The Value of Accurate Documentation in Medical Bill Reimbursement

Medical documentation has myriad applications in today’s health care administration – being reference-source for future encounters; enabling coordinated care, both within and across the clinical network; contributing to macro health care planning and reforms; ensuring clinical data privacy and security as per HIPAA norms; and ensuring flawless medical billing. Notwithstanding providers’ effort to document as best as they can, “accuracy” continues to be a matter of great concern. While inaccuracies in medical documentation can lead to lapse in medical care quality and breach of trust, it is the reimbursement that will be most affected.

Every reimbursement starts with medical billing, which is calculating the cost of administering medical services. Clinical documentation – which contains physicians’ narration of entire course of medical management – is the source on which billers rely upon in assigning monetary value to medical services. Because most of the physician documentation is supposed to be true, medical billing is as good as your clinical documentation. But, physicians, with all their good intention and focus, may not always be expected to document without omission or error. And any omission or error may either correspondingly reduce reimbursement or expose your bills to chances of denial or delay.

One way to do away with omission or error is to encourage doctors to check back on every chart before they move on to the next patient. But doctors are seemingly busy, and may not wish to keep the next patient waiting or compromise on clinical priorities. In such cases, internal staff may be assigned with the job of elaborating the doctor’s notes into comprehensive charge sheets or case summary. Training and orienting the so deputed staff is crucial before they take over the charge and start feeding medical billers with charge notes.

Clinical documentation has undergone remarkable changes recently – paper-based charts have given way to automated documentation. Medical practitioners are lot happier with pace and ease with which modern-day systems can generate voluminous reports that can easily be exchange across the health care network system. But, automated documentation is also inherent with investment, implementation, and training issues. Moreover, patient security and privacy may be at a higher risk from hacking concerns. All these issues may prompt the intervention of competent medical billing service providers who know how to upgrade providers’ internal clinical documentation in sync with medical billing and coding.

Medicalbillersandcoders.com – known for its catalytic role in clinical and operational management of a majority of medical practices across the 50 states – is prepared for the next challenge: changing face of clinical documentation in ICD-10 and HIPAA 5010. With the entire provider-fraternity transiting to a more robust, comprehensive, and technology-driven clinical documentation environment, it hopes to own up the responsibility of transformation. It is well-served by its core group, comprising clinical documentation specialist, expert medical billers and coders, and strategic partnership with best-known vendors of automated documentation systems. The fact that it has already executed documentation upgrading as part of its comprehensive RCM services is a testimony to its credential and competence.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

It Pays To Be a Medical Billing and Coding Specialist

Choice of a profession is determined by its stability against job market fluctuation, potential growth and monetary rewards. Medical billing and coding profession seem to be one those few professions that possess all these attributes. While professionals in other spheres are fighting lay-offs and salary cuts, medical billers and coders’ present and future looks highly secure. And it pays to be a medical billing and coding profession!

The primary reason behind this optimism is that care providers’ reliance on medical billers and coders will increase further. As the recent reform foretell major overhaul in coding and billing practices, providers may see it worthwhile to entrust an activity that is not their specialty. This shift in strategy could further increase the demand for qualified and competent medical billers and coders. It is worth remembering the U.S. Bureau of Labor Statistics (BLS) reports, which forecast a 20% growth in demand for medical and billing professionals between 2008 and 2018.

Second, the payback time for a medical billing and coding specialist is faster – it takes less than a year to complete a formal training, or about a year-and-a-half for an associate degree.  Therefore, you can expect to be industry-ready or certified professional within your budget. Moreover, with certainty of being employed in a secure and stable profession, you can easily recoup your investment in few months.

Third, training and education is unbelievably convenient – online medical billing and coding degree and diploma programs have virtually removed barriers of time and place. All you need to do is to select a credible source of training and education based your specialization. With so much convenience around, you should save considerable amount of time and money that would otherwise be spent conventional mode of training and education.

Fourth, medical billing and coding profession is not physically exhausting – most of your work is conducted through a computer, and it usually involves helping out your physicians and patient to avail the best possible medical reimbursements. Therefore, medical billers and coders are better off when compared with other healthcare personnel who usually work long hours and are required to move patients, stand or walk for long periods of time, clean up after patients and so on.

More importantly, profession in medical and billing offers flexibility to schedule your work hours based on your convenience. As providers are more inclined to outsource medical billing and coding from external consultants, there is an upsurge in home-based billers and coders, who seem more than pleased with the prospect of operating from the comfort of their homes, having a perfect balance between their personal and professional lives.

Medicalbillersandcoders.com – which has successfully orchestrated training and placement of a majority of medical billers and coders across 50 states – hopes to play a bigger catalytic role. Its core team of expert billers and coders, affinity with leading knowledge sources, and partnership with prospective employers will essentially be responsible for providing aspirants with a jump start to their career in medical and coding.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

Life as Medical Billers & Coders in Today’s Economy

The world’s largest economy has had to weather one of the worst recessions in the recent times. Not too long ago U.S. GDP hit the rock-bottom (at -8.9 in the middle of 2009). While it has slowly been coming out of the depths, the growth is not enough to bring down unemployment rate, which is hovering around 7.9% as of October, 2012. While most of the service sectors seem to have been affected uniformly, health care sector has remained an exception. And, medical billers and coders, being integral to health care industry, too have benefited from this. While, they have not been totally immune to lay-offs or salary cuts, at least percentage wise they are the least affected, with only 3-4% of the certified billers and coders being unable to find jobs.

The reason why medical billers & coders are least affected is health care is something indispensible – whether a positive GDP or negative, health care spending continues as usual, and providers’ reliance on billers and coders remains unaffected. The 3-4% unemployment is largely because of those billers losing jobs on account of being tied with lone-standing or small practices who may have decided to wind up operations. Otherwise, qualified and experienced professionals continue their lucrative association with clinics, hospitals, and group practices.

