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The Ultimate Cheat Sheet on Medical Billing

January 05, 2016

 The Ultimate Cheat Sheet on Medical Billing

It is an important, difficult as well as a rewarding job to work as a medical biller and coder. It is no secret that to succeed in this field one must know how an error free claim is filed, knows the vital acronyms at the back of their hand, should have been on top of their game as far as ICD–10 is concerned and save time by exactly knowing what to look for in a payer contract.

It is absolutely essential to have a clear, complete and concise medical documentation to provide quality medical care to the patients. Appropriate documentation is also essential to get timely and correct payment for the services provided.

One of the biggest advantages of having a cheat sheet is increased confidence to bill at the highest level which is appropriate in accordance to the medical service provided. Furthermore, it will maximize revenue and aid in improving the documentation to eliminate RAC audit risk. Reports suggest that many providers end up under coding which results in loss of revenue. A cheat sheet they can ensure their base is covered.

Let us look at a few things that a cheat sheet should have.

Filing a clean error free claim

The cheat sheet should cover steps about filing a clean error free claim. A clean medical claim comprises of no mistakes and is processed without any additional information from the provider or third party.

The claim should have a procedure code along with a supporting diagnosis code, this will remove any questions about medical necessity and the claim should not have any expired or deleted codes. One of the most necessary steps here is that the claim should include all the required information; like patient name, address, date of birth etc; in the proper fields. Finally the most important point is the claim should be submitted on time.

Some Billing and Coding Acronyms

Usage of acronyms and abbreviations in billing and coding is quite common. In fact this is extensively used in medical records to save time. Each practitioner will keep his own set of acronyms handy which are related to his specialty but there are some common abbreviations which are used by all; namely; CMS, EDI, EOB, HIPAA, HMO, POS, WC and few more.

Vetting Payer Contracts

Payers offer myriad coverage to their members and billers and coders need to be able to read the contracts and extricate the necessary information which will be required to follow up on the claims. Usually payers have standard contracts that they offer.


As discussed billing and coding is a complex as well as a rewarding job. Complex as there are several factors to deal with and rewarding because if the job is done well it will earn good revenue for the practice.


Category : Outsource Medical Billing