Medical Billers and Coders

  Long-standing concerns in DME (Durable Medical Equipment) known for unquestionable billing practices, led the government to take action for tackling fraud in the insurance industry. Medicare, the nation’s largest health insurance program, regulates the billing structure of the maximum number of healthcare providers. Due to its highly fragmented nature, Medicare is prone to widespread fraud thereby rising healthcare costs, taxes, and premiums. DME billing is  the process of submitting and receiving payment for a claim from the insurance company . Medicare pays for services given to the severely sick/disabled at home such as wheelchairs, arthritis kits, etc. But many DME companies supply cheap or bad quality equipment at good quality equipment rates to make profits or sometimes bill Medicare for equipment never provided. To crack down, on this fraud, the Centers for  Medicare & Medicaid Services  (CMS) issued new rules catering toward reducing needless consump...

Does in-house billing eat up too much time in your practice? Are you overly dependent on a number of employees to bill for your practice? Or are you losing significant money with your billing and coding practices? Well, if your answer is yes, then the time has come to outsource your  Podiatry Billing and Coding  work to an offshore entity. The financial well-being of your Podiatry practice is specifically related to timely billing and coding procedures. In the day and age where business outsourcing is gaining traction day by day, Podiatry Physicians from Florida are also not holding back when rendering the services of an offshore billing entity. Contracting a quality  medical billing and coding agency  is a standout amongst the most critical choices you’ll ever make with respect to the business part of your practice. It is important that your podiatry charging organization has the experience, important to handle the complexities displayed by Podiatry charging...

  ASC billing and coding is one critical undertaking, which if not performed wisely could lead the facility to the threshold of business losses. As Healthcare provider and payer regulations keep altering each year, the billing department of an ASC needs to refurbish their old charging provisions with new ones. But, as all problems today have a solution, so do this, and this is where  Outsourced Medical Billers and Coders  come to the forefront.  Outsourcing ASC Billing provides long-term profitability and the opportunity to grow without disrupting the ongoing RCM cycle of your practice. Choosing the right billing agency to handle your claims while outsourcing company charging prerequisites should not be taken lightly. There’s a significant amount of money and trust involved as you are relying on another person with your revenue cycle, which is the lifeline of your practice. Before selecting the right company, Physicians need to become as informed as pos...

  Professional medical billing services try to reach a level of efficiency when it comes to revenue cycle management of podiatry practice because of their exhaustive collection practices, incessant execution of billing tasks, and updated knowledge of prescribed documentation regulations. Podiatry billing like every other specialty billing faces its own set of challenges. Unskilled billing staff and inefficient billing practices can work havoc on the RCM process of your practice. Here are the reasons why Podiatry Practice Increase Revenue with Outsourced Billing Services.  The Reasons Why Podiatry Practice Increase Revenue with MBC: Better Understanding of Podiatry Billing Guidelines Centers for Medicare and Medicaid Services (CMS) are very particular about the prescribed billing guidelines. The team of billing experts is well-versed in podiatric procedures and related codes. This helps your podiatry practice to achieve your goal of flawless billing. Do check that the comp...

  Every successful doctor needs to know the crucial insights that go into podiatry billing to make it profiteering. With the view of recent regulation changes, your podiatry billing will need to understand the need for a modifier that acts as a myth. Here are Some Common  Podiatry Billing  Myths Busted for your Reference: Myth I: Modifier 24 is applicable to all services performed in the post-op period Reality – Modifier 24 is used in addition to an appropriate E/M code, in cases when the Evaluation & Management service takes place during a post-operative global period for reasons not related to the original procedure. We can say that this modifier indicates that the surgeon is treating the patient for a new problem altogether. This modifier is only for use during the postoperative period (10 or 90 days). This is because according to rules you cannot bill separately for evaluation & management-related services pertaining to the original surgery during the glo...

