Balance Billing, Out-of-network Surprises with Common Billing Errors

Course Description

It’s time to do the billing and we have all experienced it, many times, our physicians document everything the biller/ coder may need to get the billing coding done; however, it is sometimes hard to locate this documentation. When we have spent time on these records and are unsuccessful at locating the information, we will send a query. I will not embarrass anyone, just answer quietly to yourself or laugh.... how quick is your turnaround? If you can honestly answer less than 48 hours, we all want to work with your physicians!

In my experience as a biller, coder, auditor, and instructor, it was truly amazing to discover that many of these errors are right where they need to be. Just gotta be a detective! (Got your attention now, don't I?)

Learning Outcomes:

• Spot documentation and billing errors before they delay or reduce payment
• Trace missing information in records using simple, detective-style methods
• Understand why errors happen and how to correct them efficiently
• Use documentation clues to locate what’s needed without repeated queries
• Communicate findings clearly with clinical and billing teams
• Strengthen internal processes and education to prevent repeat mistakes
• Improve audit readiness and overall billing accuracy
• Build confidence in reviewing, correcting, and submitting cleaner claims

Areas Covered in the Session:

• Reviewing radiology referrals and reports
• Reading notes from a previous visit and perhaps even farther back
• Reviewing check-in notes and phone call notes
• Reviewing previous visits, especially if for pregnancy
• Knowing when it is OK, after a diligent search, to overwrite with “no history noted”
• Reviewing lab results and diagnostic findings
• Checking medication lists for accurate documentation
• Verifying information in patient intake forms
• Live Q&A Session

Recommended participants:

• Medical Billers, Coders, and Auditors
• Practice Managers and Office Administrators
• Compliance and Revenue Cycle Professionals
• Physicians, NPs, and PAs Involved in Documentation and Billing Review
• Clinical Documentation Improvement (CDI) and HIM Professionals
• Billing and Coding Trainers or Educators
• Claims Processing and Denial Management Teams
• Healthcare Consultants and Compliance Specialists
• Students and New Entrants in Medical Billing and Coding
• Anyone Involved in Improving Accuracy, Compliance, or Reimbursement Processes

About the Presenter

Alice Marie Reybitz is an RN in the State of Florida. She has been a Biller and Coder since 1998. She has worked undercover for the FBI in Medicare fraud. She has been a nursing and a coding instructor. She has spoken at AHIMA and AAPC symposiums and conferences. She has written several articles for professional coding journals. She just recently earned her Certified Death Doula Designation to assist Hospice patients and their families.