Medical Billing and RCM: high-yield desk drill

The rule

Post what the remittance says. Route what will not balance. Do not rewrite the record to force a payment.

Next step

Name the remark reason and the next owner. Keep unmatched lines on an exception queue.

Never miss

• Charge equals paid plus adjustments plus patient responsibility.
• You do not decide what the payer pays.
• Eligibility and authorization errors belong to access.
• No note, no claim.
• This desk does not issue a coverage denial.

Traps

• Writing off a variance so the dashboard is green.
• Borrowing another clinician's NPI.
• Sending the lifetime chart as an appeal.

Shortcuts

• Balance the 835 first.
• Route by reason.
• Cite the notice for any filing window.

Terms

• Exception. A remittance line that will not post cleanly and needs an owner.
• Variance. Paid amount does not match the contract allowed amount.
• Clean claim. Required elements present. Not a payment promise.

Memory hooks

• POST-THEN-ROUTE. Account for the line, then send the leftover Daily RCM motion.