  All healthcare providers are searching for a streamlined DME billing operation team that may handle their DME billing process without much hassle. According to MarketWatch, the worldwide marketplace for Durable Medical Equipment (DME) is predicted to achieve up to USD 246.6 billion by the year 2026. This rise is predicted because of the advantages that DME products like a wheelchair, nebulizers, canes, crutches, walkers, etc. wear to people. Besides making patient’s life easy, DME products also help these patients live a life without much pain making them independent. Streamline your DME Billing with MBC The right process will make your DME billing and coding process all the stronger and help you get closer to your payments. Besides the above benefits, technological advancement within the DME medical equipment is additionally another reason for the increase of the DME market and in fact, the rising geriatric population. As old people are more prone to chronic diseases and requ...

  Durable Medical Equipment (DME) is equipment that includes oxygen supplies, wheelchairs, iron lungs, catheters, etc. As you are starting a Durable Medical Equipment (DME) company, be prepared with time on hand, money, endurance, and determination; as it ultimately boils down to being paid for the products sold by your company. This means receiving DME bills from clients (patients/healthcare providers) and accepting the insurance, billing the insurance, and finally receiving payments for the  DME billing  from the insurance provider- is called  Credentialing For DME  Companies. DME business also referred to as Home Medical Equipment business is replete with potholes along the way which need to be cleared. One of them is ‘ Provider Credentialing .’ Credentialing simply denotes verification. It’s also known as DME credentialing, DME medical credentialing, DME provider enrollment, insurance credentialing, or getting on insurance panels. These terms imply that t...

  Like other healthcare specialties, family practice billing also depends upon apposite and timely documentation and communication with patients and insurance payers. The doctor’s office starts the process by serving a patient and documenting the normal SOAP notes. Next, the medical coder translates the visit into the appropriate numerical codes that allow for easier communication with providers. Do keep in mind that the documentation that leads to coding also improves the analysis of services such as charges and procedures to improve your practice management. If you choose to work with a  specialty medical billing company , they can help you with practice management and coding, as well as billing. While maintaining HIPAA compliance and any other state or federal regulations, they charge insurance providers and patients. You can definitely rely on them for proper collections and billing maintenance, saving you time and hassle on the follow-up process, all while increasing ...

  “General Surgery” is a discipline of surgery having a central core of knowledge embracing anatomy, physiology, metabolism, immunology, nutrition, pathology, wound healing, shock and resuscitation, intensive care, and neoplasia, which are common to all surgical specialties. Due to the numerous illnesses looked after by a general surgeon, the billing and coding (for surgical sub-specialties too) often come with numerous challenges as well. The complexities of coding, procedure rules manifold, and complex contractual adjustments are required to be addressed with care and expertise for apt and timely reimbursements. The complexities include being knowledgeable about the latest rules such as moderate sedation being separately billable, the addition of new mammography codes, new coding for endovascular ablation and endovascular revascularization, under Hemodialysis access – coding for angioplasty and stent placement, thrombolysis or Thrombectomy, a new option for GERD – esophageal sp...

Podiatry is the therapeutic strength worried about determining and treating ailments, wounds, and deformities of the human foot. This claim to fame incorporates therapeutic, careful, mechanical, and physical medications for the foot. In that capacity, podiatrist billers are in charge of coding these medications. Podiatry billing and coding require careful use of modifiers and knowledge of inclusive procedure coding. For each podiatry specialization, there is an equivalent specialization in the therapeutic coding and charging rules, directions, and procedures required for that explicit kind of prescription. Podiatry is the same since it likewise requires an exceptional arrangement of therapeutic coding and charging strategies. Podiatrists treat an exceptionally specific arrangement of indications, infections, and conditions. Some of these medications are for routine consideration, though others are identified with basic issues, such as metabolic, neurologic, or fringe vascular illne...

  Compliance guidelines that govern the Ambulatory Surgery Center’s reimbursement are wide-ranging, complex, and ever-changing. Hence, it’s important for ASCs to hire or partner with Ambulatory Surgery Center medical billing and coding management consultants who understand the legal rules placed on ASCs, including specialized coding, accreditation, documentation, and reimbursement care contracts. Here are Prominent Ambulatory Surgery Center Medical Billing Functions are Affecting Your Practice Revenue The Rise in the Number of Accounts Receivable (AR) Days AR basically refers to the average number of days that an ASC takes to collect payments for the services provided. Days in  AR  are one of the main methods that ASCs use to measure their financial performance. The factors impacting the AR days are procedure scheduling, patient pre-registration, insurance verification, patient financial counseling, patient payment plans, and patient collections. An important tip her...