Being in a protective industry has surely helped them to be immune to the impact of the current economic scenario. But what is truly remarkable is the kind of flexibility and adaptation that these professionals exhibit in coping with adverse conditions.

What primarily stands out is their commitment to remain as competent as ever. Employers are increasingly growing quality conscious, and medical billers and coders are required to be as seamless as possible. Billers and coders are proving their mettle by undergoing refresher courses that keep them abreast with latest developments.

Networking with peers too is proving to be ingenious way to getting employed or reemployed. As per reliable statistics, over 38% of aspirants and professionals are known have followed networking as a means of finding employment opportunities.

Some professionals devised work-hour adjustment to adapt to these testing times. It is believed that currently there are two categories of professionals – one working an average of 31 to 40 hours per week, the other devoting an average of 41 to 71 hours per week. The former accounts for nearly 38% of the total medical billers and coders, and the latter constitutes 58% of the total medical billers and coders. Together, they have found a way out to remain active without being unemployed or unpaid.

There have also been instances of medical billers exhibiting extraordinary capacity for excellence, which have been suitable rewarded with health insurance & dental insurance through employer, sick leave from employer, and prompt benefits & incentives.

Therefore, it is apt to say that medical billers and coders have not been comforting under health care security, but responding creatively to evolving economic conditions. As a result, they have been able to remain least affected in terms of being unemployed or unpaid. It seems brighter days are ahead of them. In fact, The Bureau of Labor Statistics (BLS) reports that medical billing and coding will grow by 20% between 2008 and 2018, which is enough incentive for billers and coders to remain focused and optimistic.

Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – being a leading platform for provider-biller interface – is committed to help billers and coders maneuver through these testing times. Over the years, we have helped a majority of professionals connect with their true calling across 50 states in the US.  And, as we enter into a time of great transition, we are even more focused on facilitating right employee-employer connection, enriching professional experience, and more importantly promoting service excellence.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

Forecasting the Future of Medical Billing and Coding Post ICD-10

United States is on the verge of a major billing and coding reform – the introduction of ICD-10 in particular marks the beginning of the most robust, effective and efficient system of billing and coding ever to have been followed. While providers and payers will benefit from progressive changes, medical billers and coders will have the onus of keeping their expertise renewed from time to time. One of the best ways to be ready for future challenges is through preparedness based on forecast for a certain milestone period. 2020 happens to be that immediate milestone period.

Medical billing and coding will have undergone considerably sophistication by 2020. Amongst a number changes to impact billers and coders, following happen to be on top of the agenda:

• Progressive coding specificity
• Billing automation
• Career requirements

ICD-10 currently has 70,000 odd codes. And, given the progressive nature of ICD-10 coding system, it may have added a few more by 2020. All this extension means that coders will have to be conversant of codes as and when they added. Therefore, coders need to have access to such information from reliable sources.

Billing automation is another area that billers and coders need to watch out for. It is expected that the industry will have reached maximum automated billing and coding by 2020; paper medium will more or less have lost its edge. Therefore, professionals should continually seek upgrading their knowledge on billing and coding software. More importantly, they would be required to mediate EHR practices between providers and payers. Their employability will primarily decided by their technical competence.

While career opportunities will have risen considerable by 2O10, the skill-level too will have grown equally demanding. Among other professional traits, billers and coders ability to promote patients’ privacy and safety through confidential clinical documentation will have received utmost prominence. Therefore, it is crucial that aspiring professionals keep on conforming to evolving privacy and safety rules under HIPAA 5010. These fundamental requirements should not seem difficult given the prospects of rewarding career – The U.S. Bureau of Labor Statistics expects the growth to be around 16% till 2020, with an entry level salary of $35,010.

Billers and coders will continue to have a bright and promising future well beyond 2020. Even though technology will take-over manual operations, billers and coders’ personal touch will still be indispensable to efficient and effective medical billing management. This is precisely the reason to believe that they will have a secure future despite the accompanying challenges. Therefore, professionals should continue to be optimistic of the future.

As medical billers and coders look forward to a future of hope, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – the largest platform for career aspiration in medical billing and coding – is committed to help them navigate to successful career paths. While our core team of expert billers and coders helps improve your competence, our extensive network with employers facilitates compatible placement.

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Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services  according to their preferences of specialty, city, software and services performed.

Does a Medical Coding & Billing Job Offer You Healthcare’s Security from an Office Setting?

Career in health care industry has rarely been unsecure. While professionals in other sectors have had to undergo turbulent times recently, people in this priority sector have maintained steady progress despite economic reversals. And there are reasons to it: first, health care is indispensable; more significantly, it is supported by world’s largest public insurance schemes – Medicare and Medicaid; and the contribution of private insurance players is also noteworthy. This remarkable story of sustenance and growth does not end here. With the Federal Government extending public health insurance to every American, care providers, support staff, payers, and everyone related directly or indirectly to health care will have their future protected.

Amongst those who have been benefited most by the string of recent health care reforms are medical billing and coding professionals. While these reforms have made clinical documentation and operational management more complex for providers, they have opened up myriad of career opportunities for medical billers and coders. Providers now consider it impossible to manage mandatory EHR compliance and ICD-10 transition without the intervention of external billing and coding consultants. With so much of reliance, it is only fair to say that profession in medical billing and coding offers the most of the health care’s security.

Unlike most medical jobs, profession in medical billing and coding is easy to start off. Any graduate can aspire to become one. Financially too it is less burdensome – a qualification can be achieved with as less as $2,600. Aspirants can enroll themselves with Federal Government approved institutes for a formal certification program in medical billing and coding. With a few years of on-field experience, they can expect to be approached by leading hospitals, clinics, and physicians practices.

