CPBs have demonstrated:

• An understanding of various types of insurance plans

• Expertise in applying payer policy, Local Coverage Determinations (LCDs), and National Coverage Determinations (NCDs) for successful claim submissions

• Knowledge of CPT^®, ICD-10-CM, and HCPCS Level II coding guidelines

• Successful navigation of healthcare industry rules and regulations, including HIPAA, False Claims Act, Fair Debt Collections Act, and Stark Law.

• An understanding of the life cycle of a medical billing claim and how to improve the revenue cycle

• Expertise in effective claim follow-up, patient follow-up, and denial resolution