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Coding and Billing

Medicare physician fee schedule: Centers for Medicare and Medicaid Services Overview

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Medicare physician fee schedule: Fee Schedule Search

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Medicare policy on charging for missed appointments

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Medicare Provider-Supplier Enrollment webpage

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National Correct Coding Initiative

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OIG Compliance Program Guidance

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Out of Network

Colorado statute that provides "full" payment for non-par services when insured is inpatient at a par hospital and was hospitalized by a par doctor. Intended to hold the insured harmless from out-of-network charges when hospitalized in a participating facility by a participating physician, and receives services from a non-participating physician that the insured did not choose, such as a pathologist, radiologist or anesthesiologist. See Consumer Protection Statute section 10-16-704

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Prescription for a healthier practice: Claims revenue cycle

Use this tool to evaluate your practice's capability to submit claims efficiently and accurately; analyze health insurer payments for accuracy; and effectively address delays, denials and reductions in payment.

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Prescription for a healthier practice: Eliminate manual workers’ comp and auto claims processing

Switch from a manual claims process to electronic billing or “eBilling” for workers’ compensation and auto claims, which will help your practice reduce administrative costs, receive timely acknowledgement of your claims’ status and reduce the time it takes to submit bills. By doing so, physicians get paid faster and eliminate most of the hassles involved with paper billing. The AMA has developed tools to help your practice automate medical billing for workers’ compensation and auto injury. Start with the AMA’s Property and Casualty (workers' compensation and auto injury) Toolkit.

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Prescription for a healthier practice: Learn about vendors offering e-billing solutions

The AMA provides a listing of e-billing vendors physicians may consider using, particularly for workers’ compensation and auto claims, to streamline the process and help you get paid more quickly and with fewer denials. Access the AMA’s workers’ compensation e-billing vendor listing to learn about some of the many practice management system vendors and clearinghouse vendors offering these solutions.

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Prescription for a healthier practice: Prepare for health insurer retrospective audits

The AMA and the American Academy of Neurology present this AMA-members-only resource "How to prepare for a health insurer retrospective audit" to educate physicians and their staff about the recoupment efforts of health insurers through the retrospective audit process. They encourage physician practices to use this resource to guide them through the retrospective audit process from the initial notification from the health insurer to contesting the audit's findings.

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Prescription for a healthier practice: Protect your practice from inappropriate discounts

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Prescription for a healthier practice: Simplify the claim audit and appeals process

This interactive resource can help reduce the administrative burden by delivering a step-by-step course of action to appeal an underpaid, delayed or inappropriately denied claim. AMA members can access the National Managed Care Contract Database to look up state laws and regulations, which may need to be cited or quoted directly in an appeals letter. Also refer to the issue brief, "Overpayments and underpayments" for additional information.

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Preventive Services Overview of Medicare Preventive Services

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Prompt payment: Fact Sheet - Colorado’s Statute

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