Medical coding and billing is equally rewarding too – an entry level salary is $35, 920, which can rise to $58,150 with a few years of experience. As for the opportunities and growth, medical billing and coding is expected to register 21% growth between 2010 and 2020, which is an unprecedented record.

Judging by the exponential growth in health care spending, providers’ shift to outsourced billing and coding operations, and an increasingly stringent multi-payer reimbursement environment, medical billers and coders’ significance will only increase further. According to the World Health Organization (WHO), total health care spending in the U.S. is the highest in the world. With the Health and Human Services (HHS) Department expecting health share of GDP to be at a historical high of 19.5% by 2017, medical billers and coders will be greatly required to mediate providers’ RCM process with payers.

With so much of growth potential around, aspiring professionals should be eying on their share of apple pie. Medicalbillersandcoders.com – which has been a leading launching platform for career in medical billing and coding – hopes to complement aspirants’ efforts with learning and employment resources. The fact that it mediates majority of provider-biller engagements is ample testimony of its credentials.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

How can Physicians Balance Roles at Work to Increase Medical Billing Efficiency of Their Clinic?

Over the last few years the healthcare system in the United States has witnessed modifications in policies and regulations, in order to make healthcare facilities cost effective and accessible to people from all income groups. However, a substantial percentage of the population still remains uninsured and the introduction of the Patient Protection & Affordable Care Act in 2010, aims to increase the number of people insured and make healthcare more patient friendly.

Doctors need sufficient face-to-face time with their patients to provide the best possible medical care. Changes in healthcare regulations and rise in the number of patients have raised the bar for services provided by physicians, hospitals as well as insurance companies. For instance, in the coming months, the insurance companies are obligated to cover sicker patients without asking for higher premiums and must cover preventive screening services for certain diseases. The physicians are expected to adopt health information technology; databases like EMR/EHR (for patient records), dealing with the insurance claims; billing details, coding, follow up on the claims and other technical responsibilities. They are also expected to be compliant with the regulations of HIPAA, CPT and the upcoming ICD-10 coding system.

Hence as healthcare providers get increasingly burdened with these challenging technical activities which require time and proper training to perform, physicians and other medical staff spend more than half of their time dealing with billing and insurance formalities when the same could be spent diagnosing & treating patients. However as physician’s core activity being patient care they are finding it increasingly difficult to balance their roles at work to increase revenue generation.

Inevitably lack of time and increased regulations can cause inaccurate coding, errors in patient records, failure to comply with the regulatory standards which are some of the issues faced by the physicians. In this scenario more and more physicians are facing delays in claims processing, rejection of claims, increased penalties etc. Moreover, incorporating IT systems for medical billing along with trained personnel can be a costly affair.

One of the most favorable solutions to this problem lies in – physicians outsourcing their paperwork requirements to medical billing companies – while they solely concentrate on patient care. Being specialists in medical billing the billing company’s support staffs are certified, up-to-date and have better infrastructure hence are able to easily manage the entire Revenue Cycle Management (RCM) along with denial management and appeals while conforming to patient confidentiality, offering physicians the balance required in their work.

MedicalBillersAndCoders.com has been providing assistance to physicians and healthcare organizations across 50 states in the United States to receive timely reimbursements for over a decade now. We have certified billers and coders who are well versed in handling all sorts of discrepancies & situations. We also provide professional solutions in medical billing, coding, RCM, denial management, along with regulatory compliance helping  physicians to balance their roles and concentrate mainly on patient care while we strive to achieve maximum & timely revenues for our physicians.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services  according to their preferences of specialty, city, software and services performed.

Denial Management – Integral to Physicians’ Conquering Reimbursement Challenges While Medical Billing

Denials are responsible for major erosion of practice revenues, and, despite the best efforts, denials continue to assume monstrous proportions. The situation has grown so alarming that:

• Medical practices fail to collect 25% of the money they are owed
• $125 billion is left in the bag as unpaid claims
  
• Only 70% of claims are paid the first time they are submitted
  
• Of those denied claims, 60% are never resubmitted to payers
  
• Medical practices never pursue 18% of claims at all

While payers (whether Medicare, Medicaid or private health insurance companies) are justified in denying claims with inherent errors, it is physicians who are responsible for not pursuing with resubmission and intensified efforts. This is where Denial Management becomes significant.

Denial Management comprises thorough analysis of denials and ways to convert denials into reimbursements. The crucial part of an efficient denial management practice is re-appealing with substantial proof.But the actual process of your denial management starts with knowing the reasons for denials.
Over a period of time, it has been seen that payers base their rejections on the following:

• Registration inaccuracies, wherein either patient’s insurance is not verified or a wrong payer is mentioned or it is difficult decipher patient’s identity
  
• Charge Entry with unacceptable procedure or diagnosis codes
  
• Lack of referrals & pre-authorizations
• Inadequate information about patient
• Claims with code duplication for the same procedure
  
• Lack of substantial proof for medical necessity of a procedure
  
• Inaccuracies in clinical documentation
• Bundling non-allowable items or applying modifiers where they are not permissible
  
• Lack of credentialing

 Once you have known the root causes for denials, it should lead you to analyze the extent of denials as against the actual submission. Practice Management System (PMS) makes it easy for you to track down denied claims. The advantage of having a PMS in your practice is that it reflects the exact payment posting against each of the submitted claims making it easy to identify the under realized or denied claims.

Having known the reason and the extent of denial, it is now time to put your denial management skills into practice. While coding revision and modification set the things in motion, it is the relationship with the payers and adjudicating agencies that would eventually tilt the balance in your favor.

But it has been found out the physicians are either reluctant or do not have time to focus on these denial management skills amidst their busy clinical schedule. The fact that their internal staff too lacks these skills has not helped their cause. Therefore, medical billing consultancies that offer to integrate denial management processes into your medical billing practices should offer the much needed relief.

