One of the tasks of a coder/biller is to communicate with physicians and office personnel about coding guidelines and reimbursement trends. Lindsey Morgan, your supervisor, has asked you to speak at the staff meeting about recurring problems. In the following situations, compile a script to use when speaking to the staff so that you can describe the issue and ramifications of such. Outline possible solutions to the problems, corrective actions to be taken, education needs, and so on. Note any official guidelines or policies researched as necessary to clarify or demonstrate your point. What staff is responsible for rectifying the situation? Could these situations have been avoided or prevented?

1. The medical office you are employed at does not participate with Blue Cross Blue Shield (BCBS). Over the last three months, 20 BCBS patients have been scheduled, seen and treated. Eighteen of them resulted in insurance denials. Two of them had out-of-network benefits, but they had not met their out-of-network deductible, therefore no payment was made by BCBS. No money other than a $15.00 co-pay was collected from each patient at the time of service.

2. The billing department has seen an increase in data entry errors in patient demographics and in charge entry. Staff are still keying in dashes (-) and punctuation even though they have been instructed not to do so. Also, numbers are being transposed when entering codes and insurance ID numbers. The number of units are also being overlooked, and at times not counted correctly.