  Receiving denial claims is upsetting for both the medical staff and the doctor. It happens often that, irrespective of how much one takes care of ensuring that everything is in the line and proper there are still denial codes. When repeated problems occur specifically involving  ICD-9 or CPT codes, instead of looking at the claim denials as a defeat it’s time to come up with a crucial solution. Outsourcing your podiatry medical billing and coding services to a professional company like MBC. When the healthcare industry is giving so much attention to patient care, it makes it tough for any podiatry practitioner to keep up with quality care. Since billing is eating too much time. Taking time in correcting the errors, training the staff, leading to proper payments, ensure that the documentation is on the line. So, why not get out of this billing stress by involving a professional medical billing and coding partner like MBC to do the backend job? Here’s why you should...

  Medicare covers surgical procedures provided in freestanding or hospital-operated ambulatory surgical services centers (ASCs). In January 2008, Medicare began paying for facility services provided in ASCs— such as nursing, recovery care, anesthetics, drugs, and other supplies—using a new payment system that is primarily linked to the hospital outpatient prospective payment system (OPPS). (Medicare pays for the related physician services—surgery and anesthesia—under the physician fee schedule.) Like the OPPS, the ASC payment system sets payments for procedures using a set of relative weights, a conversion factor (or base payment amount), and adjustments for geographic differences in input prices. Beneficiaries are responsible for paying the Part B deductible and 20 percent of the ASC payment rate Approved Procedures of Ambulatory Surgical Services The unit of payment in the ASC payment system is the individual surgical procedure. Each of the approximately 3,600 procedures appr...

  Ambulatory Surgical Center Terminated Procedures The following guidance determines the appropriate ambulatory surgical center (ASC) facility payment for a scheduled surgical procedure that is terminated due to medical complications, which increase the surgical risk to the patient. Payment is denied when an ASC submits a claim for a procedure that is terminated before the patient is taken into the treatment or operating room If the surgery is canceled or postponed because the patient on intake complains of a cold or flu Payment is made at the rate of 50 percent if a surgical procedure is terminated due to the onset of medical complications after the patient has been prepared for surgery and taken to the operating room but before anesthesia has been induced or the procedure initiated For example If the patient develops an allergic reaction to a drug administered by the ASC prior to surgery. Modifier 73 should be utilized to indicate that the procedure was terminated prior to ...

  The Trump Administration is taking aggressive actions and exercising regulatory flexibility to help healthcare providers contain the spread of the 2019 Novel Coronavirus Disease (COVID-19). CMS is empowered to take proactive steps through 1135 waivers as well as, where applicable, the authority granted under section 1812(f) of the Social Security Act (the Act) and rapidly expand the Administration’s aggressive efforts against COVID-19. As a result, the following blanket waivers are in effect, with a retroactive effective date of March 1, 2020, through the end of the emergency declaration. CMS is ending the specific emergency declaration blanket waivers for SNFs/NFs, inpatient hospices, ICF/IIDs, and ESRD facilities. CMS passed several temporary emergency declaration blanket waivers for SNFs which were intended to provide healthcare providers with extra flexibilities required to respond to the COVID-19 pandemic. Emergency Declaration Blanket Waivers for SNFs 3-Day Prior Ho...

  Ambulatory surgical centers have certainly been a revolution. However, there are some surgical procedures wherein the physicians working at the facility have been subjected to a pay cut or the revenue generated for their procedures has not been fully paid. Well, various reasons hamper the revenue cycle of ASCs, but the most problematic region for the losses is improper medical billing and coding structure. Yes, you heard that right, because this has become a falling trend where the in-house accounting department is finding it difficult to verify and code the perfect procedures while tackling the prerequisite of healthcare providers as well. While procedures like the spine, orthopedic surgery, and ophthalmology are known as top revenue generators, specialties like plastic surgery, oral surgery, and urology regularly face revenue losses. In this Blog, Here we discussed the list of procedures where ASCs are losing money. Here is a List of Procedures Where ASCs are Losing Money: ...