Introduction:

In order to properly code a bill for medical necessity, it is important to understand different plans and the requirements for billing each. It is true that they all use the ICD-10-CM diagnosis coding system, the CPT procedure coding system, and the CMS-1500 form, but each type of carrier has certain requirements for a clean bill.

Tasks:

• Create a billing manual constructed of summaries of each type of insurance.
• Include the major requirements for billing for each type.
• Note inpatient or outpatient differences where appropriate.
• Explain how to determine from the patient which type they subscribe to.