Medical billers and coders – being a proven medical billing consortium offering quality and result-driven medical billing services – across all 50 states for over a decade with experience in handling a varied payer mix – are known for elevating practice revenues through integrated denial management. To substantiate our denial analysis, we follow these steps carefully:

• Figure out specific causes for the accumulation of the denied receivables. Such denial analysis provides us the characteristics of the denials, and an opportunity to get them resolved comprehensively
• Analyze the financial impact of the denials; our team of expert medical billing professionals is adept at identifying the general pattern and stake of the denials to evaluate its impact on financial returns
• Provide feedback to improve the efficiency through root-cause analysis and financial impact analysis of denials

MBC’s unique integrated approach has helped physicians of varying sizes & specialties by interpreting the reasons for denials, increasing resubmission and realization through instant denial analysis and management process.

For more information visit: Medical Billing Companies

How can A Medical Billing Service Help in Increasing Revenue at Your Practice?

Quality and cost have been inseparable. And, as U.S. health care industry is defined by new quality benchmarks, cost of administering medical services too seems be rising proportionately. While physicians continue to respond with appreciable clinical efficiency, they seem to have lost ways to find sustainable existence and growth. The existence of intense competition has forced them to operate at the most competitive prices, and off-set with volume. But, volume has failed to generate real revenues due to several reasons. As a result, many practices have either been forced to wind up operations or sell off.

One of the primary reasons for disproportionate revenues vis-à-vis actual volume is failed medical billing practices. Physician practices are either incompetent or lack the requisite infrastructure to take on the challenges of medical billing. The presence of multi-payer system too has not helped their cause. Medicare, Medicaid, and private payer environments pose unique challenges, which can be handled only by experts.

Sweeping health care reforms too have contributed to physicians’ billing woes. While reforms have generally been promulgated to streamline health care delivery and billing, physicians have found it tough to adapt to monumental transitions such as mandatory EHR compliance, ICD-10 coding, and performance-linked reimbursement regime or ACOs. There have also been instances of failed experiments on account of lack of expert or outside billing consultancy. The impact of these reasons is reflected in under-realization of claims, denials, and undesirable A/R days.

The solution to these inherent challenges lies in a full-pledged Revenue Cycle Management that can effectively mitigate under-realization of claims, denials, and undesirable A/R days. Physician practices that have been or likely to be impacted with revenue issues on account of internal billing incompetence and Federal Government’s clinical and operational reforms would do well to engage RCM consultancy that:

• Increases revenue collections by ensuring patients are eligible for medical services and verifying pre-authorization prior to the examination
• Allows tracking each stage of a claim or batch from first logged to posted payment
• Vigorously follows up with unresolved claims issues and diligently appeals denied claims
• Evaluates denial rationales and coding errors in order to establish follow-up procedures that maximize recovery rate
• Employs predictive modeling to forecast future revenue streams and support cash flow
• Is compliant with Medicare and HIPAA 5010 norms, and operates on certified EMR platform that satisfies HITECH requirements, qualifying physicians for performance incentives
• Provides unparalleled transparency through comprehensive reporting and web-based tools that let you manage performance

It is also imperative that your Revenue Cycle Management (RCM) provider follows the tried and tested process, which comprises orderly execution of patient pre-authorization, eligibility and benefits verification, claim submission, payment posting, denial management, A/R follow up, reporting, and litigation management.

Medicalbillersandcoders.com – with credentials and expertise in managing revenue cycle processes for physician practices of varying sizes across the 50 states in the United States – holds the reputation of being a leading RCM provider with a comprehensive approach, encompassing  patient scheduling and reminders, patient enrollment (demographics and charges), insurance enrollment (for physicians and offices), insurance verification, insurance authorizations, coding and audits, billing and reconciling of accounts (payment posting), account analysis and denial management (EOB analysis), AR management (insurance and patient), and financial management reporting.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services  according to their preferences of specialty, city, software and services performed.

Monitoring Potential for Up-Coding Errors in EHR with the Help of a Medical Billing Service

There has been considerable resolve and persuasion from the Federal Government to introduce Electronic Health Record System across the health care continuum. The Health Information Technology for Economic and Clinical Health (HITECH) Act has indeed given much impetus to pace of conversion from paper to electronic medium. The bait of financial incentives and penalties for complying with ‘Meaningful Use Criterion’ or otherwise has done wonders to the overall macro clinical efficiency as well physicians’ operational efficiency. In fact, no one would have foreseen the extent of transformation when the Federal Government first announced its major IT reform in 2009.

One of the significant advantages of EHR is that it has enormously simplified complex documenting during the billing process. As a result physician practices have been able manage higher level coding with far more degree of confidence than before. But, amidst all these catalytic effects of EHR, EHR is also known to have paved for errors that had not been possible with paper documentation. While EHR’s ‘cloning feature’ allows one to copy previous notes to current notes, it could also inherit errors in the previous notes or be filled with information that may not be pertinent to the current visit.

The consequence of such cloning is that it may promote coding inconsistencies or up-coding. While physicians may benefit initially with inflated reimbursements, they may be susceptible to audit later. Therefore, with their credibility at stake, they should see that EHR is utilized for the purpose it is meant for: safe and efficient patient care. Whether EHR errors come from system inadequacies or personnel incompetence during billing, physicians should actively involve themselves in resolving them through:

• Charting reviews while processing bills through electronic systems
• Sourcing EHR systems from vendors who promise what is right for you
• Generating baseline CPT frequency report of your E&M services for each provider before you adopt an EHR
• Evaluating variations in coding patterns
• Reviewing your practice records and looking for evidence of cloning or carrying forward notes on physical exams and patient histories
• Shutting down “auto-coder” if your EHR has one

