Medical Billers and Coders

  Medical billing can be challenging for all types of medical practices; however, for internal medicine physicians/internists, it can be even trickier as the billing procedure for them is quite unique.  Internal Medicine Practices  is a medical practice providing healthcare services for adult patients Why is Billing Unique for Internists? For the majority of medical conditions, patients first go to internal medicine practitioners for diagnosis and basic treatment. From there they are referred to specialists for further medical care if required. Due to this, internists become dependent on other practices or practitioners for payment and the billing process gets complicated Internal medicine practitioners offer diverse services. They see approximately 30-40 patients on a daily basis. Besides hospitals and nursing homes, they also visit patients at offices and homes. Due to a high number of patients, they need to handle a large volume of claims which creates a greate...

  Physicians who are part of DME services now face an important operational decision: whether to persist with in-house billing staff or entrust to external sources. The long-held belief that in-house billing staff would manage DME-related billing complexities seems to have failed them recently – most of the in-house-staff-managed DME billing are reported to have high incidence denial, delay, or under the realization of DME bills from Medicare, Medicaid, and private DME health plans.  And, now that physicians strongly feel the reason to replace in-house DME billing, should they be embracing outsourced DME billing straight away? Yes, but not before they debated the pros and cons of DME billing outsourcing. Arguments in favor of DME Billing Outsourcing The primary argument in favor of outsourcing DME billing is that it will bring a fresh perspective to hitherto stereotyped practices – outsourced DME billing providers, with their specialization, could iron out deficienci...

  The lack of primary care providers in the country is a topic that has been hotly debated among many circles and written about vehemently. Not many medical students are ready to enter primary care due to a lack of great financial prospects for the future. This is resulting in even more shortage of physicians and problems when it comes to the reputation of this line of medicine. The remuneration problems along with other difficulties faced by Primary Care Physicians (PCPs) are affecting the revenue of PCPs and bringing a disparity between other physicians who practice other specialties of medicine. Here are numerous reasons for the reimbursement disparities for PCPs and some possible solutions for countering this problem. One of the reasons for the lesser amount of remuneration for PCPs is that specialists who perform routine procedures such as some specific types of surgeries take a lesser amount of time to complete their task compared to a PCP whose case can be of any nature. ...

  There is a distinctive difference between billing for Durable Medical Equipment (DME) services and other clinical procedures – durable medical equipment services are ancillary to the primary clinical purpose, and their admissibility is subject to certain conditions. One of the best ways to overcome the DME billing challenges is outsourcing the DME billing services and RCM system.  Physicians since long have found these conditions tricky and challenging to understand, and often either been denied or underpaid for DME services, which may either have been Deemed medical unnecessary, Uncertified by Medicare/Medicaid/private health insurers, Beyond the permissible reimbursement level Lack of solid grounding in the Healthcare Common Procedure Coding System (HCPCS), which governs level II codes designated for DME equipment and supplies While physicians have the right to recommend DMEs as part of clinical treatment, they will have to back their recommendation with sufficie...

  Medical Billing Challenges in Family Practice Family Medicine forms a crucial point of entry in the health care system, and the need as well as the shortage of family physicians in the United States is becoming a growing concern. Other specialties such as radiology, neurosurgery, and dermatology are more attractive due to the higher amount of compensation provided to physicians in these areas. Moreover, the looming Medicare cuts that have been postponed for a long time and are now extended to January 1, 2012, present another problem for family practitioners in avoiding losses in income. Family medicine and family physicians play a vital role in the healthcare system of a country. Another important factor is the health reforms coupled with an increasing number of aging baby boomers in the coming years which would keep family physicians busier than before and hard-pressed for time and money. Chronic Hurdles Medicare is facing problems because of Federal fiscal troubles and Med...

