AR person role and responsibilty - Part 3


Modifiers provide the coder with a means to indicate that a service or procedure that was performed has been altered by some specific circumstance but not changed in its definition. The proper use of modifiers reduces the need for separate procedure listings to describe the modifying circumstance. Modifiers are typically used to indicate that:•A service or procedure has both a professional and technical component.•A service or procedure was performed by more than one physician and /or in more than one location.•More or less of the service or procedure as described was performed.•Only part of a service was performed.•An adjunctive service was performed.•A bilateral procedure was performed.•A

service or procedure was provided more than once.•Unusual events occurred.


When an AR Rep calls a carrier and then finds out from the insurance that the procedure code is incorrect, then he should be able to understand that the code was incorrectly billed and that the audit department had missed out on tracking this, since charge entry or cash posting needs to be audited and make certain that all entries in the computer are accurate.
Therefore it is the primary responsibility of the audit department to make a correct check of all the charges that were entered or all the cash that was posted, if this department works with efficiency then the entire billing process would be a lot easier since most of the problems would be killed at the front end itself.

EDI Enrollment.

Electronic Data Interchange is a department of Fast claims transmission they would allocate a vendor number, which is the number we would always need to use whenever submitting claims. This would be especially be valid because the EDI dept would verify as per carrier requirements an initial sample edit check, and if our claim has passed this initial edit then the claim would be forwarded to the carrier, otherwise we would receive a Rejection Report, using this report the AR Analyst needs to contact the desired people either the account manager or center and obtain the missing information so that the claim(s) could be refiled. There is another way to submit claims i.e. Paper claims, we would need to print out on HCFA 1500 (which is the name of the bill) and have them mailed out to the carrier. They basically check the claims in their system and then forward them over to the carrier from which we would either get paid or denied. They would also give us transmission reports, which could be used to identify and act upon rejected claims in a very timely manner.

Patient Bills

Is an option where through the computer we would release patient bill statements via Fast Claims department, they print out this bill and have them sent out the various patients? In this way we could contact the patients for any money that remain pending from their end.

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