved in contracted billing
Who Should Read This
- Medical coders
- Medical billers
- Practice managers
- Healthcare office staff
- Revenue cycle professionals
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