Practically, it may seem too much to ask of physicians who are primarily motivated by clinical focus. The best recourse is to engage competent EHR consultants or medical billers and coders who offer EHR consultancy as an extended service. Medicalbillersandcoders.com– with an extended capability for EHR sourcing, implementing and monitoring for physician practices of varying sizes and specialties – should practically solve all of your EHR related woes. Our strategic alliance with leading EHR vendors will help you find custom-made EHR systems that make it easy to find out cloning and up-coding even before the claim is submitted to the payers or Medicare/Medicaid.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

Combining Medical Billing and Coding to Deliver Maximum Physician Revenue

'Medical billing’ and ‘Medical coding’ may have sometimes been used interchangeably to mean the act of claiming reimbursement from insurance payers, but essentially they are two separate and specialized jobs. Medical coding precedes medical billing, and it is irreversible. While a medical biller is entrusted with far more task than a coder, it is the quality of coding that largely decides the success of medical billing. That is why medical coding is often termed as a ‘specialty’ by itself while medical billing, its ‘sub-specialty’.

Medical coding is based on the descriptive narration of the medical services or procedures done by physicians. The coder assigns appropriate codes based on the physicians’ clinical summaries. Here, he may have to verify with diverse source points to validate the correctness of the physician summaries. Typically, he may have to rely on the transcription of the doctor’s notes, ordered laboratory tests, requested imaging studies and other sources. Such verification is necessary in avoiding denial, delay or exposure of claims to payer audit remarks.

Coder’s general responsibility is restricted to assigning CPT codes, ICD codes and HCPCS codes to both report the procedures that were performed and to provide the medical biller with the information necessary to process a claim for reimbursement by the appropriate insurance agency/s. But he may also be required to audit and re-file appeals of denied claims. In certain cases, coder may also educate providers and recommend the appropriate application of federal mandates and compliance that require providers to use specific coding and billing standards through chart audits.

Medical billing, on the other hand, is a series of activities culminating in ensuring maximum reimbursement for physicians. A medical biller job begins with filing insurance forms in the admissible formats with the payers. He may be required to clarify diagnoses or to obtain additional information so as to substantiate physician claims for reimbursement from payers. Like coder, he should also be familiar with CPT; HCPCS Level II and ICD CM codes to help him better understand the clinical summaries.

Apart from preparing invoices, medical biller may even be involved in rectifying past error on account of coding discrepancies. Collecting payments, making adjustments, interpreting Explanation of Benefits (EOBs), and handling denied claims, and processing appeals are all part and parcel of a biller’s routine.

Irrespective of whether coding and billing are done separately or by the same individual/s, the success of physician reimbursements depends on how best they complement each other. While medical practices used to manage coding and billing as a comprehensive internal function, it later started impacting their core function – clinical efficiency. Therefore, outsourced coding and billing became the accepted practice. And, with the US health care industry embracing its biggest billing and coding transition (ICD-10), along with the other reforms affecting the industry physicians’ reimbursement rates may further be impacted. Therefore, finding competent billing and RCM service providers makes much more sense than embarking on costly in-house practices, which may or may not yield the desired results.

Medicalbillersandcoders.com – with demonstrated ability in ensuring maximum reimbursement for a large pool of physician practices across the 50 states in the US – should be your first choice of billing and RCM services. Capable of maneuvering through multi-payer and ICD-10 environment, our billing services live up to being the most comprehensive with Patient Enrollment, Insurance Enrollment, Scheduling, Insurance Verification, Insurance Authorizations, Charge Entry, Coding, Billing and Reconciling of Accounts, Denial Management & Appeals and Physician Credentialing services.

For more information visit : Medical Billing Blog

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies   in USA & help doctors to shortlist Medical Billing Companies, 

Medical Billing Services  according to their preferences of specialty, city, software and services performed.

Navigating through Regulatory Changes that Dramatically Affect Medical Billing

The limited reach of US healthcare network leaves a large part of American population outside the net of healthcare. This problem has stalked US governments traditionally and to expand the reach of healthcare to make healthcare available to a larger part of US population, successive governments (in varying degrees and as suited their political beliefs) have introduced regulations to make healthcare cheaper for and easily accessible to the care receiver.

In continuity of this tradition, the last few years under Obama administration have been witness to a flurry of regulations. Whilst one can argue that they have addressed the traditional concerns and empowered US healthcare to stand up to the challenges of technology and needs of modern day healthcare, the regulations have also affected the day-to-day healthcare operations carried out by medical practitioners coiling up every treatment procedure with regulatory activities burdening care providers with activities they neither have time nor qualification to perform.

The Affordable Care Act will expand the number of insured people by more than 30 million people. To restrict the increasing cost of Medicare, the act will create a panel of experts to prevent reimbursing for treatments not found effective and create incentives for healthcare providers to offer bundled payment modules to care receivers.

These are indeed very effective measures to take healthcare to lower income groups in the US and reduce healthcare costs, but they throw considerable operational challenges to healthcare operators. The effect of increase in number of insured Americans from a care provider standpoint is quite simple to understand: it will mean more regulatory responsibilities for care providers in way of having to deal with technical details related to billing and coding, using codes appropriately, etc., leading to not just time spent by them on nonmedical activities but also exposing them to the prospect of inaccuracies in preparing insurance claims resulting in claim denials.

However, the bundled payment aspect warrants a deeper look to understand the impact of regulations on day-to-day healthcare operations. A treatment episode is a sprawling affair. It includes various phases of treatment an individual goes through from pre-hospitalization diagnosis through hospitalization to post hospitalization care. Each one is a distinct healthcare activity and traditionally has had separate healthcare fees. Bundled payments club together the different fees associated with each phase of a treatment episode and offer the care receiver one fee for the entire treatment life-cycle, saving him money.

