In medical billing and coding, we must know how to choose the appropriate CPT, ICD-10-CM, HCPCS, and modifiers based on the documentation for services and procedures. This is then what is submitted to insurance carriers for payment consideration. But if it was only that easy. Medical necessity is increasingly important and is being proven in medical claims. The most effective way of doing that is to know the policies of the insurance carriers your patients are covered by, and keep updated on changes to those policies. Changes to these policies cannot only happen when there are coding changes, but any time the insurance company reviews and updates current policies, or creates new policies. This can be a full-time job in itself, keeping up with the changes and understanding how to decide who in your office needs to be aware of the changes. This webinar will take a look at how insurance carriers and Medicare share policies and their changes. We will take a close look at Medicare’s NCD, LCD, NCCI, and Relative Value File to gain an understanding of everything that is offered in this information because many commercial insurance carriers also follow these policies. We will also look at the websites of the major insurance carriers and where to find coding and reimbursement policies relative to the specialty or specialties in the medical office. After we find the policies, we will discuss tips on how to stay updated and efficiently apply new and updated policies in the office setting for compliance and timely reimbursement, with fewer denials.
- Where can we find the many policies for Medicare?
- Which Medicare policies do commercial insurance carriers adopt themselves?
- When to apply an NCD or LCD?
- Understand the 3 parts of the NCCI edits
- Know the information available in the Relative Value File (MFSDB)
- Apply NCCI to all medical billing and coding
- Locate commercial insurance carrier policies
- Efficiently update policies that affect your office
- Educate office staff and providers on new or changed policies
Areas Covered in the Session:
- Medicare NCD
- Medicare LCD
- Medicare NCCI edits
- Medicare Relative Value File (MFSDB)
- Commercial Insurance Carrier Policy Locations
- Applying a policy
- Medical Necessity
- Prior Authorization
- Medical office education
- Insurance carrier newsletters and notices
- Non-Physician providers
- Qualified Healthcare Professionals
- Surgery Schedulers
- Claims adjusters
- Physician Assistants
- Revenue Cycle Staff
- Practice Manager
- Insurance Claim Processors
- Reimbursement Specialist and Staff
- Non-Physician Practitioners
Lynn M. Anderanin, CPC, CPB, CPMA, CPC-I, CPPM, COSC is the Sr. Coding Educator for Healthcare Information Services, a revenue cycle management and consulting service in the Chicagoland area. Prior to relocating to Chicago, Lynn was the Billing Office Manager and surgical coder for Hand Surgery Associates, now Michigan Surgery Specialists in the Detroit Area. She has over 39 years of experience in all areas of the physician practice including Practice Administrator, Billing Manager, and Director of Operations. Her experience is primarily in the specialties of Orthopaedics, Rheumatology, and Hematology/Oncology. She has been a speaker for many conferences, including the AAPC National Conferences and Workshops, Community Colleges, Audio Conferences, Certification classes, and Webinars. Lynn became a CPC in 1993, a Certified Instructor in 2002, a Certified Orthopedic Surgery Coder in 2009, an examination in which she participated in creating. She passed the Certified Practice Manager exam in 2015, the Certified Medical Auditor exam in 2016, and the Certified Professional Biller exam in 2021. Lynn is the founder of the first local chapter of the AAPC in Chicago, which is now 25 years old, and a former member of the AAPC National Advisory Board as well as several other committees for the AAPC.