In order to properly code a bill for medical necessity, it is important to understand different plans and the requirements for billing each. It is true that they all use the ICD-10-CM diagnosis coding system, the CPT procedure coding system, and the CMS-1500 form, but each type of carrier has certain requirements for a clean bill.
Tasks:
Create a billing manual constructed of summaries of each type of insurance.
Include the major requirements for billing for each type.
Note inpatient or outpatient differences where appropriate.
Explain how to determine from the patient which type they subscribe to.
Sample Solution
Introduction
Billing insurance can be a complex and confusing process for both providers and patients. This billing manual is designed to provide healthcare providers with summaries of the most common types of health insurance, in order to better understand the different forms of coverage and reimbursement processes that are associated with each one. By familiarizing themselves with these summaries, providers can help ensure they are accurately processing patient claims and receiving timely payments.