Results 1 to 3 of 3


  1. #1
    Default Documentation/Coding/billing
    Medical Coding Books
    I am looking for clarification and supporting documentation in regards to coding and billing insurance companies for services that you know will not get paid. It is my understanding that coders should code the services provided, regardless of the insurance payor or if they are self pay. Is it considered to be undercoding to not code and submit the services provided? Can we pick and choose according the the payor what is billed and what is not? If Medicaid denies payment, due to content of service does that mean we as coders should not code it. Then I bill the same service to a BCBS and they pay it.

    Can someone please direct me.

    I was taught code what is documented, send it to the payor, if they deny payment for what ever reason, you address the denial. Is it OK not to bill the self pay patient for services that you know Medicaid will not pay?

  2. #2
    I'm going thru almost the same thing right now and am interested in the answer as well. What I have come up w/ is you can't really pick and choose who and what you bill. If/when you get audited, you'll have a lot to answer for. Not billing for things because they won't get paid for so "we" don't to have the write offs isn't ok to me but I'm interested in what others think.

  3. #3
    Coding/Billing is so different sometimes...just because we learn something for coding, it could be different with billing I hate that

    If you know something is "non covered" up front... prior to billing.. the patient should sign a waiver and self pay up front. for Medicare they have to use an ABN form... for privates like BCBS, they require a signed waiver by the patient that you can make up yourself... you always have to put on there what is non covered, why it is non covered, and how much it will be... the patient has the option of having the service or declining the service... if they sign the waiver, you don't necessarily have to bill the insurance. most physicians i believe file it as a courtesy, if they pay and the patient has already paid, the patient will get a check for the overpaid amount.
    some physicians ask that if the patient want to self pay up front, they can file the claim to the insurances themselves and ask for reimbursement directly back to them. sometimes, which i don't recommend... is the patient will sign a waiver, not pay up front, insurance is billed...and then either the insurance pays or the patient is billed after the fact.

    the key to all of this is having a signed waiver on file and that you know something is noncovered.
    for medicare, if you have a signed abn on file, there are certain modifiers that you have to bill the claim with notifying medicare that the abn is on file. once you receive the denial, you then bill the patient directly.

    the link to the abn is

    the modifiers for abn to medicare: GA, GZ, GY

    i'm not sure if medicaid has a specific waiver they use...i would contact them.

    hopefully this helps........

Similar Threads

  1. Billing Insurance without medical documentation
    By cwilson3333 in forum Billing/Reimbursement
    Replies: 10
    Last Post: 02-28-2013, 08:35 AM
  2. Radiation Oncology Coding, Billing, Documentation
    By Codersmile in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 02-18-2011, 08:43 AM
  3. Documentation for Billing Labs
    By 00052616 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 05-26-2009, 12:49 PM
  4. Documentation for billing under a provider?
    By actram110 in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 03-18-2009, 10:26 AM
  5. Billing without documentation
    By KLS515 in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 02-11-2008, 01:15 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.