AI prompts for medical billing teams

Attached is our denial report for [date range] with claim, payer, CARC and RARC codes, provider, CPT and billed amount. Put every denial in one category: eligibility, authorization, coding, timely filing, duplicate, medical necessity or other. Total the count and dollars by category and by payer. Then tell me which categories the front desk could have prevented, and the top three root causes.

From the attached denial report, pull every eligibility or coverage denial for [month]. For each, show registration date, location, registering user if listed, and the CARC. Count by location and by user. Then draft a one-page tip sheet for the front desk on the three errors behind the most denials. No patient names in the tip sheet.

Attached are our remittance export for [month] and our contracted rate table for [payer]. Compare the allowed amount with the contracted rate for each CPT and modifier. List every line paid more than $[1] below contract, with the difference. Total by CPT. Exclude lines adjusted only to patient responsibility. Show your math for five examples.

Attached are our unpaid claims export and each payer's filing limit in days: [attach or paste table]. For each unpaid or rejected claim, calculate days since date of service and days left before the filing limit. List claims with fewer than [30] days left, sorted by days left. Flag claims accepted by the clearinghouse but never acknowledged by the payer.

Attached are our encounter export and charge export for [date range]. Find encounters with no charge entered more than [3] days after the visit. Group by provider and location, with the count and oldest date of service. List the 20 oldest open encounters. Show median days from visit to charge entry by provider.

From the attached charge export, find visits billed with both an E/M code and a minor procedure on the same date by the same provider where the E/M has no modifier 25. List them by provider with date of service, codes and payer. These are for coder review, not automatic correction.

Attached is today's clearinghouse rejection report. Group rejections by edit or rejection message. For each group, give the count, the likely fix in plain English, and who usually fixes it: front desk, coder or biller. Sort by count, highest first. List any claim rejected more than once.

Attached is our patient and insurance credit balance report. List every account with a credit balance, with amount, age and source: patient overpayment, payer overpayment or duplicate payment. Flag credits older than [60] days. Then draft a refund summary for [manager] grouped by payer and by patient refunds, with totals only.

Attached is our E/M code count report by provider for [period], aggregated, with no patient data. For new and established office visits, show each provider's distribution across levels as percentages, next to the practice-wide distribution. Flag providers whose share of level 4 and 5 visits differs from the practice by more than [10] points either way. Neutral language. No conclusions about coding accuracy.

Attached are [payer]'s [policy name] from [last year] and the new version effective [date]. List every change: covered codes, modifiers, documentation rules, frequency limits and prior authorization. Quote the old and new text side by side, with page numbers. Then tell me which of these CPT codes are affected: [list codes].

Draft appeal letter templates for our five most common denial reasons: [CARC codes and descriptions]. Each template needs payer and claim fields in [brackets], the specific argument for that denial type, the documents to attach, and a closing request. Keep each under one page. Professional, no filler.

Attached are our month-end reports for [month]: charges, payments, adjustments, A/R by aging bucket and days in A/R. Compare each to the prior three months. Write a one-page summary: what moved, by how much, and which aging bucket grew. List three questions leadership will ask and the data that answers each.

Write a patient letter explaining a balance after insurance. In plain words, explain what the plan paid, what's left and why (deductible, coinsurance or non-covered service), with [brackets] for amounts. Give three ways to pay, mention the payment plan option, and list [phone number] for questions. Eighth-grade reading level. Kind and clear, no threats.

Draft a patient payment plan policy for [practice name]: minimum balance to qualify, minimum monthly payment, maximum term, what happens after a missed payment, and when an account goes to [collections agency]. Add a one-paragraph patient-facing summary. Leave [brackets] for every number so leadership can set them.

Write a phone script for our billing office for patients who call about a statement. Verify identity with [two identifiers], explain the balance, offer the payment plan, and handle "I already paid" and "my insurance should cover this." Say when to escalate to [billing manager]. Write it in English and Spanish.