A Patient-Centered Medical Home (PCMH) is not a particular type of hospital or building but an alternative approach to delivering health care that provides coordinated, continuous patient-centric medical care, managed by a team of individuals led by a physician. PCMHs employ the latest technology available to make optimum use of time and funds in order to deliver the best possible healthcare to patients. Although the concept is not new it has gained recognition and popularity among patients and physicians alike due to the recent health reforms. There are numerous pilots being carried out in various parts of the country and the results are positive and fruitful for healthcare providers and patients. Coordinating Patient Care Primarily, a PCMH integrates care across the healthcare spectrum including specialists, hospitals, therapists, laboratories, druggists, and home health to avoid duplicate care and curtail errors. It aims to assist physicians in keeping up-to-date with the patien...

  The necessity of Durable Medical Equipments (DMEs) had never been so high – in the U.S. 30% to 54% of those over 65 years have some form of disability; around 75% to 90% of such disabled require some form of DME to keep them mobile or enabled.  It is also estimated that around 1.5 million people are currently in need of wheelchairs and braces. And, when you add the population that is likely to be in need of other forms of durable medical equipment – prosthetics, orthotics, and supplies (DMEPOS) – it will be some opportunity for people involved in Durable Medical Equipment Practice Services: physicians, pharmacies, and manufacturers/suppliers. But, because DME services are physician-recommended, we are more interested in how physicians themselves can recommend, source, and administer DMEs. While physicians can benefit immensely from an integrated DME management, there are challenges on the way – being equipped with a Medicare-enrolled and recognized pharmacy, sourcing suppl...

The shortage of primary care physicians in the United States will soon worsen due to the added pressure on resources because of healthcare policy changes by the government. The rising number of elderly people in the country is also putting tremendous pressure on the services provided by primary care physicians. A white paper by the American College of Physicians examines the parameters of the shortage and its effect on the quality and the cost of care. According to the white paper, the estimated number of people with at least one chronic condition will exceed 150 million by the year 2015, building even more pressure on primary care delivery systems. Moreover, the number of U.S. medical graduates entering family medicine residency has significantly dropped over the last decade which is exacerbating the situation. The government issued a fact sheet on June 16, 2009, about the steps that it plans to take in order to alleviate the shortage of primary care physicians in the country. The ...

  The way that business offices can have reference patterns amongst consumers is a tactical opportunity as the insurance market moves to high deductible plans and hospitals take in new physicians into their business. According to a survey conducted by Connance in 2011 Americans who received hospital services in the past 2 years, merely 21% of patients engaged with the business office after discharge are completely contented with hospital billing, and those less happy are less liable to recommend the hospital to their friends and acquaintances. Moreover, the survey also suggests that among the insured respondents, 31% had high deductible plans. Overall contentment with the hospital billing procedures is low with just twenty-one percent awarding billing processes a score “5” (on a 1 to 5 scale) and sixty-five percent giving a “3” or less. Customers with balances due of fewer than $100 are likely to be less unhappy, with thirty-six percent giving business office procedures a top s...

The shortage of PCPs in the United States has been a well-publicized and well-documented issue. However, the solutions to the various issues faced by primary care in the country have been obscure even after the implementation of the Affordable Care Act. The complications in finding the solutions to the challenges faced by primary care stem from factors ranging from policy reform to changing demographics. According to a New England Health Institute report, primary care in the country is facing a crisis due to the shortage of PCPs and the increase in demand for such physicians. Factors Complicating Primary Care Physician’s Tasks According to a report by the American Medical Association one of the biggest challenges faced by primary care physicians is the increasing number of visits by elderly patients. The report clarifies that the average visit duration has increased due to the fact that an increasing chunk of the total visits by adults to PCPs is to elderly patients. The report als...

  Medical billing for Skilled Nursing Facilities has undergone metamorphic changes ever since the Balanced Budget Act of 1997 came into effect in 1998. One of the significant requirements under the new legislation is that Skilled Nursing Facilities are not permitted to unbundle services administered by contracted healthcare providers. As a result, most of the services provided to Medicare beneficiaries are to be bundled together and billed by SNFs under the Prospective Payment System (PPS) in one consolidated claim. The SNF concerned is then responsible to pay for contracted services out of the per diem rate that it earns for caring for a Medicare beneficiary. Eliminating Skilled Nursing Facilities (SNF) Medical Billing Complication While this imposition may have helped reduce potential fraud and abuse due to double billing by healthcare providers, SNFs have certainly had a hard time understanding: What services are covered under consolidated billing What is billable unde...