Albeit, this everything-rolled-together approach requires sound coordination among various specialties involved in a treatment episode for data sharing and final pulling together of medical information to prepare claims using appropriate codes for each phase of treatment. Big healthcare bodies have addressed some of these concerns (like internal coordination and easy availability of medical data while preparing claims) by making all the services available under one roof but are struggling with others, like using appropriate codes and spending resources (time and money) on non-medical activities, all leading to low rates of claim reimbursement and revenue leakage. Finding it difficult to withstand the financial onslaught wrought by denied claims and losing patients to big care providers, small operators have aligned themselves with big care providers losing their entrepreneurial independence.

Coping with the changes caused to medical billing:

The irony of this whole US healthcare industry saga is that what has caused this is not a healthcare issue but an administrative one. To handle this issue, a care provider either needs an in-house setup with a strong revenue management system staffed by well-trained billers and coders to handle the entire claim preparation process using appropriate codes and medical details where necessary and knowledge of software platforms to submit the claims electronically to ensure HIPPA compliance or needs to outsource the entire claim administration process to a biller and coder.

Medical Billers and Coders, the largest billing and coding consortium in the US,  has helped care providers in all 50 states of rural and urban US to address these issues helping them to save time and cost, an advantage they can divert to their core business, healthcare, and also share with the customer. MBC’s experienced billers and coders are familiar with all regulatory details and prepare claims with high degree of accuracy ensuring low rejection rates.

MBC can also spruce up your revenue management cycle by pruning up your processes, replacing your old software platforms with new and appropriate ones and training your staff in administrative details as also cross-functional competencies thus reducing your downtime and ensuring the continuity of your billing process in the absence of a staff.

Increasing Revenue through HIPAA Compliant Practices

HIPAA (Health Insurance Portability and Accountability Act), which was first enacted in 1996 to improve the efficiency of healthcare delivery, has come to be recognized as the standard for  electronic data interchange (EDI), security, and confidentiality of all healthcare-related data.  The Act mandates: standardized formats for all patient health, administrative, and financial data; unique identifiers (ID numbers) for each healthcare entity, including individuals, employers, health plans and health care providers; and security mechanisms to ensure confidentiality and data integrity for any information that identifies an individual.

Healthcare providers exchange healthcare data for a variety of purposes: collaborative clinical management, national healthcare planning, and more importantly for medical billing. Medical billing is a series of tasks comprising claims submission, charge entry, denial management, payment posting, tracking of accounts, appointment scheduling and rescheduling, billing and reconciling of accounts, patient enrollment, patient scheduling and reminders, financial management reporting, AR management (insurance and patient),  medical coding audits, insurance verifications; insurance authorizations and follow up of rejected claims. The sum total of these tasks is collectively called Revenue Management Cycle (RCM).

Providers at each of these RCM task are required to follow HIPAA norms. One of such predominant norms is electronic processing of billing and coding in accordance with the HITECH’s meaningful use criterion. Failure to comply may invite mandatory data breach notifications, heightened enforcement, increased penalties and expanded patient rights. The cumulative effect of these impositions may unduly delay claim realization, thereby affecting practice revenues. Providers may even face intense audit and scrutiny, which may be detrimental to their credibility and sustenance in a highly competitive healthcare industry.

Therefore, it is advisable that providers’ outsource proven, web-based framework that allows them to collaboratively manage their HIPAA/HITECH Act compliance initiatives including HIPAA Audits and HITECH Privacy Breach Management using a single, integrated solution. Using such robust system (an integrated EHR with EMR and PMS), they will be able to perform the entire range of clinical and operational functions in sync with the HIPAA norms. Once they have their clinical and operational functions (billing included) on the right track, it will be easier to expect unhindered and fast realization of claims. The advantage of engaging a HIPAA-compliant outsourcing company is that it assures confidentiality of patient and practice information in accordance with the norms laid down by the Health Insurance Portability and Accountability Act (HIPAA). This helps avoid unnecessary litigation and maximize claim reimbursement.

Medicalbillerandcoders.com comes across as a trusted name in HIPAA compliant medical billing and RCM services. For over a decade, we have been helping healthcare providers (across the 50 states in the US) realize maximum revenues through reliable HIPAA compliant practices.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services  according to their preferences of specialty, city, software and services performed.

Billing “Urgent Care” As It Emerges As One of the Fastest Growing Specialties

Urgent care is fast developing as a viable alternative to what has traditionally been known as “family practice”. The main reason behind this new-found fancy is that physicians can now operate from designated facilities without having to trek around offices, nursing homes, and hospitals. Additionally, urgent care centers are preferred to other similar types of ambulatory healthcare centers, such as emergency departments, and walk-in primary care centers by the scope of illness treated and facilities available on-site. It will not be long before we witness further addition to already 8,700 urgent care centers (UCCs) across the US.

While it is true that practicing Urgent care offers physicians an extended scope and avenue for revenue generation, there are certain criteria (established by The Urgent Care Association of America) that physicians must abide by. These criteria describe scope of service, hours of operation, and staffing requirements. A qualifying facility must treat walk-in patients of all ages during all hours of operation. It should treat an entire range of illnesses and injuries, and have the facility to perform minor procedures. An urgent care center must also have on-site diagnostic services, including phlebotomy and x-ray. Because of this inclusive medical service coverage, Urgent care medical billing has become far more complex than usual. Urgent care physicians will be called upon to deal with:

• Code that allows urgent care centers to code and get reimbursement for the extra expenses involved in providing urgent care services
• Code that allows the urgent care center to receive reimbursement at one flat rate (Global Fees for services rendered at Urgent care centers) for all visits coded with it
• The usage of evaluation and management (E/M) codes as per EMTALA guidelines if it is a Type B emergency department
• Facility codes in urgent care
• National Provider Identifier (NPI)
• E/M Code plus Procedure Code in Urgent Care
• Level 1 E/M Code 99211
• Codes for services rendered during extended hours
• E/M Code + IV injection procedure code

Added to this complex coding is a reimbursement environment which has become more restrictive post a series of healthcare reforms recently. This additional burden of revenue cycle management (RCM) to an already overweighing clinical schedule may impede the very focus of clinical excellence. This is precisely the reason why physicians are turning to specialist billing and revenue cycle management from “urgent care medical billers”. Consequently, there has been an unprecedented demand for billers and coders in this domain.

