Although it is not mandatory for physician medical billers to be certified, but we insist that they participate and complete the CMRS exam, this policy however applies to fresh recruits hired by us, the experienced billers working for our company have a thorough knowledge of billing and coding processes having completed 8 to 10 years of service, and they obviously are exempted.
We helped a cardiology center receive reimbursements for an angioplasty procedure. The insurance claim was filed by them on the patient's behalf. The insurance company rejected the claim because the patient's demographic information was inaccurate. There were inaccuracies in the ICD-9 Procedure Codes, and the CPT code for Peripheral Angiography was not accurate as well.
The insurance claim documents were processed by the inadequate in-house billing and coding staff of the clinic. The cardiology center then hired our services and we quickly re-processed the claim documents with all corrections made, the claim documents were sent to the insurance company.
We also followed it up by calling the insurance company regularly, and after 30 days we are able to get the reimbursement for the clinic. The Explanation of Benefit (EOB) list had most of the claims reimbursed for which the claims had been filed.