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California balance billing ban challenged in court
Comments
As a medical coding educator and consultant, I preform audits of submitted claims to third-party payors for medical offices and clinics who are looking to increase their reimbursement. The first item I ask for is a copy of the facilities superbill (also called an encounter form or charge ticket) and I have yet to see a superbill free of errors. The superbill is a very poor way to code an encounter especially since most facilites employ billers. If the facility employs a certified coder, the superbill is updated as often as the insurance companies update and the submitted claims will match and be paid. If a claim is denied or downcoded a biller will usually re-submit the claim without changes whereas a coder will re-submit with documented proof from the medical record and coding standards and guildlines which leads to justified payment.
Therefore, although medical facilities deserve timely and accurate reimbursement, is it fair to ask the HMO et al to pay without first assuring the claims sent are accurate? Sending accurate claims is the facililtes responsibility --fix your internal billing procedures now before the ICD-10 puts you out of business in 2011.





