Wiki General question for the billing experts

[ollielooya]

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

 

[jogarzusa73]

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.

 

[Lisa Bledsoe]

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.

 

[amny1212@yahoo.com]

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