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If my CMS form is red, white and blue and I stand on my head will I get paid?

November 12, 2010

Michelle Campbell
Sage – Customer Support Technician

Doesn’t it seem every time you figure out how to get paid by the insurance company they realize it and change the specifics?

Do you ask yourself, “If I stand on my head and use a green pencil they will pay me?” I know I know that may be slightly exaggerated, but it does seem that way sometimes.

I hear from doctors and billers everyday who say they have always sent claims a certain way or nothing is different since last week when they sent their claims. Yet now they are denied. The old denial game! We joke about it, but it is not a joke anymore.

When I started billing 20 years ago the providers were driving a Mercedes-Benz and living in exclusive country clubs. Today they are driving KIA’s and live right next door to me!

Ok some still have very lucrative practices, but very few of the Family Practice doctors I know enjoy these luxuries. That means timely filing and payment is more important than ever and being denied is devastating and time consuming. Providers just cannot afford it.

Medical Billing
This is where Medical Billers become so important to the practice. Coding has become so specific and detailed that in order to stay ahead of the payment “game” billers must be extra diligent in their efforts to bill correctly the first time.

Here are some tips to help you produce clear and clean claims:

1. Read the insurance company websites. They provide a wealth of billing specifics, codes and general rules. They probably also provide manuals and specific block by block instructions.

2. Do not delay. Follow your claims daily and be aware of what is paid, accepted and also denied. Acting quickly on a denied claim is very important since Timely Filing is a huge problem for most offices. Many practices lose hundreds or even thousands due to delays and resubmissions.

3.) Now I know this is going to sound a bit “hokey,” but when in doubt ask your biller friends in other practices. Exchanging information with others in your field is an extremely important tool.

As a support person myself, I have used other billers and technicians for information that has proved extremely helpful to me.

What measures have you used to streamline payments? I would love to hear your recommendations.

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