Physicians Practice: Apply the Right Rules at the Right Time

When submitting medical claims, not only do you need to get the codes right but you have to apply the right rules. AAPC’s Director of Product Development Raemarie Jimenez, CPC, CPMA, CPPM, CPC-I, CANPC, CRHC, recently published an article in Physicians Practice that reviewed how the rules vary between code book guidelines, payer preferences, and Medicare limitations.

“One of the biggest mistakes a practice can make is applying Medicare rules to all payers. This can cause improper reimbursement,” she says. “There are some procedures Medicare does not cover that private payers will and vice versa.”