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Bulletproof Your Medical Billing Claims

Bulletproof Your Medical Billing Claims

Documentation is the Kevlar jacket for the medical billing industry. When you’re compiling your medical billing claim make sure that your documentation is detailed and exact in nature. Never submit a medical billing claim without documentation as it will only deny or delay your reimbursement on your claim.

A good example is if a patient presents in an ED twice in one day. Generally most carriers will deny a medical billing claim showing duplicate visits. However if medical documentation shows the necessity of those visits were for two different services such as a critical care code (99291-99292) or reports prolonged care (99354-99355) in addition to the E/M code, the carrier may take a second look instead of denying the claim.

In the end, the reimbursement will be higher than for one E/M service, but it will be hard-won money. In some cases, you may simply be better off combining the visits, even if they are for unrelated problems. If your patient has had more than one E/M service on the same day – you will want to bundle the codes that address the same problem.

The bottom line is if you choose to make two visits into one, don’t automatically raise the level of the combined visit to a level 5 or the carrier will most likely downcode your medical billing claim. Instead file your medical billing claim and get as detailed as you can with your documentation and your claims will be bulletproof.

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