Results 1 to 4 of 4

General question for the billing experts

  1. #1
    Location
    Everett, WA
    Posts
    886
    Default General question for the billing experts
    Exam Training Packages
    KNOW YOUR PAYERS! CALL THE PAYER TO CHECK ON POLICIES!! This "commandment" has been re-iterated since I first started to learn this business. HOWEVER, we're also told for uniformity in billing to adhere to the gold standard of MCR. This does makes sense in so many ways.

    HERE'S THE QUESTION: We have 31 different payers. If I choose to grasp each one's payer policies', can I bill differently for each? In other words, if I know MCR will not pay for a certain code due to bundling edits, yet know another payer WILL pay and does not observe the bundling edits of MCR, am I safe to go ahead and bill accordingly? My supervisor is worried about uniformity of billing and is concerned that by billing for a procedure for one company and NOT doing so for another can create problems. I say that is why it important to know the payer policies, and therefore we can do this. Otherwise, go by MCR standard and follow the "safe" route. She's leery of this too, because she feels we will lose revenue.

    Hope I've provided enough detail. Bet this question has a very easy answer..

    ----Suzanne E. Byrum CPC

  2. Default
    Are you referring to Labs, there is some lab procedure that could not go unbundlled and should go in panel per Medicare guideliens also checked your LCD for payable DXs other than that in regards to other procedures just refer to your quarterly CCI edits in appending modifier 59.

  3. #3
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Quote Originally Posted by ollielooya View Post
    KNOW YOUR PAYERS! CALL THE PAYER TO CHECK ON POLICIES!! This "commandment" has been re-iterated since I first started to learn this business. HOWEVER, we're also told for uniformity in billing to adhere to the gold standard of MCR. This does makes sense in so many ways.

    HERE'S THE QUESTION: We have 31 different payers. If I choose to grasp each one's payer policies', can I bill differently for each? In other words, if I know MCR will not pay for a certain code due to bundling edits, yet know another payer WILL pay and does not observe the bundling edits of MCR, am I safe to go ahead and bill accordingly? My supervisor is worried about uniformity of billing and is concerned that by billing for a procedure for one company and NOT doing so for another can create problems. I say that is why it important to know the payer policies, and therefore we can do this. Otherwise, go by MCR standard and follow the "safe" route. She's leery of this too, because she feels we will lose revenue.

    Hope I've provided enough detail. Bet this question has a very easy answer..

    ----Suzanne E. Byrum CPC
    There is absolutely nothing wrong with following different payer policies.
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Smile Medical Biller
    I have run into some instances where commercials inurances tell me they follow Medicare Guidelines in terms of billing.So if your not communicating with the insurances companies in question,following Medicare should be fine

Similar Threads

  1. Question for the Experts?
    By Brandy0618 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 07-24-2013, 02:20 PM
  2. Correspondent looking for interviews w/billing experts
    By rko@industrycorrespondent.com in forum Orthopaedics
    Replies: 0
    Last Post: 01-04-2012, 12:07 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?

Login

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.