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 is being proven on 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 the way in which 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.

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