Reimbursement 101: Overview of Billing and Coding Issues by Health Care Setting

Foley partner Judy Waltz, co-chair of the firm’s Providers of Health Care Services Area of Focus, presented at an American Bar Association webinar titled “Reimbursement 101: Overview of Billing and Coding Issues by Healthcare Setting.”

Billing and coding play crucial roles in all health care settings, and there are several common issues that health care providers and entities may encounter. Analyzing billing and reimbursement data is essential to identify trends, optimize revenue, and ensure compliance. This presentation covered key areas for both facility and professional services:

• Coding errors: Mistakes in assigning accurate medical codes for evaluation and management (E/M) services, procedures, modifiers, and diagnosis codes.
• Insurance denials: Carriers may deny claims for various reasons, such as incomplete documentation, incorrect coding, or lack of medical necessity.
• Payer reimbursement guidelines.
  • Facility Services: DRGs, APCs.
  • Professional Services: CPT, HCPCS, Modifiers, ICD-10 codes.
• Payer audits: Ensuring that provider and organizational claims are accurate, compliant with coding and billing guidelines and meet payer coverage criteria.

The on-demand recording can be found here.