Catching Medical Billing Denials Before They Happen

The biggest medical billing problem is getting denied payment for a claim. A service for which many patients are denied is counseling to quit smoking or the cessation of other tobacco product related use counseling.

Since this is a voluntary activity, many payers have a hard time reimbursing for this service. The patient either has no coverage for the counseling under their plan or is only allowed a certain amount of counseling sessions for the smoking cessation purpose. What happens if another physician has already done medical billing for these counseling sessions? Chances are, you would not get paid. In many cases you won’t find out until you have already done the counseling and submitted the medical billing. Medicare & Medicaid Services have come up with a medical billing solution to let you know how many sessions a patient has already used.

If you have a patient that wants counseling for stopping smoking but they aren’t on the up and up, and they have already seen another physician for this same service, you can access the CWF (Common Working File). This is a database that will tell the provider just how many visits that patient has already used towards the tobacco cessation-counseling limit. It will, in essence, tell you if your medical billing will be denied for a frequency of service limitation.

Use the CWF database and it will help your practice improve medical billing reimbursements. If you see that a patient has used up all counseling sessions, you may by all rights, deny them service. The Common Working File is a very functional system that is proving to be very helpful in simplifying medical billing.

View all Articles by: Melissa Clark, CCS-P