Question

As a billing specialist you are responsible to billing claims to the third-party payers.

You find that a third-party payer is not reimbursing the clinician for an E/M service on
the same day as a procedure. How you would you explain to the clinician, in a tactful
manner that the provider must also include modifier 25 to the E/M visit to be paid for
both services.

Answer 1

The goal of the medical biller is to ensure that the provider is properly reimbursed for their services. In the pursuit of this goal, errors, both human and electronic, are unfortunately unavoidable. Since the process of medical billing involves two incredibly important elements (namely, health and money), it’s important to reduce as many of these errors as possible. In this brief course, we’ll introduce you to some common errors in the medical billing practice.

Before we jump into that discussion, however, let’s review the difference between a rejected and denied claim.