In order to properly code a bill for medical necessity,

In order to properly code a bill for medical necessity, it is important to understand different plans and the requirements for billing each. It is true that they all use the ICD-10-CM diagnosis coding system, the CPT procedure coding system, and the CMS-1500 form, but each type of carrier has certain requirements for a clean bill.

Tasks:

  • Create a billing manual constructed of summaries of each type of insurance.
  • Include the major requirements for billing for each type.
  • Note inpatient or outpatient differences where appropriate.
  • Explain how to determine from the patient which type they subscribe to.

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