EPIC: Posting office charge

Charge Review Instructions for Billing Accuracy

Posting Charges -Insurance

1. Superbill Review

  • Verify if a charge was collected on the date of service.
  • Check the guarantor account to ensure the prepayment was applied.

  • If the prepayment was not applied, allocate it to the appropriate charge and proceed with charge entry.

2. Patient and Guarantor Verification

  • Confirm that the patient and guarantor names are correct.
  • The guarantor should not be the same as the patient unless the patient is over 18 or has a legal guardian.
  • Ensure the responsible party (signer of the registration form) is listed as the guarantor to avoid claim denials.

3. Service Date

  • The service date must match the date of service recorded in the system.

4. Coverage Review

  • Verify insurance coverage against the superbill.
  • Ensure that primary and secondary insurance are correctly listed.
  • Commercial insurance should always be primary, and Medi-Cal should be secondary.

5. Claim Information – Prior Authorization

  • Document the prior authorization number and expiration date.
  • Verify that all CPT codes on the claim are included in the authorization.
  • If the authorization is expired, coordinate with the insurance verifier listed on the superbill.

6. Service Provider – Billing Provider

  • Ensure that the provider name matches the superbill.

7. Department Verification

  • The department must be listed as CPCA Sacramento.

8. Place of Service

  • Confirm that the place of service aligns with where the consult, echo, or EKG was performed (e.g., CPCA CHICO, CPCA STOCKTON).

9. Referring Provider

  • Verify that the referring provider matches the referral.

    The referring PCP must be documented on the CMS 1500 form since our office is a specialist provider.

    If billing for CCS, referring PCP requirements depend on the SAR details:

    • If SAR reflects our provider – No referring PCP needed.
    • If SAR belongs to another provider but our provider sees the patient – List the SAR provider as the referring PCP.
    • Cardiac Center SAR – No referring PCP required.
    • We must use the primary and secondary DX listed on the SAR - then we can list the diagnoses we are coding for.

10. Diagnosis Review

  • Confirm that diagnoses from the superbill align with provider notes.
  • Cardiac murmur and arrhythmia should not be listed as primary diagnoses but must be included as secondary diagnoses.

11. CPT Coding & E/M Guidelines

  • Follow insurance-specific rules for Evaluation and Management (E/M) codes.
    • New codes: 99205, 99204, etc.
    • Old codes: 99245, 99244, etc.
    • Establish /Returning patient: 99215,99214, etc...
  • If unsure of an insurance rule, use the new E/M codes.
  • Most insurances require Modifier 25 for separately billable E/M services.
  • Verify documentation for time-based coding (patients are typically seen for 45-60 minutes).
  • If discrepancies arise, notify the lead for note adjustments.

12. Echocardiogram & EKG Coding

  • EKG (Electrocardiogram) should be coded as 93000 with Modifier 51 if multiple procedures were performed.

    If billing for Holter or Event placement, DO NOT bill for EKG, as most insurances will not reimburse both.

    For Holter Placement:

    • Update the Holter Log (P-Drive > MA > 01 MA LOG).
    • Mark the placement as “BILLED.”
    • Ensure provider notes indicate the necessity of Holter/Event monitoring.
    • Confirm prior authorization includes the correct CPT codes.

13. Cardiac Tab Review

  • Verify the accuracy of EKG and ECHO service dates.

  • If errors are found, contact the Medical Assistant from the service date.

14. Final Charge Review & Error Check

  • Utilize the Error Tab before submitting charges to identify required adjustments.
  • Carefully review to prevent claim denials and ensure compliance.
  • Address and correct any system alerts before finalizing.

By following these structured guidelines, we can ensure accuracy in charge processing, reduce claim denials, and streamline billing operations.



Created by: DP