Posted in Insurance, Payers and CPT reinbursement, Training

GHI and CPT code 94200

To avoid unnecessary delays in collecting the patient responsibility, it is a great idea for your staff to look for a pattern on how the given insurance company reimbursement policy and medical necessity policy apply to which CPT codes.

For example, according to GHI medical billing policy- CPT code 94200 is part of Diagnostic Testing and therefore a $20 copay applies to this code.

Letting the patient know what her/his financial responsibility for the visit is going to be, BEFORE the office visit will reduce confusion and help your office to reduce the number of uncollected revenue.

****Please note that if you are billing with code 94200 or 94060 the copay of $20 will be applied to that code instead.

Posted in Insurance

Practice/Patient Financial Responsibility Policy

Having a Practice/Patient Financial Responsibility Policy for your patients, increases your chances of collecting anything that is owned at the time of services rendered. It decreases the number of time and money spent by your practice on contacting/generating patient statements. Not to mention it builds a better relationship between your practice and your patients.

Posted in Insurance

ICD-10…more responsibility for providers?

So, I took a ICD-10 training course from AAPC, for professionals. I have to say that from a Medical Biller perspective I didn’t see a lot of drastic change. However, there was a lot more change for the providers/doctors.

Those of you who have been documenting extensively for your patients have nothing to worry about….Yes, it will take a while for the payers to start processing your claims correctly and get payment. But you will have a less change of a rejected or denied claim, based on the simple fact that your diagnosis did not correspond to the treatment codes and you have no supporting documentation to show for it.

ICD -10 are more focused and more detailed but they are also more descriptive and require the supporting documentation to accompany the diagnosis.

There is more pressure on the provider to make sure that the documentation is correct so that the coder could select and code the diagnosis properly.

Please do not be discauraged. There is plenty of help…Courses from AAPC or even Availity. Or maybe you prefer a mobile approach of having an app on your phone with the ICD-10 refences. Of course, lets not forget your EHR/EMR software which could be quiet useful.


So, cheer up and brace the new ICD-10 with open arms and ease!