  Patient billing is one of the major complaints that patients have when it comes to the total experience of getting medical care. If your hospital is relating patient satisfaction to the patient’s clinical experience, an important aspect is being missed out. How your patients will assess their overall quality of care will depend majorly on their billing and payment experience. The purpose of  hospital billing  is to bill the claims for in-patient and out-patient services provided by hospitals or healthcare organizations. Every successful interaction your medical office will have with the patients (from the time of appointment scheduling till the bill is paid in full) will help your hospital achieve excellent patient satisfaction results. What needs to be done? Hire well-trained medical office staff Create a team of certified coders and billers Improve front-end processes Perform workflow and productivity assessment of the in-house staff Provide training and dev...

  According to a Physician Compensation survey conducted by Sullivan, Cotter, and Associates, specialty physicians across the US saw a 1.9% increase in their compensation in 2014. Internal medicine physicians also experienced a two percent change in their compensation between 2013 and 2014. The median total cash compensation for them recorded in 2014 is $213,428.  Our internal medicine billing process is streamlined so that you can have a healthy revenue cycle management. In this blog, Here we shared more reasons why you choose the MedicalBillersandCoders for the Right Internal Medicine Billing Solution. Even though the internal medicine specialty witnessed a slight increase in compensation this year, many internists continue to grapple with a shrinking bottom line. This is because treatment by an internal medicine physician depends on or collaborates with different diagnostic laboratories and care to justify. Due to such varied aspects of the treatment episode, the medical...

  Basics of Neurology Billing Understanding the Basics of Neurology Billing is essential for healthcare providers who offer neurology services to patients. Neurology billing involves the process of submitting claims to insurance companies or other payers for reimbursement of the services provided by healthcare providers. Neurology billing codes are used to identify the specific services provided, and these codes are based on the Current Procedural Terminology (CPT) system. The CPT system is maintained by the American Medical Association (AMA) and is used by healthcare providers across the United States to bill for their services. It is important for healthcare providers to have a thorough understanding basics of neurology billing codes and how to use them properly. Failure to use the correct codes can result in delayed or denied payments, leading to financial losses for medical practices. Additionally, medical practices must ensure that they comply with all relevant regulations...

Primary Care physicians (PCP) treat patients with all types of acute physical, mental, and chronic ailments and diseases. The patients form a wide range of patients; people of all demographics, socioeconomic groups, and so on. PCPs are thus expected to have thorough knowledge in multiple areas. The versatility of the physician ranges from seemingly simpler ailments like treating a cold to giving vaccinations to providing healthcare tips like the bane of smoking. Such a variety of treatments needs physicians to be well-versed in carrying out appropriate billing for getting reimbursements. “We Excel in:  Outsource Primary Care Medical Billing Services “ How can Outsourcing Primary Care Help Manage Revenue? Many billing experts work on a one-to-one basis with the staff to increase reimbursements and minimize denials. These billing companies work so well that they assign a professional who actually operates as an extension to the physician’s office. They keep themselves abreast w...

  Outsourcing Hospitalist Billing Increases Revenue By outsourcing hospitalist billing, a team of experts will manage the accounts receivables (AR). Billing experts capture denials and accurately report the EoB (explanation of benefits) information, resulting in a considerable drop in the processing time. In the case of an in-house billing system, the claims would have to wait if the biller goes on a holiday or falls sick. Outsourcing billing services take care of such situations and ensures a steady flow of claim submissions. Accurate and Timely Submissions Professional billing service providers submit accurate medical bills and file claims on time. This results in an increase in the number of medical reimbursements. With expert billers, there would be minimal coding errors, which ultimately lead to reduced claims denials. Outsourced billers keep track of the progress of denials and help streamline them and the claims appeal too. They categorize payers as per the respect...

