It is a strange world we live in. We expect most things to a simple matter of ABC. We do not want to think. We do not want to have to go through the rim to figure things . We want it all, there for us in plain simple steps to follow. The medical billing world is no different. Medical Billing people do not want to think. Call me the info that I need to do the calculation and the next call. Unfortunately, there are times when it is not so nice and clean when it comes to submitting a claim to an insurance carrier, especially if you are sending is entitled to a heavily regulated carriers such as Medicare. Sometimes, the institution will want some narrative explanation as to why this claim is sent. Here notes come into play.

A note in the medical billing talking about is not something you play on the Yamaha keyboard, or a post-it note to the person in the cubical next to you, to you at lunch time for a smoke. A note is that a short narrative explanation is that the insurance carriers to explain why a certain procedure was and why it is billed. More importantly, it explains why the insurance by the requirement should be included in the first place.

But why are they necessary? Why would you want to explain Medicare, why a particular claim is billed? If a procedure is completed, or a device is needed for a patient by a doctor, should not be reason enough? Is not the doctor, the word right? If he does not know best? Well, maybe he has, as far as medicine goes. What medical billing, that's another story. Behold, the doctor may feel that a certain procedure or the device is intended for patients, insurance carriers may not feel the procedure of the device should be covered. This is very common with some types of elective surgery in which patients in the immediate health is not a problem, and the operation is for more comfort and appearance. For example, in some cases, surgery for haemorrhoids is not covered by insurance, especially if it is a new technique, such as IRC. In this case, a narrative note must be made to the carrier to explain why this operation is necessary, and why it should be covered by insurance.

In most cases, these data are also paid. But there are cases where a detailed explanation, which is determined by the insurance claim is denied, even with the narrative statement. In this case, there's always a complaint and review process, but these things that are always accessible.

The point to all this is, however, if a medical biller sends a claim to a particular procedure that specifically stated that a detailed justification is required, that have a better Biller by the doctor or get. Otherwise, the chances that the claim is not raised, not a slim.

Michael Russell

Your independent guide to Medical Billing