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Showing posts from August, 2022

Dermatology Year-End Billing Challenges: Why Revenue Drops and How Outsourcing Protects Practices

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Top Year-End Billing Pain Points Dermatology practices face some of the most complicated coding and reimbursement issues at the end of the year. Seasonal appointment spikes put additional pressure on billing teams struggling with: Declining reimbursements for common procedures such as biopsies, lesion excisions, cryotherapy, and Mohs services Payer-to-payer coding variability, especially on pathology-linked services Bundling disputes where multiple procedures performed in the same session are denied due to improper modifier usage Cosmetic vs. medical necessity confusion, leading to denials when documentation doesn’t clearly justify why a lesion needed removal Increased scrutiny on skin cancer—related services due to rising utilization These persistent challenges often leave dermatologists with more unpaid claims, lost revenue, and rising patient AR at year-end. What Practices Are Doing Right Now To reduce claim rejections before the year ends, most dermatology practices are: Re-trainin...
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Durable Medical Equipment (DME) Billing: Steps to Follow

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Durable Medical Equipment (DME) Billing   is different from the other   medical billing   and   coding   for the specialties. Unlike the other coders and billers who work on DME need specialized training to deal with different medical situations and equipment that require different types of modifiers as requested.  DME billers need specialized in-depth, specialized knowledge of different types of HCPCS Level 2 codes. Let’s understand the procedures of coding that can be implemented to make the billing process more effective: ICD-9 codes are 3-5 digits in length and speak to the patient’s conclusion CPT restorative charging codes are in fact HCPCS Level I codes. They are 5 digits in length and speak to the methodology performed at the patient’s visit HCPCS codes are in fact HCPCS Level II codes. They incorporate the two numbers and letters and are likewise 5 digits in length. These codes speak to the majority of the provisions or gear utilized in the patient...
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Location: Texas, USA
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Initial Step in Behavioral Health Billing Process

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  Medical Billing itself a complicated process. However, medical billing for Behavioral health is a whole new level of complexity. We make the Behavioral Health Billing Process smoother and efficient to get paid faster. Behavioral Health billing comes with its own set of unique and complex challenges. Between the types of services offered, unbundling concerns, pre-authorization, and the number of staff and their time availability, behavioral health facilities are often at a disadvantage compared to other health professionals. By ensuring that the process for Behavioral Health Billing is running error-free you can spend more time and energy focusing on what truly matters – you can focus on your patients. Why is Behavioral Health Billing So Difficult and Complex? Medical billing for behavioral health services is more complex than other areas of healthcare of the types of services, scope, time, and restraints placed on behavioral treatments. For an instance, if someone visits a behavi...
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Location: Texas, USA
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What are Current Trends in Ambulatory Practices?

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The number of visits to ambulatory practices fell by nearly 60 percent in the early stages of the pandemic which leads to financial pressure on sustainability for practice owners and administrators. Moreover, frantic patients are the main contributor to the sudden rise of daily call volumes as fear of the virus added a new layer of stress and anxiety. In such situations, providers opted for various critical decisions as reduced staff struggled to meet the demands of patients under new safety guidelines. As a result of this turbulent time, many aspects of ambulatory practices have undergone a transformation. Current Trends in Ambulatory Practices: Position Yourself for Success and Sustainability In the current dynamic healthcare environment, the efficiency and effectiveness of both your practice and business processes will drive your success. Today RCM has become more complicated and critical due to changes to payment codes, managing the intricacies of payer billing, and documentation r...
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Location: Florida, USA
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General Surgery Billing Alerts that determine your Revenue Cycle