ICD-10 and DME Billing DME billing is the process of submitting and receiving payment for a claim from the insurance company. Implementing, maintaining, and educating staff on proper billing is vital to a DME provider’s success. The challenges facing Durable Medical Equipment (DME) organizations with the upcoming ICD-10 coding system are plenty. Although the DME you bill for will still employ the same HCPCS codes, the actual difference will be in the diagnosis coding itself. Firstly, the transition from ICD-9 to the new ICD-10 coding system has led to an increase in the number of codes for procedures from 3,824 to 71,924 and simultaneously has also increased the number of codes for diagnosis from 14,025 to 69,823. Secondly, there are few one-to-one, cross-walked codes in the ICD-10 Thirdly, it is a known fact that the DME providers receive meager information from the physician to convert the codes accurately thus leading to delays in claims causing a shortage in cash flow. ...

  Ambulatory Surgical Centers (ASCs’) are very busy places with a constant influx of patients; hence additional administrative tasks can be time-consuming. With ASCs’, there may be challenging times when deadlines are short and compliance regulations are stringent, so managing billing can be a costly affair in ways more than one. Therefore, outsourcing may seem to be an effective option for Ambulatory Surgical Centers. Outsourcing ASC billing can be beneficial in many ways as listed. Furthermore, there are a lot of aspects that need to be taken care of when billing. Any negligence can cause a loss of revenue. The in–house team may or may not be able to cope with the changing regulations resulting in the submission of incorrect bills. Moreover, the ASC teams’ primary role would be to attend to the patients and the simultaneous billing could seem like an added stress. Industry Snippet The ASC industry is pegged at 28 billion dollars with an annual growth rate of 4%. It is employ...

  Denied ASC claims and moderate repayments jeopardize profits and are a window into the trustworthiness of the procedures and work process of surgery centers. In this blog, we will look at some of the striking reasons for denials in surgery claims and also address and ideally lessen the recurrence of issues brought about by denied claims. Missing Documentation Connected to the Case Payers may require extra documentation, for example, the agent note or embedded receipt, connected to the case, which experts suggest can be a slowing down strategy by the payers to abstain from paying the case. To refrain from accepting persistent solicitations for extra documentation, you can sit down with the payer and lay out which reports are expected to get the case paid. Generally, the payer will ask for medicinal records for one case, and afterward an operation note for another, and afterward something else for another. The Issue with Payer’s Framework for Claims and Payments If your surg...

  Managing a doctor’s facility is not an easy task, especially when you are in neurology. Overseeing medical development and keeping a healthy business structure can be possible when all the fuss of medical billing services is outsourced to a professional and trustworthy association. As you tackle more patients and offer more extensive administration or specialties, for instance, your income extends too. Entrusting your neurology billing & coding to experts like us enables you to focus your resources on patient care while taking care of your financial stability and growth. With demanding circumstances and situations in healthcare, where dwindling revenue is becoming rampant with increasing profitability becoming the need of the hour, you can envision what a help it would be if a  medical billing service  could take care of the expanded sum and rate of cash that is coming in now. Are Neurology Administrative Tasks Becoming Monotonous? In case you’re feeling some e...

  With regard to medical coding and billing, analyzing every part of the task is important for ensuring minimal errors. For some bustling Ambulatory surgery centers, overseeing the billing procedures is a consistent battle, and the explanation of which is lost behind incomes. To help ASC manage an efficient charging process, outsourcing the surgical center billing would help a lot in dealing with a patient’s claims, reimbursement, and errorless billing documentation. Keep reading to learn ASC billing and coding. Here are some things that ASC Billing Managers should keep in mind for a smooth Billing Process: 1. Maintain Records of Unbilled Patient Accounts Patient records with balances ought to be checked at all times. Many facilities have a choice to prepare electronic patient statements through a clearinghouse from their practice administration framework, or they can print paper claims right from their office. How regularly this is done depends on the facilities; most facilit...