Reimbursement Tips! Always check your payer’s policy for any special documentation or billing instructions. The Payer should tell you what is required for reimbursement.

• Private payers often require pre-authorization for any unlisted procedure.
• Some payers have specific documentation criteria, depending on the type of procedure provided (e.g., an op note to support an unlisted surgery, an imaging report for a procedure or the NDC number for an unlisted drug code).
• Many payers will ask you to submit a code for procedures to help determine coverage
Other information that may be required (Be sure your documentation supports any/all information you submit to the payer.
• A clear description—nature, extent and need—for the service being performed.
• Time, effort, equipment used to provide the treatment.
• Time spent, number of times the service was provided.

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