Oct 15 2024 53 mins
Mastering Medical Billing: Overcoming Claim Denials and Utilizing Key Resources
In this comprehensive episode, we dive deep into various medical billing challenges and solutions. Key discussions include handling billing issues with UnitedHealthcare, specifically around lab claims and CLIA validation, and addressing billing problems with Medicare Advantage and other insurers like Cigna and Blue Cross. We offer practical advice on resubmissions, correct coding, and documentation to avoid denials. The importance of leveraging resources such as the AAPC website, MACs for webinars, and networking for educational support is emphasized. The episode features expert insights, such as those from healthcare attorney on combating downcoding and dealing with insurance companies. New and experienced billers alike can benefit from tips on maintaining contact lists, timely filings, and utilizing payer portals effectively.
00:00 Introduction and Initial Query
00:18 Clarifying the Issue with Modifier 90
01:00 Understanding CLIA Requirements
05:25 Dealing with UnitedHealthcare Denials
07:12 Exploring Other Potential Issues
09:33 Addressing Sentara Insurance Glitch
12:00 Blue Cross Medical Advantage Claim Issues
18:06 Cigna Appeal Process Challenges
22:01 Medicare Advantage Plan Denials
26:44 Medicare Billing Challenges
27:17 Humorous Anecdotes and Introductions
28:02 Addressing New Biller Concerns
30:06 Sharing Tips and Resources
31:33 Useful Websites and Tools
34:08 Insurance Company Contacts
35:02 AAPC Website Resources
36:32 Medicare Denial Codes and Policies
37:43 Importance of Bookmarking Resources
39:20 Access to Payer Portals
40:47 Training and Networking
42:00 Medicare Billing Programs
44:42 Final Thoughts and Suggestions