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Schematic of Professional Part B Claims Flow

Denied. Paid. Appealed. or. Not Appealed. Schematic of Professional Part B Claims Flow. Practitioner completes medical record & billing sheet. Claim is prepared by your organization’s billing office or agent. Billing office applies codes, modifiers and V codes.

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Schematic of Professional Part B Claims Flow

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  1. Denied Paid Appealed or Not Appealed Schematic of Professional Part B Claims Flow Practitioner completes medical record & billing sheet. Claim is prepared by your organization’s billing office or agent. Billing office applies codes, modifiers and V codes. Claim submitted electronically to your CMS regional contractor (Pt B Carrier). Process Improvement Claim is run electronically against billing algorithms for age, sex, provider type, provider specialty, benefit coverage and limits, duplicate services, etc. A Non-fit at any step will cause electronic auto-denial. Pay? Yes No Analyze denials. See flow # Report of denials (usually electronic) is sent to your organization and should be reviewed. Denial reasons will be listed by code and defined. Decision: Resubmit. Resubmit Pay? Yes No Paid

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