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Thread: Coping question

  1. #1

    Default Coping question

    AAPC: Back to School
    I work for a Fam Prac Dr. I ended school in Mar of 2009, I took the test & got certified in Jun 2009. The dr. is bringing billing inhouse. My question/problem is this. The dr. consistantly expects me to know what the insurance will cover & won't cover for a patient. I dont know without a phone call. Or what code to use to get paid by the insurance. I don't know, I'm still learning this. I'll find out (that's what I tell her) but I cant give her the answer in the time she wants it, like now. I'm having problem coping with this, I feel so stupid like I dont know what I'm supposed to. She also argues with me about a code. She wont listen to why I had picked a certain code. Is there someway I can fastrack this learning? The insurance websites r confusing. Thanx

  2. #2
    Join Date
    Apr 2007
    North Carolina

    Thumbs up

    The insurance plans are getting better with providing guidelines on what they will or will not pay. But, with that being said...the websites can be hard to navigate. "Coding" and "billing" are similar yet they can be very different, at times. Just when you nailed down the concept of the "coding convention", the carrier creates edits and guidelines they may deviate from the very thing you learned. The answers you're looking for may depend on where you live. One state can vary on their guidelines for the very same code. There are some super, super coders on this forum. What you don't understand...post your questions here. Someone will know the answer.

    Keep your head up!

  3. #3


    It won't make you feel any better . . . but we have all been there at one time or another. Unfortunately, Insurance coverage varies by plan. So even if your practice only sees patients with BlueCross/BlueShield, coverage will still vary for each patient's plan and you are right in that you won't know without a phone call to the payer. Unfortunately, most patients don't know what their plan covers either.

    The only way I have found to help a doctor understand my reasoning behind my code choice is to show it to them in writing, with supporting documentation. Ultimately, though the responsibility for code choice is theirs as their name is on the claim.

    Keep a notebook to track the details involved for those times when you and the doctor don't agree on the code choice. If compliance becomes an issue, you will at least be able to show that you tried to educate the doctor.

    You don't EVER want to choose a code simply "to get paid by the insurance". If your doctor is pushing you to do that, you need to educate her on what constitutes Fraud and Abuse.

    Good luck.
    Marie West, CCS-P, CMSCS, CEMCS, CCP
    Certified in Coding and Compliance
    (Because what you don't know CAN hurt you!)

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