At a time when the market is still peaking, Medicalbillersandcoders.com – the leading source for specialist billing and RCM services – has taken the lead in supplying the right billing and RCM sources to urgent care practitioners. Spread across all the 50 states in US, we provide experienced billing experts for urgent care billing & RCM for your medical practices.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Servicesaccording to their preferences of specialty, city, software and services performed.

Navigating Through a Multiple Payer Environment – Providers’ Perspective

Healthcare delivery in the United States of America has come a long way from cash-based to insurance-backed. Currently, over 85% of the nation’s residents have health care plans either through employers’ private pools, private companies, the veterans’ health administration, the children’s health insurance program and Medicare/Medicaid /TRICARE. While insurance payers (whether Federal or private) essentially cover health risks of the insured, they differentiate themselves with their respective restrictive operational requirements. The impact of this restrictive payment environment is such that health care providers are increasingly finding it difficult to procure their payments on time. And, with the Federal Government inclined to make health insurance mandatory, care providers’ only hope is to find a way to deal with multiple regulatory insurance payers.

Unlike United Kingdom and Canada, which have single-payer system, US is characterized by Federal and Private Payer systems. And Federal system is again sub-divided into Medicare/Medicaid/TRICARE.

The majority of insured Americans receive their health care (insurance) coverage via a private insurance company. Currently in the country, 59.3% of all insured Americans have coverage through private insurers. These private insurance holders can once again be classified under:

• Group insurance, which is availed through an employer with provision to cover spouses and children, based on the particular package
• Individual Insurance, which is purchased by the insured himself to cover his or his family health risks
• Managed-care plans: The two most popular types of managed-care plan providers in America are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). An HMO plan will have a predetermined facility and doctor for you and/or family. When you need treatment, you will have to visit the contracted facilities and see the contracted physicians in order for the insurance to pay the bill

With so many variants of private healthcare policies, healthcare providers usually have a hard time understanding and billing with private payers. The stress is so much that it is actually started to impede their clinical efficiency, which is their main concern. There is a whole lot of stressful restrictions that providers will come across, such as:

• dealing with deductibles and copayments,
• establishing medical necessity of a procedure
• dealing with preexisting conditions

Though dealing with Federal Payer system is relatively less difficult, providers have to deal with state-specific rules that govern Medicaid/Medicare:

• With the Federal Government hinting at extending Medicare base from the current 28%, providers will have more Medicaid/Medicare supported visitors
• Federal Government entertains Medicaid/Medicare beneficiaries’ bills from only a few designated providers. Therefore, care providers have an overriding duty to check insurance authorization prior to administering medical services
• Further, Medicare/Medicaid is also bound by restrictions on repetitive, pre-existing, and quantum of admissible medical expenditure to its beneficiaries

If understanding multiple payer system and their respective restriction constitutes half of the battle, billing and coding in ICD-10 and HIPAA 5010 Version will constitute the other half. But, providers, with their clinical efficiency at stake, would do well to assign these operational issues to external billing consultants.

Medicalbillersandcoders.com with credible history of helping physicians realize maximum claim realization amidst multiple payer environment – will help make the task a lot easier. Our medical billing professionals are highly trained and certified with experience in handling multiple payer environment and the latest coding practices. Their expertise combined with our technology edge is a sure way to turnaround your practices’ revenues.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services  according to their preferences of specialty, city, software and services performed.

Healthcare Systems Adopt Trend of Outsourcing in the New Era of Value-Based Care

In the time when both, federal and provincial healthcare quality initiatives have come up with healthcare reforms, thus making EHR mandatory in order to avail the incentives under ARRA, the compliance with Medicare Medical Billing norms, demand of documentation under Medicare’s Accountable Care Organisation (ACO) model and the transition of both ICD 10 and HIPAA 5010, health care documenting in healthcare would probably never be the same. Though these reforms have been introduced with the sole aim of increasing the clinical and operational efficiency in healthcare organizations, the physicians have a lot to cope up with and this can hinder them from focusing in their function of providing medical services.

In the era of value based care, physicians find it tough and time consuming to balance administrative along with their prime function of patient care on their own. Outsourcing the administrative processes which needs expertise and resources is significantly more appropriate approach when these aren’t available in house. Health care organizations and physicians are increasingly seeking contractors for services like billing, coding, medical staffing and information technology services in order to bridge the gap. The companies providing these services have no doubt proved to be beneficial for the growth of its clients. Moreover, it has been found that the growth in outsourcing between the 2010 and 2011 was reported to be around 13.1% with 20 outsourcing firms which served 16,463 clients.

Benefit of Outsourcing

Partnering with an outsourcing firm has brought more technology and expertise in the industry, thus expanding the job options in the field, along with helping physicians extract most of the money for the services they deliver.  Contrary to the popular belief that the small healthcare firms do not need outsourcing, truth is small facilities too are finding it beneficial to outsource as they adopt electronic billing and EMR implementation along other reforms in the new era of value-based care.

Outsourcing the task of medical billing relieves the medical professional from various administrative tasks. The health care organization can be saved from a few issues which are unavoidable like:

• Staff retention: with the outsourcing process, healthcare organization need not worry about recruiting, managing & retaining billing staff and training new billing staff  when old staff retires or moves on, hence helping in smooth functioning of the billing process
• Billing possible on all days: with in-house billing there is complete dependency on fixed staff members and in case of absence of any of the staff members or any holiday, the billing process is kept on hold, but with outsourcing this headache is eliminated ensuring on-going billing process throughout the year

Outsourcing can make your office run more efficiently and systematically with small investments which although go unnoticed, but are considerable in total like postage charges and telephone bills also reduce. Added costs for labour, office system and other operational expenses are also reduced considerably. Furthermore a better turnaround time with better revenue cycle is guaranteed along with improved collection rate on an average of nearly 20%.

