Biller and Coder Review Questions

Biller and Coder Review Questions

The following are questions that a biller or coder may consider as part of the review of the Incomplete Charges:

  • Is the correct appointment linked?

  • Is the Insurance correct?

  • Is a Case needed? (For example: Worker's Compensation or a visit countdown for an Authorization)

  • Is a Worker's Compensation accident date needed?

  • Should there be an authorization? If so, is the correct one attached?

  • Is the facility correct?

  • Is the provider correct - billing/rendering?

  • Does this Insurance require a referring provider?

  • Do the Diagnosis Codes support the CPT®? 

  • Are the CPT codes correct?

  • Are the Modifiers correct?

  • Are the correct Diagnosis Codes linked to the correct CPT codes?

  • Are the units correct?

  • Are the Procedure line items In the correct order (line 1,2,3 etc)?

  • If this is an injectable, does it have the NDC number?

  • If you see a Copay popup window, should you post it to this Encounter? Most of the time, you should click the receipt link to apply the copay. However, there are instances where there is more than one Encounter per visit and you must determine to which encounter the copay belongs.


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