Medical Billers and Coders

The constant change in the healthcare industry has impacted timely reimbursement for medical practices over the past few years. Pathology Medicare and Medicaid have gone on a reduction spree as far as physician reimbursements are concerned. Most third-party payers like   Cigna   and   Aetna   are keener on signing up contracts with physicians that focus on fee-for-service, where the reimbursement is less than 100% more often than not. Here are a few ways to enhance revenues and have a perfect billing process in place. Be Familiar with your LCDs Pathology billing companies need to be familiar with Local Coverage Determinations (LCDs) and know the ins and outs of how they are related to various specialties and other frequently billed services. LCDs give a crystal clear picture of the instances when some procedures are covered by Pathology Medicare. They will also indicate the specific circumstances under which a procedure is considered appropriate and absolutely necess...

There are not a lot of us who believe that family practice physicians are adequately paid for the kind of valued care they deliver to patients and to the health care system. As an established   medical billing   and   coding organization , we regularly observe how desperately clinicians need primary care payment reform. Agreed that there is a better future for the healthcare industry on the horizon, but as of now, we have to make the best of what the dysfunctional healthcare system offers. For many doctors whose reimbursement depends in part on our productivity, increasing gross revenue is one vital element to your success. Family practitioners can protect their  revenue  stream by being equipped to provide as many procedural services as possible and also by making sure that they are billing and coding for the minor procedures that they already perform, but might not know that they can be paid for. Strategies to increase your family practice revenue Review the s...

Many internists are opting out of private practice due to rising costs and reduced reimbursements. Billing and administrative challenges are also adding to their woes, forcing them to join large medical groups or take up jobs in hospitals. They are quitting their private practice to avoid the revenue challenges and the hassles of running a medical office. According to industry surveys, it has been observed that more than 70% of doctors are spending one full day in a week on paperwork. For instance, a Physicians Foundation survey states that approximately 44% doctors are looking for ways to reduce their work hours and patients. Estimations have been made by the industry experts that productivity of physicians is estimated to drop by 25% due to mounting administrative burden. Similar to other specialties, many internists and their staff are also struggling with financial and administrative issues that pile up throughout the day or the month. Few Industry Facts Internal Medicine doctors h...

The technique by which Current Procedural Terminology (CPT) codes are developed with the goal that physicians can get paid for the services and procedures they give is an extremely entangled procedure, one that deserves some explaining. Furthermore,   Medical Billers and Coders (MBC)   is effectively occupied with this procedure and advocates for the eventual benefits of its clients, which incorporates improved payment for   primary care   codes and subspecialists under Medicare. Primary Care Codes for Improved Payment CPT codes are utilized to report medical services and procedures performed by physicians and other health care experts. The CPT Editorial Panel meets during that time to audit new and existing CPT codes for approval or updating. Values are assigned to new CPT codes and re-examined for existing codes by the Relative Value Update Committee (RUC), an advisory body that makes recommendations about the value of physician services to the Cente...

Physicians in general surgery are facing an uphill task of medical billing keeping in check the different needs of the facilities and keeping a tab on the effective revenue cycle management to look for frequent denials and which of the claims need more efficient coding. The channel of insurance payment has been one of the most straining factors for general surgery physicians today affecting the bottom line of the revenue and in turn affecting the facility.  Individual physicians have a high cost of staffing and also   revenue management   which has led to many of them being absorbed by groups acquired by the hospital. General Surgery is one such facility that has seen a rise in individual costs and most of the facilities are either in the group or combined with hospitals. Tracking different types of patient care from appointment scheduling to registration and different steps for collection of the balance fall under revenue cycle management. The healthcare revenue cycle is...

Despite the fact that the basic observation might be that using the services of an Ambulatory Surgical Center (ASC) will spare cash, as contrasted to using the services of hospitals for outpatient surgery. However, this may not generally be the situation. Actually, the outcomes can differ significantly from state to state. A restorative office handles the regulatory errands for a therapeutic practice, clinic, or another medicinal facility including welcoming patients, planning appointments, registration, and enlistment; also collecting cash and various different assignments including medical billing. While the vast majority of alternate undertakings performed by the medicinal office are the same overall healing centers, ambulatory hospital billing services are most certainly not. If you ask most medical billers, they will mention that there are noteworthy contrasts in the handling of medical cases over various claims, specialties, and facility services. There is a flat-out contrast in ...

Primary Care First Model Options is a set of voluntary five-year payment options that reward value and quality by offering an innovative payment structure to support the delivery of advanced primary care. It will help in prioritizing the doctor-patient relationship; enhancing care for patients with complex chronic needs and high need, seriously ill patients, reducing administrative burden, and focusing financial rewards on improved health outcomes. Primary Care First Model Options will be offered in 26 regions for a 2020 start date. Background Primary care is central to a high-functioning healthcare system and thus, there is an urgent need to preserve and strengthen primary care as well as a need for support of serious illness care services for Medicare beneficiaries. PCF will focus on advanced primary care practices ready to assume financial risk in exchange for reduced administrative burdens and performance-based payments. PCF also encourages advanced primary care practices, includin...

Price transparency refers to the extent to which information is obtainable. It is when all parties in trading are aware of the product pricing i.e. awareness and knowledge of the bid price and asks price at various price levels, along with the quantities of any good or service involved. This also results in discrepancies in the billing and coding, thus affecting   revenue cycle management. DME refers to equipment such as oxygen supplies, wheelchairs, knee braces, etc. It has to be prescribed by a medical practitioner and the person buys this equipment from a DME provider or sometimes, the doctor himself calls a DME company for delivering it straight to the patient's home. This is where the price transparency has a catch. A knee brace could cost anywhere from a range of $250 to $1500 from two different DME companies. DME billing then gets erroneous due to double bills and unsuitable expenses. Effects of Price Transparency - DME billing takes a course on patients also as sometimes in...