Outpatient Facility Coding Alert - 2012 Issue 27
Reimbursement: 3 Outdated Billing Habits You Must Overcome Now
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Article Overview
This article explains common reimbursement pitfalls that arise when older billing workflows are still being used after policy and format changes. It is aimed at coding, billing, and revenue cycle staff who need to recognize where Medicare and other payer processes have shifted and update their internal procedures accordingly. The discussion centers on claim submission practices, patient notice forms, and electronic transaction standards.
Why This Topic Matters
Outdated billing habits can trigger denials, rejections, and delayed reimbursement, especially when practices continue using processes that no longer match current payer requirements. Understanding the affected workflows helps organizations reduce avoidable claim problems and keep billing operations aligned with current standards.
Article Sections
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Still Reporting Consults to Part B
Discusses a legacy reimbursement practice involving consultation reporting and how payer policy changes affected claim submission workflows. The section focuses on the billing context, affected specialties, and the need to review internal charge capture processes.
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Still Using An NEMB Form
Covers changes in patient liability notification forms and the transition from older Medicare-specific notice processes to a revised form. The section addresses administrative compliance considerations for notifying patients about non-covered services.
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Not Yet Using 5010
Reviews the move to newer electronic transaction standards and the operational impact of submitting claims in an older format. The section references Medicare FFS claim submission and related standards enforcement.
What You Will Learn
- Which outdated billing workflows are commonly associated with claim denials
- How Medicare policy changes can affect routine claim submission practices
- Why patient liability notification processes need periodic review
- What broader transaction-standard updates can affect electronic claims processing
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle teams
- Practice managers
- Compliance staff
Codes Discussed
Code Ranges Discussed
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