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For a surgeon or medical practitioner, group practice, or clinic, insights into how specialty medical billing works can be a scary task. A billing agent that does not bill the sittings correctly misses deadlines, or does inadequate follow-up can have an abysmal effect on your facilities’ bottom line. However, a well-organized billing service cannot only simplify and improve your practice but also greatly improve both your income cycle and cash flow. At Medical Billers and Coders our specialist team is well trained in general and specialty surgery charging. For a general surgery practice to be financially successful, special attention must be paid to a number of factors, right from patient information and coding the full scope of services to following the Current Procedural Terminology codes and the Healthcare Common Procedure Coding System guidelines. Keep in mind that insurance provider payments are largely determined by these categories, and it is imperative that all information and ...
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Location: Texas, USA
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Skilled Nursing Facility (SNF) Consolidated Billing (CB)

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  Consolidated Billing Background Prior to the Balanced Budget Act of 1997 (BBA), an SNF could elect to furnish services to a resident in a covered Part A stay, either: directly, using its own resources; through the SNF’s transfer agreement hospital; or under arrangements with an independent therapist (for physical, occupational, and speech therapy services). In each of these circumstances, the SNF billed Medicare Part A for the services. However, the SNF also had the further option of “unbundling” a service altogether; that is, the SNF could permit an outside supplier to furnish the service directly to the resident, and the outside supplier would submit a bill to Medicare Part B, without any involvement of the SNF itself.  This practice created several problems, including the following: Potential for duplicate (Parts A/B) billing if both the SNF and outside supplier billed; An increased out-of-pocket liability incurred by the beneficiary for the Part B deductible and coinsura...
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Location: Oklahoma, USA
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Maintaining Financial Health of Your Family Practice

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  Rising operational costs, changed payer policies, decreasing reimbursement, and increased compliances adversely affect the financial health of the family practice. In addition, operational inefficiencies and waste cut even deeper into profits and income. The presence of a certain amount of each factor is inherent in any family practice. In this blog, we shared ways your family practice might be losing money and prevention tips that can help you to maintain the financial health of your practice. Efficient Family Practice Billing Medical billing and coding are the backbones of the revenue cycle of your family practice. Following bad  billing practices  might create unnecessary financial losses. Bad billing is caused more often by the incompetence of your in-house staff. For example, front desk staff may fail to verify and document patient demographics and insurance details. Due to this, claims may be sent late or to the wrong payer and patients may walk out without being ...
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Location: Alaska, USA
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Improving Ambulatory Surgical Center (ASC) Collections

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With patients having more financial responsibility for their healthcare, outpatient settings like ambulatory surgery centers are becoming more attractive to patients. A research report from Bain & Co. estimates that the number of procedures taking place in outpatient surgery centers will rise from 23 million in 2018 to 27 million in 2021. As per the same report, out of all outpatient surgeries done in the year 2017, half were performed by ASCs. Now as things are settling down after the corona pandemic, these numbers are again looking realistic. Before getting prepared for this growth potential, you have to streamline your current ASC billing process. In this blog, we discussed Ambulatory Surgical Center (ASC) billing challenges and ways to counter them. We are confident that these tips will help in improving your Ambulatory Surgical Center (ASC) collections.  Tips for Ambulatory Surgical Center to Improve the Patient Collections Process Always Take Prior-Authorization Prior to ...
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Location: California, USA
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General Surgery Billing Alerts that determine your revenue cycle

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  For a surgeon or medical practitioner, group practice, or clinic, insights into how specialty medical billing works can be a scary task. A billing agent that does not bill the sittings correctly misses deadlines, or does inadequate follow-up can have an abysmal effect on your facilities’ bottom line. However, a well-organized billing service cannot only simplify and improve your practice but also greatly improve both your income cycle and cash flow. At Medical Billers and Coders our specialist team is well trained in general and specialty surgery charging. For a general surgery practice to be financially successful, special attention must be paid to a number of factors, right from patient information and coding the full scope of services to following the Current Procedural Terminology codes and the Healthcare Common Procedure Coding System guidelines. Keep in mind that insurance provider payments are largely determined by these categories, and it is imperative that all informatio...
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Location: 108 W 13th St, Wilmington, DE 19801, USA
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