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.


CPT® copyright 2019 American Medical Association. All rights reserved.

    • Related Articles

    • Review Statement Batch Items

      After creating a Statement Batch, it is recommended that you review the Statements before uploading the Statement Batch or before mailing if you are doing the Statements in-house. Once the Statements are uploaded/mailed, these options will no longer ...

    • Incomplete Charge Review Overview

      What are Incomplete Charges? These are Charges that have not been completed to send to the Payer. They are created by: Charges that have been sent from your Chart Documentation System; Charges that are Imported with the Import Tool; or Charges that ...

    • A/R Review and Troubleshooting

      If you are concerned about your A/R, or just want to learn more about the health of your practice, follow the steps below to take a deep dive into your A/R. Executive Summary The Executive Summary Report shows A/R broken down by month and split into ...

    • Anesthesia Billing Resources

      External Links: The Basics of Anesthesia Billing AAPC Medical Coding Books AANA Anesthesia Payment & Billing Information BCBS CMS (Medicare) Anesthesiologists Center Crosswalk and RVG from the American Society of Anesthesiologists Anesthesia & Pain ...

    • Real-Time Eligibility Responses/Errors

      These are responses that you may receive when doing an Eligibility Check. While some responses may indicate a Payer issue. Mostly, these indicate a problem with the Insured/Policy Holder Name, address, Policy Number, or Medicare Advantage Plans. ...