Confessions of a Medical Information Analyst (aka Secrets from a Payer Coder)  

Category: Coding

By Jen de Zayas, MBA, CPC, CPC-H, CCS-P

I admit that I have gone to the dark side-I work for an insurance company. I used to work for doctors and ASCs so I know what most people think of payer coders: we are all ill-trained, uneducated idiots working off of a script, and have no knowledge of the real world of medicine.  Yet insurance companies need to review bills before they pay them, and here I am.  There are some very simple things that may cause me to take a special interest in the workings of your facility, just from reviewing your bills. This is not the kind of interest you want.  I can't speak for every payer or payer coder, but I can speak to what I do all day, and give you some insight into things you may want to watch for in your billing practices.

Billing Forms
Do you know which payers will take a CMS1500 and which ones want a UB04? If you ...