The Three R’s of Medical Billing

If you’re seeing a lot of that other “R” word: rejection; in your medical billing claims – it might be a case of your medical billing claims not meeting the basic requirements for payment.

Traditionally, to code a consultation (99241-99255), the encounter had to meet three requirements:

*Request for opinion
*Rendering of services
*Report to the requesting source.

Medicare’s new guidelines requires that a physician make the require or other appropriate source for ordering services and procedures. A good way to make sure that there is no denial of the claim, is to have a written reason and request showing a logical progression of the services from the necessity and nature of the services rendered to the patient.

If you want to ensure that your medical billing claims pass the muster, you can include the other two “R’s” by showing the reason for the services being rendered; and also if there was a return visit by the patient. Once again documentation is king when you’re filing your medical billing claims and taking the time make sure your documenation is logical and detailed will better enable all carriers whether Medicare or Insurance to reimburse your medical billing claims.

The end result is that creating a paperwork trail that shows the medical necessity of every item on your medical billing claim from the start to finish of the claim will ensure that your medical billing claims receive reimbursements and not rejections.

View all Articles by: Melissa Clark, CCS-P