RCM tip of the day: Follow payer billing guidelines

In today's healthcare environment, it is more important than ever that healthcare providers follow appropriate billing guidelines for each contract with third-party payers, according to Monte Sandler, executive vice president of revenue cycle management at DocuTAP.

"With the various types of contracts urgent care providers are entering into with third- party insurers, it's extremely important to follow the appropriate billing guidelines for each. For example, clinical guidelines are not necessarily the same as those for billing," he told Becker's Hospital Review.

"Many contracts require all providers to be individually credentialed, and services to be billed under the rendering provider, whereas some contracts allow all providers to bill for services under the group national provider identifier," said Mr. Sandler.

"Medicare is very clear that every provider must be individually credentialed with all services billed under the rendering provider. Medicaid follows the same principle in most states. Failure to comply could result in criminal and/or civil penalties, so make sure your clinic is made clear of all guidelines," Mr. Sandler said.

"Further, for billing purposes, providers cannot sign off on other providers’ charts in order to bill for services rendered. Midlevel providers do not typically meet incident requirements in an urgent care setting."

If you would like to share your RCM best practices, please email Kelly Gooch at kgooch@beckershealthcare.com to be featured in the "RCM tip of the day" series.   


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