| It's a strange world we live in. We expect most | | | | that be reason enough? Isn't the doctor's word |
| things to be a simple matter of ABC. We don't | | | | law? Doesn't he know best? Well, maybe he does |
| want to have to think. We don't want to have to | | | | as far as medicine goes. As to medical billing, that |
| go outside the box to figure things out. We want | | | | is a different story. See, while the doctor may |
| it all laid out there for us in plain simple to follow | | | | feel that a certain procedure or device is needed |
| steps. The medical billing world is no different. | | | | for the patient, the insurance carrier may not feel |
| Medical billing persons don't want to have to think. | | | | the procedure of device should be covered. This |
| Just give me the info that I need to get the bill | | | | is very common with some elective types of |
| out and move on to the next claim. Unfortunately, | | | | surgery where the patient's immediate health is |
| there are times when it isn't so nice and neat | | | | not an issue and the surgery is more for comfort |
| when it comes to submitting a claim to an | | | | or appearance. For example, in some cases, |
| insurance carrier, especially when you're sending | | | | surgery for hemorrhoids is not covered under |
| claim to a heavily regulated carrier like Medicare. | | | | insurance, especially if it's a particularly new |
| Sometimes, the carrier is going to want some | | | | procedure like IRC. In this case, a narrative note |
| narrative explanation as to why this claim is being | | | | must be sent to the carrier to explain why this |
| sent. This is where notes come into play. | | | | surgery is required and why it should be covered |
| A note, in medical billing speak, is not something | | | | by insurance. |
| you play on your Yamaha keyboard, or a post-it | | | | In most cases, these claims will eventually be paid. |
| you slip to the person in the cubical next to you | | | | But there are those cases where even with a |
| to meet you at lunch time for a smoke. A note is | | | | narrative explanation, the insurance carrier will |
| just that, a short narrative explanation that is | | | | deny the claim, even with the narrative |
| given to the insurance carrier to help explain why | | | | explanation. In this case, there is always an appeal |
| a certain procedure was done and why it is being | | | | and review process, but these things take |
| billed. More importantly, it explains to the insurance | | | | forever to get through. |
| carrier why the claim should be paid in the first | | | | The point to all this, however, is when a medical |
| place. | | | | biller sends a claim for a particular procedure that |
| But why are they needed? Why should you have | | | | specifically states that a narrative explanation is |
| to explain to Medicare why a particular claim is | | | | required, that biller better have one from the |
| being billed? If a procedure is done, or a device is | | | | doctor or get one. Otherwise, the chances of that |
| prescribed for a patient by a doctor, shouldn't | | | | claim being paid are slim to none. |