MedicalBillersandCoders.com the biggest consortium of billing and coding experts, has been assisting medical practitioners and health care workers for over a decade now towards betterment of revenue cycle and management of administrative tasks. Our billing and coding experts are also constantly trained and updated with the latest reforms, thus rendering the clients stress free and relaxed as far as revenue is concerned.

How are Physicians Expected to Bill Post Implementation?

Even though ICD 9 and ICD 10 are very similar in many ways including the guidelines, rules and conventions used which consequently brings out similarity in the organization codes as well; ICD 10 is a product of many improvements done in ICD 9 coding.

In spite of the overwhelming improvements, the transition from ICD 9 to ICD 10 has been a huge challenge for the physicians, medical billers and health care workers to catch up with the advancements. Also the staggering number of new codes has made the learning process a tad complex along with complicating the coding process, making the claims susceptible to errors and vulnerable to denials. This is further exacerbated by difficult denial management.

According to the new proposed rules from Department of Health and Human Services, health care professionals would be required to bill their services using ICD 10, with effect from October 1, 2014. This date has already marked the one year extension to the previous date of October 1, 2013. Along with the introduction on 5010 new electronic codes, the physicians are also expected to meet a few other health and quality information technology initiatives like adopting electronic health records and participating in physician quality reporting system.

With the number of codes skyrocketing from 17,000 to around 140,000, healthcare providers along with their medical billers and coders need to pull up their socks in order to avoid having any problem with insurance reimbursements and denials. According to the official website of CMS, compliance date for implementation of ICD 10 is October 1, 2014 with no grace period or further delay expected, however they have not yet mentioned grace period for billing under ICD-9 without penalty post October 2014.

Nonetheless the transition period would pertain roughly for two years during which the coders would have to work simultaneously with both, ICD 9 and ICD 10. At the same time, the billers would be required to train with new set of procedures and policies, in absence of which the employer might result in lowered productivity in the future. The billers also need to learn about the policies introduced for payment reimbursements along with the new ANSCI reposting methods and electronic formatting procedures.

Medical Billers and Coders with ICD 10 implementation will additionally need to possess a more detailed knowledge of the anatomy, physiology and medical terminology and also work in close association with the doctors and educate them about the proper coding methods.

Also as mentioned earlier with no further delay expected, medical practitioners need to catch up with the new reforms; to avoid as much as possible any chance of decreased cash flow. With a possibility of increasing call volume for denials and rejected claims along with increased billing audits, it is advised that physicians take the next step towards ICD 10 transition soon.

MedicalBillersandCoders.com serving healthcare for more than a decade now have already initiated a unique ICD 10 training program which helps coders and billers get updated with the latest ICD 10 developments and reforms. Our billers and coders are already preparing for this transition as our training program endeavours to positively help you, as a medical coder and biller to remain at your competent best when the times change from ICD 9 to ICD 10.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services  according to their preferences of specialty, city, software and services performed.

Managing HIPAA Issues at your medical practices

With the application of HIPAA, (Health Insurance Portability Accountability Act), health care organisations need to be cautious with whom to share the patient information. HIPAA calls for protection of the individual’s health information, at the same time; this privacy rule also permits limited disclosure of health related information to related entity of a person who needs patient care, thus, bringing on added responsibility for the staff.

Challenges faced: Introduction of HIPAA has proved to be a challenge for medical billing over the recent years with providers required to send claims electronically in compliance with the act, in order to receive their payment. Medical billing and insurance companies have both been affected because of the regulations imposed by HIPAA requiring additional waivers and increased documentation related to HIPAA. Moreover billing software used along with business processes – practice management service vendor, billing system and clearing house – also need to be re-looked so as to become compliant with the HIPAA.

Benefits to medical practice due to HIPAA: Efficiency and cost savings are some of the many advantages of using HIPAA standard transactions:

• Electronic claims: the HIPAA rules require the Medicare claims to be submitted electronically. Most of the providers are able to electronically claim directly to their insurers
• Patient satisfaction: an efficient HIPAA compliant billing system ensures patient information privacy hence improving patient satisfaction and in turn patient count for the physician

Electronic claims have proved to be a giant leap for the health care industry. Huge gains have been estimated by the analysts by implementing the transactions as per required by HIPAA.

Current move to HIPAA 5010: According to CMS Physician offices are seeing reductions to their revenues after the move to HIPAA Version 5010. Industry experts feel problems due to this transition has affected physicians, billing clearinghouses, and public and private insurance payers as well. There has also been a lack of uniformity with certain practices billing using the older HIPAA 4010 standards, with some health plans adjudicating those claims while some clearinghouses are automatically converting 4010 transactions into the 5010 format for payment.

Streamlining your billing system: Getting a separate billing system for your medical practice can be prove to be beneficial as being specialists in their field they can easily perform assessments of your practice, using the latest HIPAA regulations and standards, also improving the revenue cycle- leaving enough time for the health care staff to do their job and physicians to solely concentrate on patient care.

Medicalbillersandcoders.com billing for more than a decade now play an indispensable role in confirming to HIPAA while billing for health care organisations. They make sure that individually identifiable information on health is protected and there is no violation of the act. MBC serving various specialities in healthcare is constantly updated with all billing reforms along with HIPAA norms while billing, helping health care professionals to concentrate on their core job of patient care, rather than worry about proper implication of HIPAA and other reforms.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services  according to their preferences of specialty, city, software and services performed.