Health Information Management

Tip: Share payer policies among departments

APCs Insider, June 3, 2011

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Instead of playing the blame game when a payer returns a claim, try resolving problems by communicating.

Start by sharing information about payer policies among departments. Every payer has its own policies, so using Medicare as a one-size-fits-all template could result in underpayment from other payers. Also, consider modifiers. Most Medicare contractors process up to two modifiers, while commercial payers may process up to four. Are coders aware of various payer policies? Probably not, unless a billing staff member shares this information with them.

Similarly, modifier -50 (bilateral procedure) can cause confusion because some payers prefer modifier -50 to anatomic modifiers -LT and -RT, or vice versa. If coders don't know what a payer wants, they might not provide correct information to the billing staff. Coders need to know what payers wants on claims submitted to them.

Most coders don't see insurance information—if a biller doesn't transfer the correct information to the bill, the third-party payer won't pay.

The tip is adapted from “Coders and billers: It's time to start talking” in the June issue of Briefings on APCs.

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