Mastering Medical Billing: Overcoming Claim Denials and Utilizing Key Resources

In this comprehensive episode, we dive deep into various medical billing challenges and solutions. Key discussions include handling billing issues with UnitedHealthcare, specifically around lab claims and CLIA validation, and addressing billing problems with Medicare Advantage and other insurers like Cigna and Blue Cross. We offer practical advice on resubmissions, correct coding, and documentation to avoid denials. The importance of leveraging resources such as the AAPC website, MACs for webinars, and networking for educational support is emphasized. The episode features expert insights, such as those from healthcare attorney on combating downcoding and dealing with insurance companies.  New and experienced billers alike can benefit from tips on maintaining contact lists, timely filings, and utilizing payer portals effectively.

00:00 Introduction and Initial Query

00:18 Clarifying the Issue with Modifier 90

01:00 Understanding CLIA Requirements

05:25 Dealing with UnitedHealthcare Denials

07:12 Exploring Other Potential Issues

09:33 Addressing Sentara Insurance Glitch

12:00 Blue Cross Medical Advantage Claim Issues

18:06 Cigna Appeal Process Challenges

22:01 Medicare Advantage Plan Denials

26:44 Medicare Billing Challenges

27:17 Humorous Anecdotes and Introductions

28:02 Addressing New Biller Concerns

30:06 Sharing Tips and Resources

31:33 Useful Websites and Tools

34:08 Insurance Company Contacts

35:02 AAPC Website Resources

36:32 Medicare Denial Codes and Policies

37:43 Importance of Bookmarking Resources

39:20 Access to Payer Portals

40:47 Training and Networking

42:00 Medicare Billing Programs

44:42 Final Thoughts and Suggestions