Results 1 to 2 of 2

Billing Workflow Model - by Payer or by Location

  1. Default Billing Workflow Model - by Payer or by Location
    Medical Coding Books
    Hi! I am just looking for a general poll (as well as failure or success stories) as to how insurance denials, appeals, correspondence, etc are worked in a multispecialty clinic setting. I am working on revamping our current work model, but am trying to get a general idea of what other coders/billers are doing and how well it's working

    From what I can see there are three options, if you decide to go with a centralized billing staff: Work by Payer (Medicare, BCBS, Medicaid, Etc), Work by Location (or specialty - work all payer mix for each location) or a Mixed Model (work Govt Payers by Payer, work all others by Specialty, varied mixes).

    I'm looking forward to hearing how you have seen these process work and what types of successes (or failures) you have had/seen based on the setup of the workflow.

    Thank you!

  2. #2
    Dover Seacoast New Hampshire
    for efficiency, arrange your centralized billing staff by payer. This way they learn the payer rules inside and out. We've done it both ways, and this way is more effective. You certainly can cross-train (I'd encourage it), but allowing your billers to develop an expertise in regards to payer-specific rules, guidelines, denial reasons, etc. is valuable.

    Our coders (also centralized, by the way) are arranged by specialty, and not by payer. This way they develop coding expertise in one (or more) medical specialties. I expect our coders to code first by the coding guidelines, and then by payer guidelines when necessary.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

Similar Threads

  1. Please Advise Selective Payer Billing
    By istanstu in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 12-20-2017, 06:29 PM
  2. Payer billing cycle madness
    By ollielooya in forum Billing/Reimbursement
    Replies: 0
    Last Post: 03-22-2013, 03:10 PM
  3. Audit workflow and policies
    By LLovett in forum Auditing General Discussion
    Replies: 2
    Last Post: 10-22-2010, 08:34 AM
  4. location billing
    By dalley in forum Billing/Reimbursement
    Replies: 2
    Last Post: 05-25-2010, 12:53 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.